Quantifying Risk of Exposure to Workplace Violence in Veterans Affairs (VA) Health Care: The Workplace Behavioral Risk Assessment (WBRA).

BACKGROUND: Few health care organizations have structured approaches to assimilate and analyze disruptive behavior data. In 2012, Veterans Affairs (VA) developed the Workplace Behavior Risk Assessment (WBRA), a tool that collects behavioral threat data from multiple systems, consolidates it, and tailors staff training based on the frequency and type of events. OBJECTIVE: This paper provides an overview of the WBRA and how it can inform nurse training. METHODS: A repeated measures design evaluated trends in workplace violence reporting and event rates across 140 VA health care systems from 2013 to 2024. Data were collected annually using a standardized electronic reporting system and reviewed by multidisciplinary teams. Risk levels were categorized based on the frequency and type of disruptive events, including manual restraint and physical or verbal violence. Descriptive statistics were used to prevalence of incidents and analyze trends, particularly among nursing professionals in high-risk areas. RESULTS: Four VA workplace settings: acute care (psychiatric and medical/surgical), emergency/urgent care, and Community Living Centers (CLC) were consistently classified as high-risk. In FY 2024, nursing staff accounted for over 90% of reports in inpatient and extended care settings and 73% in emergency/urgent care. From FY 2013 to FY 2024, reports involving nurses increased significantly, with the largest rises in CLCs (289%) and Medical/Surgical Units (271%), whereas the proportion of physical violence reports involving nurses rose from 59% to 83%. CONCLUSIONS: The WBRA enables health care systems to analyze behavioral risk data to align training with risk.