Document Type

DNP Project

Publication Date


Degree Name

Doctor of Nursing Practice

Faculty Advisor

Kerry A. Milner, DNSc, APRN, FNP-BC, EBP-C

Practice Mentor

April Alfano, RN, BSN, MA, LP


Significance and Background: Violence against healthcare workers is an international issue. The rates of workplace violence (WPV) have been steadily increasing over the last few years. The practice setting implemented the use of the Brøset Violence Checklist (BVC) system-wide in July 2022, following the Joint Commission’s new standards for WPV prevention. The BVC is a checklist of six behaviors (confusion, irritability, boisterousness, physical threats, verbal threats, and attacking objects) that the nurses score as a 1 (present) or 0 (absent), and the higher the sum of the scores the greater the risk of violence. A score of three or greater qualifies the patient as high-risk for violence and interventions are to be implemented. In one of the hospitals within the practice health system, directed security rounding is done on all patients with a BVC ≥3. This process isn’t occurring in the local, practice hospital.

Purpose: To establish and increase directed security rounding of patients with moderate and high (≥3) BVC scores from baseline to 30% in the first month, 50% in the second, and 75% in the third month. To decrease behavioral intervention alerts by 20% by 12 weeks.

Methods: The guiding framework for this project’s implementation and evaluation is the Model for Improvement, developed by the Associates in Process Improvement and adopted by the Institute for Healthcare Improvement. A total of two plan, do, study, act (PDSA) cycles were completed. The security officers were educated on the new rounding process and BVC documentation was reinforced to all the inpatient nurses. A report listing the patients with BVC scores ≥3 was forwarded to the security managers, twice per day, who then forwarded to the lead security officers who would be conducting the rounding. Directed rounding was conducted and the security officers checked in on the patients and discussed with the nurses if further interventions were required and if everyone was safe.

Outcome: Over 12 weeks, behavioral intervention alerts decreased. Rounding by the security officers increased by 100% from baseline throughout the implementation period. Random audits by the safety nurses showed an increase in directed rounding and communication by the security officers to the nurses. The inpatient nurses reported an increased feeling of safety with the more frequent rounding and the security officers reported ease of rounding and felt the nurses appreciated it.

Discussion: Workplace violence continues to be a global problem. The BVC is a risk assessment tool appropriate for inpatient medical surgical patients. Depending on the BVC score certain interventions should be implemented, including security rounding. Directed security rounding allows for high-risk for violence patients to be assessed quickly and frequently and allows time to create a plan of action to keep everyone safe. It also increases security visibility and rapport between the nurses and security team. Directed security rounding decreased the amount of behavioral intervention calls since prior to implementation. Next steps are to implement this rounding system-wide.


A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

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Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

Available for download on Tuesday, April 15, 2025

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