WakeMed’s 20-Month Zero Violence Streak: What International Nurses Can Learn About Safe Workplaces in the U.S.

For international nurses exploring U.S. nursing jobs, a top concern isn’t just salary or location it’s safety. A recent success story from WakeMed Raleigh in North Carolina shows what’s possible when hospitals take workplace violence prevention seriously and invest in nurse support.

On one medical-surgical unit at WakeMed Raleigh, there has not been a single workplace violence incident in 20 consecutive months. This isn’t a coincidence. It’s the result of a structured, nurse-led program that blends behavioral health expertise, strong interprofessional collaboration and trauma-informed care. For international nurses seeking U.S. healthcare employers through platforms like NurseContact, this kind of environment offers a powerful model of what a safe, supportive workplace can look like.

Below is an inside look at how WakeMed did it and why these kinds of programs matter for nurses worldwide.

A New Kind of Partnership: Med-Surg Meets Psychiatry

In many large health systems, clinical teams work in silos. Medical-surgical nurses manage complex physical conditions, while psychiatric nurses focus on behavioral and mental health needs. At WakeMed Raleigh, nurse leaders made a deliberate choice to break down these silos to better support both patients and staff.

Sarah Crowley, MSN, RN, nursing director for behavioral health services at WakeMed, joined forces with Jaime Penninger, BSN, RN, nurse manager for the 5C medical-surgical and intermediate care unit. Their first step was simple but critical: understand what frontline nurses were struggling with.

They found several challenges that will sound familiar to many nurses, including:

• Growing numbers of patients with behavioral health needs on medical-surgical floors
• Staff discomfort with de-escalation and agitation management
• A mix of core staff and contract nurses with varying levels of experience
• Clear practice gaps when responding to escalating behaviors

Instead of accepting this as “just part of the job,” the leadership team designed a bundle of interventions to support both patients and staff.

Step 1: Identifying High-Risk Patients Early

The first tool they implemented was a structured way to identify patients at high risk for behavioral outbursts. While many hospitals use risk scores for falls or pressure injuries, this approach applied the same mindset to behavioral risk.

By flagging patients early, nurses on the unit could:

• Adjust care plans before a crisis
• Prepare the environment and staffing around higher-risk patients
• Engage behavioral health support earlier in the admission
• Respond intentionally instead of reactively

For nurses considering U.S. jobs, this is an important signal. A hospital that systematically identifies risk is a hospital that sees safety as a priority not an afterthought.

Step2: Psychiatric Nurses Join the Med-Surg Rounds

The second major shift was embedding psychiatric nurses directly into daily life of the med-surg unit. Instead of being consulted only when “things got bad,” behavioral health nurses began rounding regularly with medical-surgical teams.

This did more than simply bring another set of clinical eyes to bedside. It:

• Normalized the presence of mental health specialists on a non-psychiatric unit
• trust between med-surg and behavioral health nurses
• Created opportunities for just-in-time teaching at the bedside
• Gave med-surg nurses a familiar face to call when situations became tense

For an international nurse entering a new healthcare system, knowing that behavioral health experts are integrated into daily can make a huge difference in confidence and perceived safety. It also speaks to a culture where nurses are not expected to “handle everything alone.”

Step3: Mental Health Response Nurses for Behavior Codes

The third pillar of the program was the creation of a specialized mental health nurse role. This role is filled by highly experienced psychiatric nurses used to working across different care settings and age groups.

These respond to two types of behavior-related calls, similar to medical activations like rapid response or code blue:

• Therapeutic Intervention Calls – Triggered when “something doesn’t feel right” or when behaviors are starting to escalate but have not yet become a crisis.
• Behavioral Emergency Response Calls – Activated during acute events when safety is at risk and immediate expert support is needed.

In both, the mental health response nurse arrives as the on-site behavioral expert. At the bedside, they:

• Lead de-escalation efforts
• Coach staff in real time
• Guide medication and restraint decisions
• Center both patient safety and nurse safety

For international choosing U.S. employer, the presence of a designated mental health response nurse can be a powerful indicator of a hospital’s commitment to safe, sustainable nursing practice.

The Real “Internal Customers”

The Nurses program at WakeMed didn’t just focus on patient; it was intentionally designed the idea that nurses themselves are “internal customers.” That mindset is especially relevant for international nurses transitioning to a new country, new culture and new healthcare expectations.

When initiative formally launched in February 2024, the mental health and well-being team approached it through a customer service lens. They recognized that their role was to support colleagues, not simply consult on charts.

