Active shooter is an individual who is actively involved in killing in a populated and confined area where in most cases they use fire arms. Their situations are unpredictable and evolve quickly and the situations are over in less than 15 minutes (“Article | Joint Commission”, 2014). During active shooter incident, three phases are included, prevention, recovery and response. Active shooting are unpredictable and evolve quickly and victims can be randomly selected and mostly it has been seen to be health care workers. There is need for active preparation for health care organizations on active shooter situation.

The articles describe different active shooters and the process they took to invade the hospitals. In all the incidents in the articles the employees, visitors and patients were injured and some died. Active shooting is prepared before by the shooters who use fire arms and are familiar with the institution and the building. Some active shooters are suicidal and end killing themselves and taking their lives while others are killed by the authorities. The incidents kill and injure people before the arrival of the authorities (Balingit, 2012) (“Responding to active shooters in hospitals”, 2013)).

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It is my surprise that some people in hospitals do not like metal detectors and it is a leading cause for guns in hospitals leading to killings. Some people may turn to killing out of anger, frustrations and pain without planning to do so before. Signs may help these people who are not criminals but honest people, frisking may discourage them from getting involved with such actions. Each active shooter in the three articles had different motive of their actions, the most people affected were the employees. This illustrates need for awareness creation, preparedness and what to do during an active shooting. 

My hospital has prepared for an active shooter with information online for employees and staff to read and how to react. The procedures and policies in this hospital illustrate the way to account for patients and employees incident. The policy has information on the ways to handle critical patients in case of an incident. It illustrates on the ways respond and report on active shooter events. It also trains employees on how to protect patients and the people affected by an active shooter.  It illustrates the high risk areas in the hospital including the pharmacy, emergency units and operating rooms.

There will be periodical drills to help all employees to prepare for an active shooter. Policies should are hang on walls on what to do during an active shooter. It has been stated the importance of all employees to familiarize with the safety plan and to abide with the set safety plan. Employees are supposed to conduct in manner that does not endanger them to the safety of other colleges during an active shooter. There are emergency lines given to contact authorities in case of active shooter emergency and information and the information to give in case of such incident.

The facility has a security plan which states that closed door in the facility should remain locked and closed. Staff should always have an identification badge displaying their information and create a safety culture which should report all suspicious activities. There is empowering information for staff that comes in contact with individuals who seem lost or suspicious. After a shooting, family member of victims are expected to arrive in the hospital and thus they should be given assistance and information about their loved ones. All facility staff should have information on the actions to address an active shooter situation within any facility. 

A live action should involve drill where facility security teams and responders and incudes the role of law enforcement officers stationed or employed in the facility. There is need for exercise with the partners as a way of ensuring everyone knows their role and others role in the scene. First, individuals should learn potentially volatile situation signs and the way to prevent the incident. Secondly it is good to learn the survival steps when faced with an active shooter situation. Lastly, it is good to be prepared on the work with the law enforcement team during the incident response. 

As a nurse it is essential to know the Run, Hide and fight response which is a three step process aiming to reduce or prevent loss of live in an active shooter situation. Run involves the evacuation from the area, while Hide is seeking a secure place to hide thus denying the shooter access.  Fight is used due to the risk of the individuals and people may make decision to attack and incapacitate the attacker or shooter to survive (“Active Shooter – Emergency Preparedness”, 2016). There are many responses for nurses which they should learn in case of active shooter including; Avoid- Deny- Defend, ALICE active shooter response, the 4As as an active shooter response and Window of Life active shooter response. As nurses it is our responsibility to overcome denial and be quick to respond and be able to recognize danger sounds, act and communicate forcefully the action necessary.

The hospital should be prepared with pre-positioned access kits that are filled with essential items that law officers may need to access the hallways and other rooms. The video control room should be accessible to help in law enforcement officers with the information they may require and the hospital should have evacuation assembly that is known by all staffs and should have big letters read by all coming to the hospital to ease accessibility. The hospital should train nurses on THREAT acronym during incident; T- threat suppression, H-haemorrhage control, RE- rapid extrication to safety, A- assessment by medical provider and T- transport to definitive care. The hospital should provide an employee assistant program that has practical solutions on referral, support and information on issues like depression, anxiety, grief and loss, legal concern and relationship challenges.

