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Updated: Jan 25, 2026

The Resident-intruder Paradigm: A Standardized Test for Aggression, Violence and Social Stress
Published on: July 4, 2013
Take a stand against workplace violence
Lindsay L Cariveau1, Nisha B Paul, Alaina M Tellson
1In Dallas, TX, Lindsay L. Cariveau is the Director of Nursing-Surgical Services at Baylor University Medical Center, Nisha B. Paul is a Quality Improvement Consultant at Baylor University Medical Center, and Alaina M. Tellson is the Vice President Nursing Excellence and Professional Development at Baylor Scott & White Health.
Background:
Workplace violence (WPV) in healthcare settings is a growing concern, with rates significantly higher than in other industries. WPV negatively impacts staff well-being, job satisfaction, and patient care quality.
Purpose:
This initiative aimed to reduce WPV incidents and improve staff safety and reporting practices at a large Level 1 trauma center in North Texas.
Methods:
Using the Plan-Do-Check-Act (PDCA) framework, an interprofessional team implemented a comprehensive WPV prevention program. Strategies included staff education, standardized reporting, use of the Brøset Violence Checklist (BVC), personal duress alarms, signage, and development of an escalation pathway. Data were tracked via a dashboard and shared governance committees.
Results:
Reported WPV events increased from 128 in Q3 2022 to 215 in Q4 2023, reflecting improved awareness and reporting. Public safety involvement rose from 77 to 108 events. Employee engagement scores improved, RN vacancy rates decreased from 17.59% to 8.54%, and staff reported feeling empowered to escalate concerns.
Conclusions:
A structured, multidisciplinary approach to WPV prevention enhanced staff safety, reporting, and engagement. Ongoing efforts include advanced de-escalation training, behavioral emergency response teams, and system-level enhancements.
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Aggression

