This chapter identifies reasons why nurse practitioners (NPs) may be at risk for institutional violence. It provides the scenarios in which the NP sets the stage to protect himself or herself from a variety of threats, with supporting rationales. Nurses are at risk for violence at work. Workplace violence may occur as a result of interactions with a coworker or when caring for a patient. Nurses and other health care professionals are also often faced with high levels of stress. NPs must play a leadership role in creating institutional policies and developing work- related programs to prevent institutional violence. A risk for violence occurs when an NP refuses to accede to a patient’s request to be excused from work. If, in addition, the patient requests documentation excusing an additional day or two, NPs must use their judgment based on their evaluation and the patient’s treatment course.