As staff recruitment and retention remain major challenges in the healthcare industry, how can healthcare organizations ensure staff members feel safe in their work environments? This question has been a driving force behind design conversations in recent years.

The Bureau of Labor Statistics reports that the rate of injuries from violent attacks against medical professionals grew by 63 percent from 2011 to 2018, and hospital safety directors say aggression against staff escalated as the COVID-19 pandemic intensified in 2020.

In a 2022 survey by National Nurses United, the nation’s largest union of registered nurses, 48 percent of the more than 2,000 responding nurses reported an increase in workplace violence—more than double the percentage from a year earlier.

Safety considerations were previously limited in large part to behavioral health units. However, because of an increase in mental health issues and violence in the general population in recent years, stronger safety considerations, including enhanced exam room designs and increased visibility, are now a pressing need in all areas of hospitals and clinics.

Safety strategies for healthcare facilities

According to the Occupational Safety and Health Administration (OSHA), possible sources of violence in hospitals, nursing homes, and other healthcare settings include verbal threats or physical attacks by patients, distraught family members who may be abusive or even become active aggressors, gang violence, domestic disputes that spill over into the workplace, and coworker bullying.

To prepare for and shield healthcare staff against agitated or aggravated patients and visitors, here are some essential design elements to consider on healthcare campuses, including exam rooms, emergency departments, and nurses’ stations.

Exam rooms: Starting with the exam room, design strategies should always mindfully establish the position of the patient and staff to the doorway. There should be a clear exit path for staff, and patients should never be able to block a staff member’s path to the door.

Staff members should also have access to charts or computers without turning their backs to patients. This helps reduce surprises and allows staff members to remain aware of their surroundings.

In some cases, a second exit point on the opposite side of an exam room may be considered for additional safety, so that if the patient were to block an exit in the room, there is another door for staff to retreat to, if needed. This strategy is especially utilized in emergency departments where there may be a higher volume of patients that can become agitated.

Emergency department: When designing emergency departments (EDs), any area where a staff member has first contact with patients requires enhanced safety considerations until the patient’s safety risk can be assessed. For example, patients might receive initial treatment in triage rooms where adrenaline can be elevated. Providing a second exit way in an opposite location of the room is one way to increase security measures, if possible.

Additionally, the nurses’ station, which should be in an area with visibility to patients and visitors. Project teams should also strategically locate campus security desks in visible areas to keep security personnel nearby if a situation were to arise, particularly during evening and nighttime hours.

Technology measures: Security cameras in waiting rooms and reception areas, along with an accessible duress button to use if circumstances escalate and a patient becomes aggravated, are key strategies to consider. Technological enhancements to ED entrances and registration areas can also provide an added level of security, including metal detectors and cameras in lobbies and behind the reception desk to allow for better awareness of surroundings.

Lockdown buttons are now a necessity to secure the front entrance if an aggressor is known to be coming or if there are additional aggravated visitors. Code-green buttons provide additional support by alerting security of any issues. Then safety personnel can quickly go to the cameras to see where help is needed and get people in or out.

Consultation rooms: Patient services and consultation rooms need to allow for some privacy for confidential conversations. To create a sense of transparency as well as security, interior windows or glass panels can be used to give other staff nearby the ability to observe staff-patient interactions and provide backup if needed.

Similar to other areas, computers should be viewable by staff without having their backs to patients, and there should be a clear exit path along with a duress button in case of emergency.

Healthcare facility entrances and lobbies: There are many design considerations to protect the clinical area from the lobby view, so the area stays secure in the event of an active shooter or aggressor. Starting with the front-entrance sequence, the registration area and primary entry points need to be protected against unwanted intruders. The front reception desk should be strategically placed in a highly visible location with access to the back of house.

Additionally, visitors and patients shouldn’t have the ability to walk behind the reception desk or in any part of the facility that gives them a direct link to staff or clinical areas.

The reception desk can be protected by doors, card readers, and, in some cases, added safety glass, with a separate door out of the space to easily get staff to safety without having to step into the lobby.

The ability to lock down the back of the house and provide staff in the lobby with a safe exit if the rest of the building is locked down are also important considerations.

Strengthening on-campus safety

Preparing for situations with agitated or aggravated patients and visitors is essential to creating proactive buffers against active and potential threats.

Design considerations such as multiple exit paths, duress buttons, and lockdown capabilities are just a few of the many ways to strategically approach healthcare campus safety planning.

Sara Malin is a healthcare architect and principal at Wold Architects & Engineers (St. Paul, Minn.) and can be reached at Andrew Jordan is a healthcare planner and principal at Wold Architects & Engineers (St. Paul) and can be reached at

For more on this topic, read “Designing For Staff Safety In Healthcare Facilities.”