What’s new? RNAO’s second edition Healthy Work Environment best practice guideline, Preventing Violence, Harassment and Bullying Against Health Workers


Best Practices in Long-Term Care, Spring 2020 Issue

By Shaila Aranha, RN, MScN, PMP, LTC best practice co-ordinator


Megan Bamford, RN, MScN, associate director,
guideline development and evaluation,


Q1. Why did RNAO decide to publish a second edition of this Best Practice Guideline (BPG)?

RNAO has a commitment to ensuring up-to-date evidence informs its guidelines and accompanying resources. Preventing Violence, Harassment and Bullying Against Health Workers, Second Edition was revised as per this commitment. It replaces two previous BPGs: Preventing and Managing Violence in the Workplace and Workplace Health, Safety and Well-being of the Nurse, last revised in 2009 and 2008, respectively.

Q2.  How did you bring together the expertise of health-care professionals from different sectors to develop this BPG? What are the activities of the expert panel members?

This is a great question. A number of strategies were used to support the selection of the expert panel members.  We conducted reviews of the literature and topic-relevant technical reports, and spoke with experts in the field to gather their recommendations. In addition, we asked panel members from the previous editions to indicate, through an expression of interest, their wish to be involved.  

Given the scope of this BPG, RNAO’s guideline development team was deliberate in ensuring the expert panel was comprised of individuals holding clinical, administrative, academic, security and student roles across a range of health-service organizations, academic institutions, and sectors including acute care, long-term care, home health care, and primary care.  

The expert panel members engaged in a number of activities to support the development of the guideline. They validated and approved the scope of the BPG, determined the questions to be addressed through the systematic review, and participated in a consensus development process to finalize the recommendations in the guideline.  The expert panel also provided feedback on the draft guideline and the evaluation indicators, and identified appropriate stakeholders to review and provide further input to the draft guideline prior to publication. 

In addition to the above activities, the expert panel co-chairs—Henrietta Van Hulle (vice president, client outreach, at Public Services Health & Safety Association) and Gordon Gillespie (professor and deputy director of the Graduate Occupational Health Nursing Program at the University of Cincinnati)—supported the facilitation of the expert panel meetings and met with the guideline development methodologists on a monthly basis to advise on any research issues or clinical questions that arose during the development process. 

RNAO truly values the time, effort and expertise the expert panel contributed to the development of this BPG.

Q3. How will this BPG support organizations, administrators, educators and clinicians to establish and maintain a healthy work environment in LTC? 

The BPG provides 15 evidence-based recommendations. These recommendations focus on recognizing, preventing and managing violence, harassment and bullying in all health-service organizations, which includes LTC.  Recommendations focus on: (1) risk assessment tools and strategies; (2) organizational policies, procedures and responsibilities; and (3) education for health workers.  As such, recommendations are relevant to clinicians delivering care, administrators who develop and/or approve policies and procedures, and educators who support learning and development of staff.  A key goal of this guideline is to enhance the safety of health-service organizations through the adoption of evidence-based practices. Safe and healthy work environments are an enabler for nurses and other health workers to optimize clinical outcomes for those receiving care. 

In LTC, the implementation of evidence-based strategies for recognizing, preventing and managing violence, harassment and bullying in the workplace will support the interprofessional team and enable them to enhance resident-centred care.  

Q4. What are some of the resources available or being developed based on the guideline for organizations to use to implement and evaluate the recommendations of this BPG?

To support the dissemination of the BPG, a webinar took place on Oct. 3, 2019 entitled Nurses in the Know with RNAO: Preventing Violence, Harassment and Bullying Against Health Workers Best Practice Guideline. The webinar provides a general overview of the development methodology and recommendations. You can view the archived webinar here.

In addition, a BPG app for use on iPhone and/or Android devices is currently in development. This app will include adapted content from the BPG ‘at your fingertips.’ For more information about RNAO BPG apps, visit RNAO.ca/bpg/pda/app, or download for free from Google Play or the App Store. 

In terms of evaluation, the BPG includes a number of quality indicators that can be used to monitor and evaluate the processes and outcomes associated with implementation of the evidence-based recommendations. The evaluation measures are found on pages 18 to 22 of the BPG. 

Please take the opportunity to explore and download the second edition of RNAO’s BPG on Preventing Violence, Harassment and Bullying Against Health Workers. In addition, resources are available in the Healthy Work Environment section of the RNAO LTC Toolkit to support uptake in LTC. If you have any questions about the BPG or the LTC Toolkit, please contact the LTC best practice co-ordinator in your region.