\nde-escalation are already taught and practiced in many nursing schools across
\nthe country, including UNC-CH, there is a dire need for this kind of immersive,
\nhands-on training. A 2023 survey<\/a> from National Nurses United shows
\nthat 8 in 10 nurses have experienced at least one type of workplace violence
\nwithin the past year, and 6 in 10 RNs reported either considering or actually
\nleaving their job\u2014 or the profession itself\u2014 due to workplace violence.<\/p>\n
\t\t\t\t\t\t![](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/11\/2ae4a992-aa9e-46a1-91a4-ed5b2d984490.jpeg\"\/)
The nursing simulation
\nlab in ITS Manning at UNC-Chapel Hill, Wednesday, Oct. 22, 2025. Photo by
\nJinrui Liu.<\/p>\n
The prevalence of workplace violence is why \u201cWe know that one out of every four nurses Though the grant\u2019s funding for the program \t\t\t\t\t\t \t\t\t\t\t\tA culture change from acceptance to de-escalation<\/p>\n For years, workplace violence was just \u201cBack in the day, when I first started, it And violence didn\u2019t always come from the \u201cI love working with doctors all day long. I Howard recalled a similar culture when she \u201cWe really didn\u2019t talk about the violence that Fast-forward to the spring of 2024, when That\u2019s when the topic of workplace violence After the TAPP retreat, the nonprofit After roughly six months of developing, The first scenario dealt with a verbally The training was voluntary, and multiple \u201cWe thought that we could do this maybe three \t\t\t\t\t\tRealistic, safe training<\/p>\n While some simulations use mannequins \u2014 models \u201cWhen people think of simulation, they think The simulation training received \u201cAll but a few of the participants, and when I \u00a0Even if a student isn\u2019t actively participating \u201cYou really do have to pay attention,\u201d Howard East Carolina University\u2019s College of Nursing ECU has also received positive feedback for \t\t\t\t\t\t \u201cTechnology has come a long way. Our mannequins Sydney Rogers, an ECU alumna who graduated in \u201cYeah, they\u2019re really good. I like Even so, Akintade said there is still room for \u201cWe are currently revising our curriculum. All \u00a0Though many positive learning experiences can \u201cThis can induce trauma, because when you are \u00a0The emotional toll was evident on some \u201cIf a training was invoking these strong \t\t\t\t\t\tAn earlier introduction can help nursing students know what to expect<\/p>\n \u00a0<\/b>The grant funding for UNC-CH\u2019s simulation \u201cI just presented to all the chief nursing If given the green light, Howard said they Akintade said he would like to see more \u201cI think there\u2019s more room, and maybe not
\nschools like East Carolina University and UNC-CH have been enhancing their
\nnursing programs, and it\u2019s why UNC-CH rolled out this grant-funded program
\nutilizing the \u201ctag team\u201d<\/a> approach in the spring.<\/p>\n
\nwill experience some sort of workplace violence during their career. That could
\nbe physical, mental, emotional abuse,\u201d Howard said. \u201cIt could be harassment,
\nbullying. It\u2019s not always just the physical violence that we think of.\u201d<\/p>\n
\nended in July and administrators have been reviewing the results, Howard said
\nshe\u2019d like to continue the program after receiving overwhelmingly positive
\nfeedback from students. She believes more training like this has the potential
\nto improve retention and decrease burnout of nurses everywhere.<\/p>\n![](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/11\/079c200c-a76c-4d54-b40c-c1c3ba973220.jpeg\"\/)
Undergraduate nursing students at ECU conducting
\nintake assessments as part of a class. Students then consulted with psychiatric
\nmental health nurse practitioner students via telehealth when the patient was
\nacting erratically and potentially violently. Photo courtesy of ECU.<\/p>\n
\nconsidered part of the job, said Bonnie Meadows, president of the North
\nCarolina Nurses Association and a nurse with more than 20 years of experience.<\/p>\n
\nwas, \u2018Oh well, it comes with the territory, it goes with the job,\u2019\u201d Meadows
