How can nurses advocate for gun safety?

How Nurses Can Advocate for Gun Safety

Nurses should systematically screen all patients for firearm access and provide evidence-based counseling on safe storage, while advocating for policy changes that reduce preventable firearm injuries and deaths. 1

Ethical Foundation and Professional Responsibility

Nurses have an ethical obligation to counsel patients about firearm safety risks as a core professional responsibility grounded in harm prevention and public health advocacy. 1 This responsibility extends from the medical profession's special duty to speak out on prevention of firearm-related injuries and deaths, with nurses positioned as frontline providers with the most patient contact time and trust. 1

Universal Screening Approach

Implement universal firearm injury risk screening across all clinical settings for every patient, regardless of reason for visit. 2 This non-discriminatory approach helps overcome healthcare's hesitancy in discussing firearms and normalizes these conversations as part of routine care. 2

• Ask each patient about firearm access during routine assessments 2
• Document firearm ownership characteristics including number, type, and current storage practices 3
• Integrate screening into existing workflows rather than reserving it only for "high-risk" patients 2

Priority Populations for Targeted Counseling

While universal screening is recommended, nurses should provide intensive counseling for specific high-risk groups:

Households with Children and Adolescents

• Firearms are now the leading cause of death for children and adolescents in the United States 4
• Millions of youth live in homes with loaded firearms, with only half of these homes securing their guns 4
• Unintentional shootings involving toddlers are increasing across the United States 5

Patients with Dementia

• Approximately 60% of persons with dementia own firearms, but only 16.9% store them safely (unloaded and locked) 3, 1
• More than 90% of firearm injuries in older adults are suicides 3
• About 40% of dementia patients develop depression, and firearm access during depressive episodes increases suicide completion likelihood 3
• One-third of persons with dementia exhibit combative behavior as disease progresses 3

Patients with Mental Illness and Substance Use Disorders

• Patients with mental illnesses associated with greater risk of self-harm or harm to others require counseling 1
• Patients with substance use disorders should be systematically identified for intervention 1

Evidence-Based Counseling Protocol

Three-Tiered Counseling Approach

1. Safe Storage Counseling 3

• Educate that safe storage consists of storing every firearm unloaded and locked, separate from ammunition 3, 1
• Firearms should be stored in locked gun safes, cabinets, or cases 3
• Ammunition must be stored separately in a locked location 1
• Keys to locks should be given to family members, caregivers, or friends when appropriate 3

2. Lethal Means Counseling 3

• Provide statistics showing that firearm presence in the home increases suicide risk 3
• Explain that restricting firearm access reduces firearm injuries 3
• Discuss the high case fatality rate for suicide attempts with guns 3
• Address how unsafely stored firearms increase risk of homicide, suicide, and unintentional injury for family members and healthcare professionals 3, 1

3. Firearm Removal Counseling 3

• Discuss temporary transfer of firearms to legally authorized individuals 3
• Explain options for legal transfer to family members not living in the home 3
• Consider removing firing pins or otherwise disabling weapons 3
• Discuss extreme risk protection order (red flag) laws where available 3

Risk Assessment Framework

For patients with dementia specifically, the American Geriatrics Society developed a structured protocol: 3

• Use Clinical Dementia Rating (CDR) scale to assess disease severity 3
• Assess physical, psychiatric, behavioral, and environmental factors 3
• Use validated Patient Health Questionnaire-2 to screen for depression 3
• Apply Behavioral Pathology in Alzheimer's Disease Rating Scale for behavioral symptoms 3
• Assess presence of young children or teenagers in the home 3
• Evaluate patient's or family member's ability to handle firearms safely 3

Policy Advocacy Role

Nurses should actively advocate for evidence-based legislation at national, state, and local levels: 1

• Support universal background check systems 1
• Advocate for child access prevention laws that hold firearm owners accountable for safe storage 1
• Support reporting requirements for lost or stolen firearms within 72 hours 1
• Promote policies requiring home health agencies to establish no-weapon or safely stored weapons policies 3, 1

Overcoming Implementation Barriers

Common Obstacles

• More than 50% of nurses are unfamiliar with state laws on safe gun storage 6
• Most nurses lack prior training in educating others on firearm safety 6
• Many practice settings lack policies, teaching plans, or patient educational materials 6, 5
• Time constraints and uncertainty about what to do with collected information create barriers 6

Solutions

• Provide one-hour interdisciplinary training classes involving security departments 6
• Develop standardized documentation policies and safety protocols 6
• Create patient educational pamphlets for distribution 6
• Establish workplace policies and teaching plans specifically addressing gun safety 5
• Make educational materials readily available at point of care 6

Practical Implementation

More than 80% of nurses report they would feel comfortable providing firearm safety information if materials were available. 6 Interestingly, nurses who are gun owners are more likely to screen for firearms (62.5%) and teach about safe storage (75.0%), suggesting that personal familiarity with firearms may reduce hesitancy. 5

Documentation and Follow-up

• Establish clear documentation systems for firearm screening results 6
• Create referral pathways for high-risk patients 1
• Follow up on counseling effectiveness at subsequent visits 3

Critical Caveat

The firearm safety counseling protocol for dementia patients, while evidence-based, remains untested and requires validation through randomized controlled trials measuring behavioral outcomes such as storage behavior changes or firearm removal. 3 However, given the magnitude of risk—with firearm-owning persons with dementia potentially reaching 12 million by 2050—nurses should implement available guidance while research validation proceeds. 3