Meet-Greet Breakfasts

To build trust, the mental health team hosted informal breakfasts with staff. During these sessions, they:

• Introduced the mental health response nurses and psychiatric team
• Explained scenarios where they could be helpful
• Clar how and when to call for support
• Reassured that they were partners, not critics

This kind of intentional-building can be especially reassuring for who are new to the U.S. and may worry about “bothering specialists or asking for help.

Medication Support and Proactive Orders

Another support was med-surg nurses in managing agitation with medications. Psychiatric nurses are typically very comfortable with theseimens; med-surg nurses often are notThe worked to ensure:

Active agitation management orders were in place for at-risk patients
Nurses had protocols instead scrambling for orders mid-crisis
Staff could discuss behavioral plans with psychiatric nurses in

This proactive reduced high-stress, last-minute calls and helped nurses feel in control For international nurses practicing in the U.S., having these frameworks in place can transform an “overwhelming” to “manageable.”

A Customer Attitude the Bedside

One small important detail this program is the language and attitude nurses use when they at a call. They with a simple: “I here help.”

That phrase two things:

• The nurse is there to support both staff and patients
• No one is being judged for calling for help asking for support is expected and encouraged

That kind of culture is essential to preventing burnout and moral distress For international nurses comparing U.S. nurse employers, it’s worth asking:

• your hospital when staff call for help?
• Are specialist nurses seen as teammates or as outsiders?Trauma-Informed Care and Workplace Violence Training

Alongside changes, WakeMed invested in targeted education for, including:

• Trauma-informed care training – Helping nurses understand how trauma shapes patient behavior and responses to
  Workplace violence reduction training – Equipping staff to safely respond to escalating behaviors while maintaining professionalism empathy

This dual helped staff:

Prioritize early warning signs of escalating behavior

• Respond ways that reduce rather than trigger aggression
  Preserve therapeutic relationships, even with challenging patients

For international nurses the U.S. healthcare system, training like this can ease the transition and provide practical skills that travel across specialties settings.

Results 20 Months, Zero Violence

The outcomes this program have been striking, both for patient safety and nurse well-being. On the 5C medical-surgical intermediate care unit WakeMed Raleigh:

• Nurses confidence in de-escalation improved by about 30%- Comfort with agitation management orders increased by %- Use of violent restraints decreased
• Staff became more proactive and prepared, rather than reactiveMost notably, these changes led to 20 consecutive months a single workplace violence incident the unit.

Beyond the metrics, nurse leaders report something just as valuable:- Stronger relationships across units

• A where nurses supported not isolated
• A sense of safety and teamwork

This year program being expanded to additional units at WakeMed’s Cary and North hospitals, as well as itsrier Creek emergency departmentanother sign leadership sees safety and support strategic not temporary projects.

This Matters International Nurses

NurseContact is a portal that connects international nurses with U.S. healthcare and streamlines hiring process matching and interviews to support. Stories like WakeMed’s provide a practical lens for potential employers.

When you are considering a U.S. nursing job through NurseContact look for hospitals that have formal workplace violence programs strategies do you use to workplace violence?”
Use behavioral specialists as integrated, just consultants- training trauma-informed and de-escalation

• Treat “internal customers” safety and well-being matter
• and share real outcomes around violence reduction and nurse support factors aren’t about statistics; they shape your day-to experience at bedside. A well-supported med-s or intermediate care can:
• Less fear of going work
• Stronger teamwork- patient
  More sustainable careers, when you’re far from home

For international, relocating the U.S is a major life decision. Choosing an invests in psychological safety, interdisciplinary collaboration and,-pract response systems is just as important evaluating pay, benefits and location.

Using NurseContact Find Supportive, Safety Employers

Through NurseContact, you can connect U.S. hospitals health systems that actively seeking international nursing talent and committed to safe, supportive environments. As you explore opportunities consider asking potential employers:

• “Do have behavioral health teams or mental health response nurses support med-s units?”
  -What of do staff receive for de-escalation and trauma-informed care
• “How do support new nurses international nurses during highrisk situations

Takeaway

WakeMed’s -month streak with zero workplace violence incidents isn’t just success story for unit; it’s a roadmap. It shows how, interdisciplinary collaboration and a commitment to support transform work environment.

For international using Nurse to connect with U.S. employers, like this to look for not just job, but a workplace that values safety, your voice and your long-term success in American healthcare