\nsaid. \u201cAnd honestly, our wording towards that, it probably has just recently
\nchanged.\u201d<\/p>\n
\npatient, Meadows said.<\/p>\n
\nlove working with surgeons, all the things. But we used to make it okay when
\nthey would just get upset and throw instruments and do all of these things,\u201d
\nMeadows said. \u201cYou would talk about it, but you wouldn’t really talk about it.\u201d<\/p>\n
\nworked as a nurse in the emergency room roughly three decades ago.<\/p>\n
\noccurred in the workplace. It was a part of your job as a nurse, and you just
\nhad to deal with it,\u201d Howard said. \u201cAnd you might have had an abusive patient
\nor a co-worker or something happen, you just moved on from that, and no one
\nreally addressed it. No one took it seriously.\u201d<\/p>\n
\nHoward and members of nursing leadership from UNC Medical Center and UNC Health
\nRex\u2014all part of a partnership known as the Tar Heel Academic Practice
\nPartnership\u2014 came together at a retreat and expressed their desire to work on
\nsomething that could make an impact on nursing practice and the profession. <\/p>\n
\ncame up, Howard said.<\/p>\n
\norganization AARP issued a call for grant proposals for the AARP Health Equity
\nand Nursing Innovation Fund, Howard said. TAPP and the NC
\nFuture of Nursing Action Coalition<\/a>, an initiative to improve health
\ncare through nursing in the state, submitted a proposal and, in July 2024, were
\none of 12 recipients awarded the grant nationwide. They received $25,000, an
\namount matched by UNC Health\u2019s Robert A. Ingram Institute for Equitable
\nHealthcare Access<\/a>, and they put those funds toward developing the
\nsimulation training program, according to a press release<\/a>. <\/p>\n
\ntesting, and having the scenarios reviewed by the Coalition and other experts,
\nthree workplace violence scenarios were created, Howard said. <\/p>\n
\nabusive, confrontational parent of a child patient who was being involuntarily
\ncommitted; the second\u2014the one Barksdale participated in\u2014 dealt with a patient
\nexperiencing severe pain, and the situation escalated because the patient felt
\nlike health care providers weren\u2019t listening; the third dealt with a co-worker
\ntrying to bully the nurse into doing something that didn\u2019t align with policy,
\nHoward said.<\/p>\n
\nsessions were run throughout the spring semester for nursing students, Howard
\nsaid. The number of participants per group varied, but Barksdale said her group
\nhad roughly 25 people total.<\/p>\n
\ntimes and get our 150. That was our goal, to get 150 participants,\u201d Howard
\nsaid. \u201cAs it turns out, nurses have very busy schedules.\u201d\u00a0\u00a0<\/b><\/p>\n
\nthat replicate human anatomy \u2014 this training only utilizes human actors.<\/p>\n
\nabout what\u2019s happening downstairs in our sim lab, right, the beds, the mannequin
\nlaying there,\u201d Howard said. \u201cWe hired actors to come in and to portray these
\ninstances of workplace violence with nurses, and we had an audience sitting
\nthere. We did this in a classroom, very low budget, low cost, but very
\nrealistic.\u201d<\/p>\n
\noverwhelmingly positive feedback from nursing students, Howard said.<\/p>\n
\nsay a few, I\u2019m talking one or two, agreed that the training was extremely
\nvaluable: the pre-briefing that we did, the actual scenario, and then the
\ndebriefing, and they felt like this could translate into practice,\u201d Howard
\nsaid. \u201cThe results were very positive.\u201d<\/p>\n
\nin a scenario, the interactive nature of the training \u2014 referred to as the \u201ctag
\nteam\u201d approach \u2014 requires them to remain engaged, Howard said. While half of the
\nroom can be tagged into the scenario by the director or another student at any
\nmoment to help, the other half of the room writes suggestions for the actors on
\nnote cards and gives them to the director. If the suggestion aligns with
\nlearning objectives, it will be incorporated into the scenario. The length of
\nthe scenarios varied, with some as short as five minutes, others as long as 20
\nminutes.<\/p>\n
\nsaid. \u201cYou immerse yourself in that situation. Everyone\u2019s there to learn,
