Staff Perspectives on Optimising Organisational Responses to Patient-Initiated Workplace Violence.

AIMS: To identify existing and ideal practices for responding to patient-initiated workplace violence in the US Veterans Health Administration. DESIGN: Cross-sectional, descriptive qualitative design. METHODS: Qualitative interviews with staff (n = 31) in eight veteran healthcare facilities located in the western United States (2023-2024). Guided by Spelten et al.'s model of strategies to reduce patient-initiated workplace violence, thematic analysis examined post-incident interventions with patients and identified recommendations for improvement. RESULTS: Educating and setting limits with patients varied by facility. Most respondents were unaware of patient education/support that occurred post-incident. Respondents disagreed about the role that patients' clinical status should play; some wanted more leeway for certain patients (e.g., those diagnosed with dementia) and others wanted a consistent response (regardless of clinical status) to create a culture of respect. CONCLUSION: Patient education and limit-setting are important elements in addressing patient-initiated workplace violence, but they are inconsistently used. Offering resources to patients is underutilised. Staff have differing perspectives on what constitutes ideal post-incident interventions for medically complex patients. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: When responding to patient violence, healthcare systems may benefit from clear and consistently implemented protocols and tailored educational interventions and support for different patient populations (e.g., dementia). Staff may benefit from guidance on balancing patient care with limit-setting during encounters with medically complex patients. IMPACT: We examined existing practices for responding to patient-initiated workplace violence and staff suggestions for improvement in a large healthcare system. Participants wanted additional and consistent patient interventions; opinions varied on how patient clinical status and intent should shape organisational responses. Staff can benefit from consistently implemented protocols for responding to patient violence. Healthcare systems may need to provide staff guidance on balancing patient care with limit-setting. REPORTING METHOD: SRQR guidelines for qualitative studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.