Systematic reviews assessing the effectiveness of violence prevention education for healthcare workers have largely been inconclusive. This research aims to fill that gap through a realist review and evaluation. By investigating "what works, for whom, in what circumstances, over what duration, and why?" we explore the 'black box' of the Provincial Violence Prevention Curriculum provided to frontline staff in emergency departments in three British Columbia Health Authorities, which aims to reduce violence towards healthcare workers from patients and visitors. The realist process of generating and testing context-mechanism-outcome configurations has lead to valuable new understandings of program effectiveness but it has not been without controversy. In this presentation, we will discuss the challenges in employing this methodology across a multi-site, multi-stakeholder healthcare setting. We will share the lessons learned during our journey, offer practical ideas and demonstrate the value of employing a realist lens to evaluations in real-world settings.