\nthat\u2019s what we believe in simulation.\u201d<\/p>\n
\nuses a variation on the tag team method in their simulations, said Benjamin
\nAbel, a spokesman for the college, and describes the overall training as
\n\u201cmultifaceted in every encounter, asking students to complete their medical
\ntasks with a consideration of the psychosocial dynamics of each experience.\u201d <\/p>\n
\nits simulation training program, which incorporates instances of workplace
\nviolence, said Bimbola Akintade, dean of the ECU College of Nursing.<\/p>\n![](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/11\/0e1ae69f-ec87-4a48-a61c-ecc11606bee6.jpeg\"\/)
A mannequin being used for
\na hands-on skills session for nursing students in ITS Manning at UNC-Chapel
\nHill, Wednesday, Oct. 22, 2025. Photo by Jinrui Liu<\/p>\n
\ncan sweat, they can blink, they have pulses,\u201d Akintade said. \u201cThe technology is
\nrealistic, but then the way the case studies are presented and how it flows,
\nstudents very quickly get into it. Students enjoy it. We get really positive
\nfeedback from simulated experiences with our students.\u201d<\/p>\n
\nMay, praised the training for providing opportunities to learn in a safe
\nenvironment.\u00a0<\/p>\n
\nsimulations,\u201d Rogers said. \u201cThey give you an idea of what you could do better,
\nand you don\u2019t have the fear of messing up with an actual patient. Instead,
\nyou’re with an actor, you\u2019re with some sort of dummy, and you can mess up
\nthere, than actually messing up in the real field. So they\u2019re really helpful.\u201d<\/p>\n
\nimprovement.<\/p>\n
\nschools and colleges of nursing across the country are doing that to
\nincorporate competency based education,\u201d Akintade said. \u201cSo it\u2019s already
\nincluded, but there are opportunities to further expand on that.\u201d<\/p>\n
\nbe gained from workplace violence training, and participants are never in any
\nreal physical danger, Howard said it\u2019s important to note the mental and
\nemotional toll it can take on students.<\/p>\n
\neven just portraying the role of a nurse, and you have an actor who is playing
\nthe role of someone else yelling at you, there was some throwing of things,
\nloud voices, this is what nurses and clinicians deal with sadly in the clinical
\nsetting,\u201d Howard said. \u201cWe had to make sure that we were supporting all the
\nlearners, because this can be definitely triggering.\u201d<\/p>\n
\nstudents\u2019 faces even after just a couple of scenarios, Howard said, which is
\nwhy time was built in to decompress after the second scenario in addition to
\nthe debriefs. On-call chaplains were made available to students as well. Having
\nthose emotional well-being resources in place to support students is crucial
\nfor this kind of training, Howard said.<\/p>\n
\nfeelings and emotions, you can only imagine what happens in the clinical
\nsetting, in the real life setting, when these things happen,\u201d Howard said.
\ntraining program ended in July, Howard said. As they have reviewed the results
\nof the training, Howard said she would love to continue it in the future,
\nincorporating more scenarios and rolling it out to the entire state, offering
\nit to nurses and even other kinds of health care workers. Right now, the
\nprogram\u2019s future looks bright.<\/p>\n
\nofficers of UNC Health, and they are very interested in sustaining this program
\nand replicating it and rolling it out even to more hospitals, to more health
\ncare workers,\u201d Howard said.<\/p>\n
\nhave everything they need to continue the program, including a facilitator\u2019s
\nmanual created using some of the grant funding to provide directions on how to
\nimplement this program in the future. The program would supplement the
\nde-escalation training that is already a part of UNC-CH\u2019s curriculum.<\/p>\n
\ndiscussion of workplace violence earlier in nursing students\u2019 education.<\/p>\n
\nwaiting until it\u2019s about time for them to graduate,\u201d Akintade said. \u201cMaybe we
\ncan introduce that earlier, which gives them the opportunity to advocate even
\nin clinical, ever before they experience this as nurses.\u201d<\/p>\n