I never wear my stethoscope around my neck. A patient once grabbed at it — attempting to pull me down by my neck. I disentangled myself and got away without physical injury, but I was rattled. I never worked with it around my neck again. I was lucky. I left acute care bedside practice without lasting physical injuries.
Recent reports of healthcare professionals killed while caring for their patients have increased the urgency for meaningful conversations on how to stop the violence faced by nurses and other clinical staff. The effects of healthcare workplace violence are extensive and long-lasting. Every day, nurses put their physical and psychological safety on the line to care for patients and loved ones.
The Ultimate Cost
In October, a nurse and a social worker were killed while caring for patients in a hospital in Dallas. That same week, a nurse practitioner was killed while working in an outpatient clinic in Durham, North Carolina. These tragic events highlight the ultimate cost of violence against healthcare workers and the extreme risk nurses face at work.
A September news release on Press Ganey's National Database of Nursing Quality Indicators stated that in the second quarter of 2022, more than two nursing personnel were assaulted every hour.
The National Institute for Occupational Safety and Health (NIOSH) states that nurses who have the most direct contact with patients are at the highest risk of violence. Hospital locations where violence most frequently occurs include psychiatric departments, emergency departments, waiting rooms and units caring for geriatric patients. Violence often happens during periods of high activity and interaction with patients, such as meal times, visiting hours or patient transport. NIOSH also notes that understaffing is a risk factor for violent events.
Is the Violence Getting Worse?
It appears that the COVID-19 pandemic and its aftermath have exacerbated the problem. A study in the September 2022 issue of Workplace & Health Safety showed that a significant number of hospital nurses reported facing increased physical violence and verbal abuse from patients, loved ones and visitors compared with pre-pandemic levels. Nurses who provided care for patients with COVID-19 experienced more violence than nurses who had not. The study also cited barriers to reporting cases of physical violence or verbal abuse to management. These include a lack of time to report, reporting processes that were not standardized, lack of management support, and a belief that violence is part of the job as a nurse. These barriers likely led to underreporting of violent events during the COVID-19 pandemic.
These results echoed 2020 data from a study on COVID-19-related bullying, harassment and stigma among healthcare workers. A research team at University of Rochester School of Medicine and Dentistry found that even on an international level, healthcare workers were much more likely to experience COVID-19-related stigma and bullying, especially in the context of violence and police involvement in community settings.
Nurses Don't Feel Safe
AACN surveyed more than 9,000 nurses in 2021, and the findings were published in Critical Care Nurse: "National Nurse Work Environments - October 2021: A Status Report." The results showed a marked decrease in the number of nurses who feel safe or valued by their organizations. Only 47% of survey respondents agreed with the statement "My organization values my health and safety," compared with 68% in the previous 2018 survey. Also, 72% of respondents reported experiencing at least one incident of verbal abuse, physical abuse, sexual harassment or discrimination in the past year.
In August 2022, the American Organization for Nursing Leadership Foundation reported the results from a survey of more than 2,300 nurse leaders. Participants were asked if they had witnessed workplace violence or workplace bullying and incivility in the last year. Over 50% of nurse managers and directors reported they had and, shockingly, the number was 72% for chief nursing officers/chief nursing executives.
Improving Healthcare Provider Safety
"AACN Position Statement: Preventing Violence Against Healthcare Workers" urges healthcare institutions to take the following actions:
- Establish a clear and consistent reporting structure for workplace violence, with specific policies and procedures on how to report violent incidents to law enforcement.
- Encourage employees to press charges against persons who assault healthcare workers, and support staff who do report them. Many states have established laws with enhanced penalties for these offenses.
- Educate staff on how to recognize the potential for violence, how to employ de-escalation techniques, and how to seek assistance to prevent or respond to violence.
- Provide resources and support programs for employees to help them cope with violent incidents.
- Evaluate staffing and patient classification systems that could increase or reduce the risk of violence.
- Ensure the presence of sufficient security systems, including alarms, emergency response and available security personnel.
Additional ways to promote safer healthcare workplaces:
- Research - There needs to be more research on violence against healthcare workers. Studies can be conducted to investigate and determine the reasons for violent incidents. Reach out to your professional and academic organizations to request that more data be collected to find evidence-based solutions.
- Advocacy - Consider reaching out to your local, state or national leaders to support legislation that fosters safe healthcare workspaces. AACN supports H.R. 1195/S4182, the Workplace Violence Prevention for Health Care and Social Service Workers Act. Also, the American Nurses Association has a website dedicated to workplace violence that details national- and state-level efforts.
- Report Your Experiences - Speak up if you experience an incident or witness violence against someone else. Report these incidents to your leadership, and document them according to your facility's policy. Press charges if you are assaulted, and support your nurse colleagues in doing the same. Consider filing complaints with national and state organizations that monitor workplace safety:
- Support Yourself and Your Colleagues - Workplace violence has a negative impact on your physical and mental health. Make sure to take care of yourself and support your colleagues when you can.
The Struggle Continues
The effort to end violence in healthcare workplaces is long-term work. Sadly, we all carry memories of close calls and terrible experiences — and we all do the best we can to stay safe.
Over the course of my 11-year career as a direct-care emergency department nurse, I've personally experienced workplace violence and harassment, and have seen my colleagues physically attacked, sexually harassed, threatened and verbally abused. Unexpected violence can come from patients, visitors and even co-workers. This situation has gone on for far too long.
AACN has stated that it is ultimately the responsibility of each healthcare organization to prevent workplace violence. Yet, there are many things healthcare workers can do. As a nurse, I feel that each of us can make a difference by reporting our experiences, sharing resources and advocating for safer work spaces for all healthcare professionals. The struggle for safer healthcare workplaces continues, and a shared approach will make it easier for all.
- Read: "AACN Position Statement: Preventing Violence Against Healthcare Workers"
- Read: AACN Standards for Establishing and Sustaining Healthy Work Environments
- Refer to an AACN webinar: "Protect Yourself: Prepare for and Prevent Workplace Violence"
- Get help with this toolkit: AONL & ENA Toolkit for Mitigating Violence in the Workplace
- Review the United States Dept. of Safety - Occupational Safety and Health Administration (OSHA): "Worker Safety in Hospitals: Caring for Our Caregivers"
- Check out The Joint Commission: Workplace Violence Prevention Resources
- Review: NIOSH Violence Occupational Hazards in Hospitals
- Learn more about the No Silence on ED Violence Campaign
- Read about the International Committee of the Red Cross COVID-19 & Violence Against Health Care: "Safer COVID-19 Response: Checklist for Health-Care Services"
What are your suggestions on ways to make healthcare workplaces safer?