Advocacy Spotlight: Enforcing Workplace Violence Prevention In Hospitals 4305

Advocacy Spotlight: Enforcing Workplace Violence Prevention In Hospitals


This fact sheet is brought to you by the Policy & Government Affairs department at the American Nurses Association - January 2023.

Action Item: Nurses have an opportunity to engage directly with State Survey Agencies to ensure robust implementation of the CMS memo, leading to meaningful prevention of workplace violence.

ANA has a long history of advocating for the federal government to address workplace violence. In recent years, ANA’s Policy & Government Affairs (Policy/GOVA) team has emphasized the impact of violence on care quality, in addition to advocating for specific employee safety standards. We had a breakthrough in November 2022 when the Centers for Medicare and Medicaid Services (CMS) released a memo to State Survey Agencies stating that “healthcare workers have a right to provide care in a safe setting.” The memo explains Medicare safety requirements for both patients and staff, emphasizing the duty of hospital leadership to ensure this safety. It lists prior instances where CMS has cited hospitals for failing these requirements and puts them on notice for continued enforcement. The memo is a welcome first step for CMS to recognize its responsibility to address threats of violence against nurses, through federal and state oversight of hospital quality.

What does this mean for workplace violence prevention?
The CMS memo explains that Medicare requires hospitals to ensure a safe environment and emergency preparedness. A safe environment for patients and staff includes procedures such as a patient risk assessment strategy to identify patients at risk of harming themselves or others. Emergency preparedness includes a facility and community specific risk assessment. The requirements also list education and training in safety policies and procedures for all new staff, whenever policies change, and are recommended at least every two years.

Explained in the Joint Commission workplace violence prevention standards, risk assessments and training are building blocks for combating workplace violence. Tailored risk assessments are critical to developing prevention policies that meet the actual needs of the environment. Consistent, leadership driven training in workplace violence prevention policies are important for creating a culture of safety.

How can you advocate for enforcement of these protections?
This notice from CMS puts enforcement of health care worker safety procedures as a priority for State Survey Agencies in their inspection and certification of hospitals. Inspectors from State Survey Agencies are “qualified health professionals”, often nurses, who physically investigate hospitals and cite those that fail standards. A citation begins the process where the hospital has ten days to respond with a plan of correction or face termination from the Medicare and/or Medicaid program.

Nurses have an opportunity to engage directly with State Survey Agencies to ensure robust implementation of the CMS memo, leading to meaningful prevention of workplace violence.
• Ask questions: Are they aware of the memo? What are their plans to integrate it into inspections? 
• Offer resources: What state/local resources have you found helpful? Some resources are listed below.
• Explore partnership opportunities: Would the Agency hold a stakeholder roundtable to hear directly about concerns? Can you partner on an education campaign to spread the word about the CMS quality requirements?

State Survey Agency Contact Information
Most State Survey Agencies are the state health department. You can access the full list of agencies on the CMS website. At the bottom of the page, you can download an Excel spreadsheet with detailed staff contact information.

Workplace Violence Resources
End Nurse Abuse Website
Workplace Violence Against Nurses: What You Can Do Webinar
Oregon Workplace Safety Initiative: Stop Violence in Health Care Toolkit
End Nurse Abuse Animated Shorts
ANA Statement on Incivility, Bullying, and Workplace Violence

Reach ANA Policy/GOVA team at  or check out RNAction for more advocacy resources.


Not a member of Healthy Nurse, Healthy Nation (HNHN) yet? Join today!
Blog Safety 01/19/2023 3:42pm CST



Explore Other Blogs

Safety 10
30 Posts 9

Your safety matters. This domain covers a wide range of topics - from staying alert at the wheel to safe patient handling and mobility.