Are nurses and health care workers facing more on-the-job violence?

March 14th, 2011 by Julie Ferguson

If you asked the average person to list professions with the highest rates of violent assault, few would put health care professionals high up on that list. But the reality is that when it comes to workplace violence, nurses, nursing aids, and paramedics have the dubious distinction of being very high up on the list; only police and correctional officers suffer a higher rate of on-the-job assaults. And many nurses say that the violence is only getting worse.
In a fact sheet on violence, The International Council of Nurses, a federation of more than 130 national nurses associations representing the millions of nurses worldwide, says that:

  • Health care workers are more likely to be attacked at work than prison guards or police officers.
  • Nurses are the health care workers most at risk, with female nurses considered the most vulnerable.
  • General patient rooms have replaced psychiatric units at the second most frequent area for assaults.
  • Physical assault is almost exclusively perpetrated by patients.
  • 97% of nurse respondents to a UK survey knew a nurse who had been physically assaulted during the past year.
  • 72% of nurses don’t feel safe from assault in their workplace.
  • Up to 95% of nurses reported having been bullied at work.
  • Up to 75% of nurses reported having been subjected to sexual harassment at work.

Last fall, the issue of safety for nurses and allied health professional was brought to the forefront after the deaths of two California healthcare workers in separate incidents. In October, psychiatric technician Donna Gross was strangled to death and robbed at Napa State Hospital. Days later, nurse Cynthia Barraca Palomata died after being assaulted by an inmate at Contra Costa County’s correctional facility in Martinez. The deaths have sparked a new push for better security and stronger worker safeguards, particularly in settings treating prisoners and psychiatric patients.
While the occupational danger in environments like prisons and psychiatric hospitals is recognized and real, these are hardly the only high-hazard settings in which nurses work. Hospital emergency rooms are widely recognized as a hazardous environment, but violence occurs in other wards, too. Last year, the Well, a NY Times healthcare blog, featured an article by RN Theresa Brown entitled Violence on the Oncology Ward. And the CDC recently spotlighted research focusing on an increase in assaults on nursing assistants in nursing homes. In that study, 35% of nursing assistants reported physical injuries resulting from aggression by residents, and 12% reported experiencing a human bite during the year before the interview. There are no healthcare settings that are immune. Assaults routinely occur in general hospitals, in health clinics, and in patients’ homes.
The perpetrators of violence are varied: While many assaults are by patients, friend and family members of patients also can commit the assaults. There are also rapists or muggers who are targeting healthcare settings or solitary workers; drug addicts and robbers, who are looking for medications; and domestic violence brought into the workplace. And it’s unclear why violence is on the rise. Many point to staff shortages. Others see the preponderance of alcohol, drugs, and ready access to weapons as contributing factors; others think that hospital administrators do too little in the area of prevention.
Some are seeking legislative relief that would require hospitals and healthcare facilities to have safety and security plans and training in place. In a posting on, respected physician Kevin Pho suggests that the rising tide of violence against healthcare workers might be emblematic of a dysfunctional health system, where healthcare is viewed as a commodity, and the caregiver-patient relationship is deteriorating. He says:

“Sometimes the simplest approaches are the most effective. Rather than adding security or installing metal detectors to prevent hospital violence, doctors and nurses could do a better job of empathizing with patients who are under stress when they are hospitalized or are angry because they’ve waited hours for medical care. At the same time, patients must realize that health care professionals are doing the best they can with an overtaxed health care system and should never resort to violence or abuse.”

In HealthLeaders Media, John Commins discusses an innovative approach undertaken by the University of Wisconsin Hospital and Clinics – a program to codify risk of hospital violence.
Recently, the Emergency Nurses Association issued a Workplace Violence Toolkit, targeted specifically at emergency department managers or designated team leaders.

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