Objectives To examine the management of workplace violent events (type II) by hospital unit nurse managers and staff.

Method Cross-sectional surveys, telephone interviews, and semi-structured focus groups were employed among nurse managers and nursing unit staff in two large hospital systems.

Results Nurse managers and staff perceived an increase in type II violence in recent years which they attributed to an increase in financial needs of patients/families, and drug seeking behaviour. Both groups expressed sometimes feeling unsupported by their institutions with regard to their safety in the context of these events due to their organisation’s focus on maximising patient/visitor satisfaction, poorly defined/enforced visitor policies, and movement away from physical/chemical patient restraints. Nurse managers perceived themselves as the designated person on their unit responsible for de-escalation of violent situations, with security called only in extreme situations. Security involvement was not consistently considered an option for managing violent events. Unit staff concurred that they relied on their managers to assist, but were left to handle this in their absence. Managers expressed feeling torn between having to consider patient satisfaction versus worker safety at times. They sometimes resorted to rotating patients, known to be violent, between hospital units for purposes of relieving staff from over-exposure to violent behaviour.

Conclusions Poorly defined and/or enforced hospital level policies results in nurse managers and staff being left to determine how violent events are managed, which sometimes occurs at the expense of their safety. Efforts at identifying effective institutional and unit level violence prevention policies and stategies are needed.