Bullying in nursing has remained an issue for decades where one person acts against another emotionally, physically or verbally in an abusive way which can be threatening, humiliating or intimidating.  In nursing, it is a widespread phenomenon with multiple side effects such as, illness among the employees, decreased quality in patient care, low level of professional satisfaction and drop out. Bullying victims tend to feel dissatisfied intimidated with both physiological and psychological effects (Yıldırım, 2009).  One reason for bullying is longstanding struggles of power which arise from conflict of values which are often caused by unsympathetic leadership styles and organisational conditions.  Another reason is political where self-interest of perpetrators due to the need of power and competitions for promotion (Skehan, 2015).

Nursing culture can lead to bullying as it is primarily associated with women who are known to act malicious towards one another. Every day more males are entering the profession and they can be bullied by the ones who think it is a female profession (Skehan, 2015). Jealous is one motive causing nursing bullying, a go- getter nurse who goes to beyond and above performance standard can be a threat to others. Nurses who are minimal performers can be threatened by overachievers, they can be fearful to their position to a better nurse who can multi task or better in technology. New nurses are very vulnerable to bullying as they fear reporting the bully for fear of losing their job. 

Bullying consequences are numerous and can cause financial, physical and psychological problems. Physical ailments related to bullying include; gastrointestinal problem like ulcers, fatigue, loss of concentration, sleep disturbances and headaches. Psychological manifestations secondary to bullying include; excessive worry, stress, depression, post-traumatic stress disorder, helplessness and impaired social skills. The effects affect the bullied nurse both personally and professionally and make him/her miss work due to the symptoms and this can lead to financial burden to the nurse (Skehan, 2015).

The conditions are serious and lead to adverse patient outcome plus time away from the job to deal with the conditions. This in turn will affect the staff patient ratio as the nurse cannot perform her or his job. Thus bullying creates physiological/psychological maladies which lead to time off and cause adverse effects to patients. The most negative effect for the nurse is emotional pain which is devastating to the person being bullied. This pain can lower someone self-worth and the nurses exhibiting the pain has far reaching impact on other staff, nit and patients and when nurse self-worth is affected it can lead to disinterest in work(Yıldırım, 2009).

I would help a new nurse as through empathy and using the anti-bullying policy where there is zero tolerance of such effects. The new nurse should be led in reporting to the management for further action and trained as an equal with the colleagues. Explaining to him the procedures of taking actions and how o deal with the stresses is essential.  It is my responsibility to train my colleagues and training each other as equals no matter our education level or promotions. Reminding them of the organisation policy is important plus reporting the issue to the management to take actions on the inappropriate behaviours. 

Bullying in nursing should be the responsibility for the whole nursing organisation with the need of ensuring zero tolerance of misuses of power and assertively protecting a collaboration culture and open communication. Anyone making complaints should be confident with the escalations of their concerns. There is need of creation of a health organisational climate through acknowledging existence of bullying, zero tolerance policies and staff education. There is need of conducting regular work area assessment which looks on bullying signs and reporting on bullying.


Active Shooter – Emergency Preparedness. (2016). Retrieved 17 April 2015, from

Article | Joint Commission. (2014). Retrieved 14 May 2016, from

Balingit, M. (2012). Hospital shootings shock Oakland 2 dead, 7 injured at Western Psych; Police kill gunman in exchange of fire.. Retrieved 9 March 2012, from

Responding to active shooters in hospitals. (2013). SecurityInfoWatch.Com.. Retrieved 14 May 2016, from

Skehan, J. (2015). Nursing Leaders: Strategies for Eradicating Bullying in the Workforce. Nurse Leader, 13(2), 60-62.

Yıldırım, D. (2009). Bullying among nurses and its effects. International Nursing Review, 56(4), 504-511.

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