Violence Against Healthcare Staff in the Workplace

Violence -in -the -workplace

As a society, we seem to be less civil. Violence against healthcare staff in the workplace is on the rise.  I have been in the healthcare field for more than 40 years.  I started as a unit secretary and worked my way up until I became an RN.  During my career I have worked OR, ER, Med surge, Hospice, Forensic nursing in the county jail, and case managed Developmentally Disabled Adults. It seems that you hear more and more of mistreatment of healthcare staff.

Over the years I have had my share of injuries from working with patients.  The worst of these was a back injury from a patient fighting me when trying to transfer from her car.  That injury resulted in back surgery for a blown disc and a workers comp file.

As nurses, it is too easy for us to think that it is just “part of the job”.  My patient didn’t mean to hurt me but her mental state didn’t help the situation and prevented understanding that we were trying to help her.

Violence against Healthcare staff is Nothing New

Violence and abuse of healthcare workers are not new phenomena.  Recent studies published by OEM (Occupational & Environmental Medicine) show staggering rates of verbal and physical abuse.  Many nurses feel that violence is increasing but the reports do not support that evidence.

I personally think that unless it is a serious event we tend to not report it.  How many times have you been called awful names?  How many times has someone high on an unknown substance tried to kick you or swing at you?  Do you take time out of a busy day to file the paperwork and report the incident?

Sadly it is not just patients and their families.  While working in the OR during an intense case,  the doctor smacked my knuckles with a hemostat.  In the “old days” there were doctors got away with being verbally abusive.

Verbal Abuse is Non-physical Violence

It seems to me that society is more accepting of what used to be known as foul language.  We have become less civil in the way we talk to one another.  People seem to be less respectful of each other.  We are living in the era of PC and no one wants to speak up.

Just because everyone does it does not take away the fact that it is a form of non-physical violence.  Health care workers tend to report this even less than physical violence in the workplace.  This type of abuse still has a negative consequence and needs to be reported. So why are we not reporting it?  The amount of time and paperwork is not worth it to report.  We just expect our patients and co-workers to act rude and verbally abusive.  It goes with the job.

These reports suggest that violence may not be identified as a problem until there is a Sentinel Incident with casualties. Why so much attention now? The answer is a complex one with several complex issues.


It is believed that the risk of verbal and physical abuse is increasing in many healthcare settings.  A nursing assistant working in a nursing home is the most assaulted US worker.  Many report weekly and some daily abuse by elderly patients.  Generally, those with dementia are the most difficult patients to manage.  As baby boomers age the numbers of elderly in long term care will increase.

Another area of concern is the emergency department where employees report that they rarely feel safe from patients and visitors.  There was a time when the most worry was from some random person wanting to rob the ED of controlled substances.  Today staff in the ED believe there is a higher risk of abuse due:

  • increasing drug and alcohol use of patients and visitors
  • presence of weapons
  • poor coping skills of patients and visitors
  • long wait times
  • the increasing number of patients with psychosis and dementia
  • the heightened level of community violence follows into the ED
  • wearing a badge or uniform could make you a target for someone looking for money, drugs or drug paraphernalia.

  Anxiety and frustration loss of control over long wait times and the high cost of care may be the underlying cause for a violent reaction.  Fragmented services, understaffed and frustrated workers in healthcare facilities can also lead to a threatening situation.


Media attention to so an increase in school and workplace violence/shootings has raised the consciousness of the public.  A popular phrase for a while was “going postal” after several incidents with postal workers becoming hostile at work.

Even as the public focuses on work environments where violence has occurred healthcare has not been included. While the media focuses elsewhere OSHA  has been writing safety prevention guidelines.  Many facilities now include Active Shooter training as a part of their ongoing effort to reduce the effects of violence in the workplace.

Even with all of the attention and increased guidelines, violence for healthcare workers remains high.  Further research on workplace violence specific to healthcare is needed to try and reduce the number of incidents.


Shockingly one study shows that much of the violence encountered by healthcare workers is reported from co-workers and managers. Non-physical and physical violence is increasingly recognized as an effect of decreased job satisfaction, occupational strain, and poor patient care outcomes.  The consequences of non-physical violence are high turnover rate.

Non-physical violence can be at the hands of visitors, co-workers, managers, and physicians.  Staff frequently find complaints of verbal and physical sexual harassment by physicians are tolerated.  Management turns a blind eye because of substantial income from their referrals.

Similar concerns for nursing home facilities when nurse aides report violent behavior from relatives due to administrations pressure to keep beds filled.  This type of violence would not be tolerated in other workplaces.  Violence in healthcare settings should be dealt with so that these environments will become safer, more civil, and desirable places to work. The shortage of healthcare staff may not improve until the abusive culture is addressed.


As more information is published both on paper and social media, more healthcare staff will recognize violence is a problem that needs to be dealt with.  These types of abuse are not just “part of the job”.  Eliminating all violence from patients may never be accomplished.  Non-intentional verbal and physical assaults from patients with psychosis or dementia are inherent in the job.

Coping with this type of violence requires support from administration and coworkers. This type of violence is traumatic and the needs organizational awareness.  The administration should implement plans that protect the staff.

Workers should learn that this violence is not their fault and can not always be prevented.  Blaming victims is unacceptable and certainly not beneficial for finding solutions.  As an employee, it is crucial to document violence so that prevention and management efforts can be developed and implemented.

Use of OSHA’s guidelines for preventing workplace violence is a good place to start.

# SilentNoMore

Say something and report if you have been a victim.  This is an epidemic that has consequences and as healthcare professionals, it is time to be proactive instead of reactive.   Watch this moving video found on the  ZDoggMD to see some examples of how this violence has serious consequences.

Eliminating violence against healthcare workers may never happen.  The question then is what kind and how much violence should be tolerated? OSHA per their General Duty law states the employers are liable when they know workers are at risk of harm.  The bottom line is agencies are expected to take action to decrease risk to workers.  More needs to be done.


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Cheryl Roby, RN

Cheryl J. Roby is a Registered Nurse and retired US Army Reserve Nurse Major. She has more than 30 years of nursing experience and 26 years of military experience in the Army Nurse Corp. During her nursing career, she has traveled as part of her military experience visiting many of the 50 states and to South Korea. She was trained as an Army Medic during the Vietnam era and later as an OR tec. She went on to become a Licensed Practical Nurse and then completed her nursing training as a Registered Nurse. She was then commissioned as an officer in the Army Reserves. She appreciated the challenge of working in various specialties and expanding her clinical and professional skill sets. Her time in the Army Reserves and California National Guard gave her the opportunity to travel to most of the 50 states and work in other medical facilities. During her career, she had the opportunity to work in several specialties to include, OR, Occupational Health, Hospice, Sexual Assault Team, Forensic/ Correctional Nurse, Nurse Case Manager for developmental disabilities, Parish Nursing as well as a Nurse Entrepreneur.

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