Tips for nurses to prepare for an active shooter

Maintaining situational awareness, reviewing your facility’s emergency response plans, and participating in trainings and drills can and will make a difference for nurses in the event of an active shooter incident.

This story was published in the Fall 2022 issue of The Washington Nurse.

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It is not easy to predict when or where violent incidents will occur, but nurses should be empowered to detect signs of threatening behavior and act quickly to protect themselves and those around them. An awareness of concerning behaviors and having action plans in place to respond to violent situations are essential parts of any workplace violence prevention program.

How can you spot signs of potentially violent behavior?

There is little evidence that violence is spontaneous or random. Violent offenders usually plan to target specific individuals such as a current or estranged intimate partner, supervisor, or co-worker. Behaviors that may indicate that an individual may act violently with the intent to harm themselves or others include:

  • Repeated incidence or history of bullying, harassment, aggression, or intimidation.
  • Increasingly pathological preoccupation with an individual or institution.
  • Close association with weapons, military or law enforcement paraphernalia, or previous attackers or assassins.
  • Financial hardship.
  • A history of physical violence toward others.
  • Directly or indirectly communicated threats.

Ultimately, you need to trust your instincts. If someone’s behavior seems concerning, do not ignore the situation or assume that someone else will take care of it. Nurses who suspect an individual may pose a threat to the health and safety of themselves or others should follow their facility’s procedures and chain of command for reporting such concerns.

What types of action plans should nurses prepare for an active shooter?

Every crisis is unique, and healthcare facilities present unique challenges for active shooter planning and response. To prepare, The Joint Commission and others recommend that nurses should be aware of their facility’s emergency response policies and procedures, including those regarding the following:

  • Activating emergency response measures and internal security alerts.
  • Procedures for lockdown and emergency evacuation.
  • Expectations for protecting and caring for patients on your unit during an emergency response.
  • What to expect when law enforcement officers arrive.
  • How to identify an all-clear directive.

There are also some strategies that the U.S. Department of Homeland Security and other experts recommend to put distance and barriers between you and the shooter:

Run. Exit, and help others evacuate if there is an accessible escape route. While exiting, keep your hands visible so law enforcement can see that you are unarmed.

Hide. If there is no safe route out or if patients lack mobility, hide. Seek shelter without windows or away from windows, and draw any curtains or blinds. Lock the door, and push all available furniture up against the door. Silence all devices, and turn off any other sources of light or noise. Get out of view, and remain in hiding until the all-clear signal is given.

Fight. As a last resort and only if your life is in imminent danger, try to distract and/or incapacitate the shooter. Act aggressively: Yell and throw items.

Are there any HIPAA considerations?

Nurses should remember that law enforcement officers are under no obligation to adhere to HIPAA. Nurses must balance their professional and legal duty to protect patients’ health information with their obligation to cooperate with law enforcement.

The HIPAA Privacy Rule permits healthcare providers to offer law enforcement requested personal health information to help identify or locate a suspect. However, nurses must be careful to limit the information they disclose to only what is specifically allowed under HIPAA. This includes the suspect’s name, date of birth, type of injury they may have sustained, date and time of treatment/incident, and a description of distinguishing physical characteristics. Other information, such as samples of the individual’s DNA, may only be disclosed in response to a court order, warrant, or written administrative request.

Nurses should also be sure to adhere to state law and their facility’s policies and procedures with regards to sharing information with law enforcement. If problems arise, nurses should be empowered to go up the chain of command and enlist their organization’s risk management or legal professionals for assistance.

Preparation can save lives

Unfortunately, in today’s environment in the United States, no organization is immune from the threat of gun violence. Maintaining situational awareness, reviewing your facility’s emergency response plans, and participating in trainings and drills can and will make a difference for nurses in the event of an active shooter incident.

Washington state is one of the few states in the nation that has a workplace violence law on the books (RCW 49.19) that stipulates actions an employer must take to protect healthcare workers.

Workplace violence modules

Workplace violence continues to be a crucial issue that impacts healthcare workers all over Washington state, despite the passage of legislation in 2019 that requires education and training to keep staff safe.

Did you know WSNA has two FREE CNE modules that address workplace violence — one on the 2019 state law requirements that affect healthcare facilities and staff and one that provides simple tips on assessment for violence, de-escalation strategies, and situational awareness?

Check them out at cne.wsna.org.


  • CNA. (2020). Active shooter response: Precautionary measures save lives. Healthcare AlertBulletin®.
  • CNA. (2022). Managing the threats of workplace violence.
  • Healthcare and Public Health Sector Coordinating Council. (2017). Active shooter planning and response in a healthcare setting.
  • The Joint Commission. (2014). Preparing for active shooter situations. Quick safety, Issue Four.
  • U.S. Department of Health & Human Services, Office for Civil Rights. (2022). When does the Privacy Rule allow covered entities to disclose protected health information to law enforcement officials?
  • U.S. Department of Homeland Security, (2008). Active shooter: How to respond.


The information offered within this article reflects general principles only and does not constitute legal advice by the Nurses Service Organization (NSO) or establish appropriate or acceptable standards of professional conduct. Readers should consult with an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc., nor NSO assumes any liability for how this information is applied in practice or for the accuracy of this information.

NSO has been the nation’s largest provider of nursing malpractice insurance since 1976, with more than 500,000 nurses insured in the program today. The individual professional liability insurance policy administered through NSO is underwritten by the American Casualty Company of Reading, Pennsylvania, a CNA company.

Reproduction without the permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com, or call 1-800-247-1500. www.nso.com.