Responding to Active Shooters in Hospital

In the United States, the workplace is a common site for hostilities, with more than 2 million citizens falling victim of workplace violence every year. Among the many other causes of work-related deaths, homicide is one of the leading causes. Homicide, as defined by the Department of Homeland Security is an incident where an individual actively attempts or engages in killing people in a confined and populated area (Adashi, Gao, & Cohen, 2015). By several accounts, Adashi et al. note that the prevalence of homicide is unusually high with the number of active shooters revealed to have increased from 6.4 between 2000 and 2006 to 16.4 between 2007 and 2013. Similar rates have been recorded with hospital settings with the incidents rising from 9 per year between 200 and 2005 to 16.7 per year in 2006 and 2011. Consistent with the results, we reviewed four articles on hospital shootings, to get a comprehensive overview of hospital shootings.

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Active shooter incidents are unfortunate incidents that have been recognized as an extant threat in hospital settings. A closer analysis reveals that the incidents are unpredictable and occur quickly, catching hospital staff unawares. Consequently, the shooting incidents involve a determined shooter with a specific target. Most killers are relatives of patients who shoot hospital staff because they are agitated or not satisfied with the kind of care their relatives receive from the people in charge (Hospital Employee Health, 2013). Some relatives kill their family members as an act of mercy killing and later kill themselves. Still, for others like the case of Western Psychiatric Institute (Balingit, 2012), it is hard to relate the incidents to any motive as the gunman walked into the hospital and began shooting. Consistent with these events, the ultimate question remains, is it possible to prevent hospital shootings. Ideally, the authors of the four articles concluded that hospital shootings could be prevented through various ways. For instance, according to a report by the Security InfoWatch (2013), instead of allowing open visiting for patients, access control should be applied, by following up with visitors about their business at the hospital as well as carefully monitoring their activities. This is not the sole responsibility of the security department; rather a group effort that involves every staff within the building. Workers should be aware of their surroundings, and if they notice suspicious behavior, they should invite a colleague and analyze the situation. Consequently, as recommended by the Joint Commission (2014), hospitals should consider training and drill non-security staff on security processes and procedures, to help them grasp potential threats and respond efficiently. 

Personal Reflection

Has your workplace prepared for an active shooter?

Active shooter incidents are unfortunate realities that hospital settings have been forced to face and be prepared. The events are unpredictable and often happen quickly. The hospital administration is aware of this, and in response, they have prepared employees by providing them with the necessary information to prevent and handle a potential active shooter.

How to Respond

In case an active shooter is in the building, employees should act swiftly by firstly, run to safety, and help evacuate others where possible. It is also important to keep hands visible so that others do not mistake employees as a threat. Prevent people from going to the active shooter zone. Secondly, if it is not possible to evacuate safety, then employees should hide and barricade themselves as much as possible. Lock the door or the entrance with a heavy object to prevent the shooter from accessing the area. Thirdly, if unable to escape or hide, the last option is to fight. Improvise weapons such as the fire extinguisher and use it as a defense tool. Consequently, when faced with a threat of active shooter, employees should reach 911 and ask for help. Provide as much information as possible to enable the law enforcement team to access the place quickly. Remain calm when interacting with law enforcement at the scene to avoid escalating the issue.

Responsibility as a Nurse Caring for Patients

In active shooter incidents, my role as a nurse covers a wide range of activities. For instance, patients will be worried about their safety, and some may go in a state of shock. I must ensure that they remain calm and assure them of safety. Where possible, nurses can also try to evacuate patients to safety and enhance the safety of those who cannot be evacuated by harnessing the doors. Consequently, nurses must respond to emergency demands by determining the type and administering appropriate level care.

Should an active shooter drill take place with live gunfire?

In the wake of many active shooter incidents in hospital settings and the absence of meaningful gun control, the ultimate question remains, should active shooter drills take place to prepare employees’ on response mechanisms should they be faced by such an incidence? The answer to this question is no. Ideally, there are several stories about people who sustained injuries or utterly freaked out during such drills, which were not announced beforehand. Using live gunfire is especially not recommended because employees might attack the “shooter” and end up being injured.

Bullying in the Nursing Workforce

Within the nursing profession, workplace bullying is a persistent problem, with bullying dating back to more than 30 years in literature. Specifically, as Vessey, Demarco, and Difazio (2010) note, bullying is a problem due to its detrimental effects on job satisfaction, workforce retention, and the psychological and physical health of nurses. The issue also has implied impact on the quality of patient care and increased risk of poor health outcomes.

Suggestions for a new nurse who is being bullied by coworkers

Although the nursing profession exemplifies caring and showing compassion for others, bullying exists in all areas where nursing is practiced. The practice is especially prevalent among new nurses from older nurses and can be in the form of intimidation, insulting behavior, unfair sanctions, and failure to assist a new nurse among others. When that happens, it is important for the new nurse to understand how to handle the situation. Firstly, when people start being negative, it is important to avoid their discussion, instead, keep quiet and while it may feel awkward at first, people will eventually learn that you do not entertain gossip. Secondly, always remain positive even when others are negative by contributing a positive point. Do not be apologetic for being positive. Thirdly, it is possible for new nurses to be wrong sometimes and afraid to admit. However, it is important to admit when they are wrong and always seek clarification. Consequently, when you encounter bullying as a new nurse, address the behavior immediately; do not be afraid to call out on the bully and tell them to stop their behavior. Lastly, only engage management as the last option.

What is your responsibility if you see a fellow nurse being bullied?

The first step to eliminating bullying in the nursing workplace is admitting the problem exists and learning how to help others to curb bullying behaviors (Townsend, 2012). Everyone within the workplace has a responsibility to prevent bullying. Nurses who have been in the profession for long can prevent bullying by treating new nurses as they would have wanted when they were a newbie. The way is making efforts to welcome new nurses and ensure they fit in the group. If they spot bullying, they should also speak against it and serve as role models for professional behaviors.


Adashi, E. Y., Gao, H., & Cohen, G. (2015). Hospital-based active shooter incidents sanctuary under fire. JAMA, 313(12), 1209-1210.

Balingit, M. (2012). Hospital shootings shock Oakland 2 dead, 7 injured at Western Psych; Police kill gunman in exchange of fire. Pittsburgh Post – Gazette. Retrieved from

Hospital Employee Health. (2013). Most hospital shootings are not preventable. Retrieved from

Security InfoWatch. (2013). Responding to active shooters in hospitals. SecurityInfoWatch.Com. Retrieved from

The Joint Commission. (2014). Preparing for active shooter situations. Quick Safety. Retrieved from:

Townsend, T. (2012). Break the bullying cycle. American Nurse Today, 7(1), Retrieved from:

Vessey, J. A., Demarco, R., & Difazio, R. (2010). Bullying, harassment, and horizontal violence in the nursing workforce the state of the science. Annual Review of Nursing Research, 28(1), 133-157.

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