November 14, 2025

Situational Awareness: A Powerful Tool for Reducing Violence in Healthcare

Healthcare professionals are not to blame for the aggression or violence they endure. Being situationally aware reclaims a measure of control, offering a means of reducing personal risk and creating safer care environments.

In 2016, the New England Journal of Medicine described violence in healthcare settings as “ubiquitous” (Phillips, 2016). Two years later, the U.S. Bureau of Labor Statistics reported that 73% of all nonfatal workplace injuries and illnesses due to violence occurred in healthcare, outpacing even law enforcement and corrections (USBLS, 2018).

The consequences extend far beyond physical harm. A 2022 study found that healthcare professionals who experienced workplace violence often reported demoralization, depression, loss of self-esteem, irritability, concentration difficulties, and reliving of trauma. These personal struggles ripple outward into the workplace, contributing to declines in care quality, absenteeism, and decisions to leave the profession altogether (Lim et al., 2022).

Physicians, nurses, and staff are not responsible for the violence directed at them.

But having no responsibility does not mean having no power. One of the most effective tools healthcare professionals can use to reduce their risk is situational awareness.

What Is Situational Awareness?

In clinical care, situational awareness can refer to keeping track of patient status and symptomatology. But in the broader sense, it means being fully aware of your environment, noticing what is happening around you and interpreting those cues accurately.

It’s not about being hypervigilant or fearful. Instead, it’s about avoiding the blind spots that distractions, stress, or fatigue can create.

Barriers to Situational Awareness

Even the most skilled professionals can find it difficult to maintain awareness. Four main categories of barriers often interfere:

  1. Environmental distractions

Overcrowded hallways, loud construction noises, or even multitasking can prevent us from noticing subtle cues of risk. These environmental distractions interfere with situational awareness by diverting attention and cognitive resources away from perceiving, understanding, and anticipating what’s happening in our surroundings. 

Examples: Loud noises, visual clutter, poor lighting, or excessive motion in the environment can mask important signals (like alarms, other people’s movements, or warning signs).

Effect: You might miss or misinterpret key information, leading to incomplete or incorrect perception of the situation.

Even if you perceive information, distractions can reduce your ability to process and interpret it accurately.

Examples: A constant background noise, people talking nearby, or juggling multiple priorities can overload your working memory.

Effect: You may fail to connect the dots between observed elements (e.g., realizing that rising temperature plus a strange smell means overheating equipment).

  1. Physical needs

Being tired, hungry, or dehydrated naturally pulls our attention inward, lowering awareness of our surroundings.

In healthcare settings, this can have serious consequences. A healthcare professional who has been on shift for many hours without a break may experience fatigue, hunger, or general physical discomfort, all of which can reduce mental alertness and responsiveness. In this state, they may be less attuned to a patient or visitor who is beginning to exhibit signs of escalating aggression. Even subtle warning cues (shifts in tone of voice, tense or closed body language, restless movements, or changes in facial expression) can go unnoticed. The accumulation of these small, easily missed signals may delay recognition of a developing threat, leaving both staff and patients at risk.

  1. Emotional needs

When emotions run high, they can dominate our focus and block our ability to recognize situational risks.

In healthcare settings, for example, a staff member who is feeling anxious, overwhelmed, or emotionally drained may become more focused on managing their internal distress than on monitoring the environment around them. This inward focus can make it harder to notice subtle cues of patient agitation, conflict between visitors, or other early warning signs of potential safety risks.

  1. Personal trauma history

Past trauma can make us hypersensitive to certain triggers while less responsive to others. 

Imagine someone who has experienced a serious motor vehicle accident. Later, while at work, they hear the sudden squeal of brakes outside. For this person, that sound may instantly bring back memories of their traumatic experience, making it far more significant and distressing than it would be for others without that history. In that moment, their attention may become fully drawn to the sound, even though it poses no real danger. This heightened focus is a natural protective response shaped by their past experience. However, it can also mean they may miss other, more relevant cues in their environment, including signals that could indicate an actual source of risk.

Consider another example. A person who has been assaulted at work by someone wearing a particular cologne may later encounter a completely unrelated individual wearing that same scent. Even though this new person poses no actual threat, the familiar smell can act as a powerful trigger, instantly drawing the person’s attention and activating a sense of alarm. Their focus may become fixed on the scent and the individual associated with it, leaving them less aware of their broader surroundings. In this state of heightened vigilance, they might overlook other cues that signal genuine risk.

Significant trauma symptoms can sometimes include dissociative reactions, which involve a temporary disconnection from the present environment. One of the most well-known forms of dissociation is a flashback. During a flashback, the body and mind may respond to danger cues from a past traumatic event rather than to the person’s current surroundings. In these moments, the individual is not reacting to actual threats in their immediate environment, because, on a physiological and emotional level, they are re-experiencing the trauma as if it were happening again. 

Building the Skill of Awareness

The good news is that situational awareness can be strengthened with practice.

One approach is to ask yourself small, concrete questions throughout the day:

  • How many people were in the elevator with me?
  • How many cars were occupied in the garage?
  • How many patients or visitors today were wearing glasses?

These exercises train your brain to notice details you might otherwise overlook.

Another tool is the SLAM technique:

  • Stop – Pause and focus your attention.
  • Look – Observe your surroundings carefully.
  • Assess – Identify potential risks and consider how you could respond.
  • Manage – Take action: address the situation if you can, or seek help from the right resources.

There are also a number of online opportunities (developed by the Department of Homeland Security) to test your skills of situational awareness: 

You Deserve Safety

You did not sign up to be abused.
Violence is not “just part of the job.”

While healthcare workers are not to blame for violence, they can reclaim some control by practicing situational awareness. It is a powerful, practical tool to reduce risk, protect staff, and create safer environments where professionals can thrive and patients can heal.

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