As a clinician in inpatient cardiovascular and acute care nursing and as a healthcare administrator, like many of my colleagues across the nation, I have encountered many violent situations in the workplace. Healthcare workers account for 73% of all violence-related nonfatal workplace injuries and illnesses, and nurses bear the brunt of that statistic, with 44% reporting physical violence and 68% reporting verbal. In fact, in 2022, more than two nurses were assaulted every hour. The rate of violence-related injuries is higher in health care than in all other occupational settings. But data often reflects reported incidents of violence. Its true prevalence is likely much higher because workers may believe that violence is part of the job and don’t report events, and not all events cause an injury.

Scott S. Christensen, DNP, MBA, ARPN, ACNP-BC, is senior nursing director at the University of Utah Hospitals and Clinics and a PhD candidate and adjunct assistant professor in the College of Nursing at the University of Utah, both in Salt Lake City.
Scott S. Christensen, DNP, MBA, ARPN, ACNP-BC, is senior nursing director at the University of Utah Hospitals and Clinics and a PhD candidate and adjunct assistant professor in the College of Nursing at the University of Utah, both in Salt Lake City.

Several factors increase healthcare workers’ risk of encountering violence. Some are related to the physical environment, including congested clinical areas, long wait times, poor lighting, limited escape routes, understaffing, and workers interacting with patients alone. Other factors involve healthcare workers’ skills in handling violent patients, and patients may be a risk factor themselves if they have a history of violence or are in an altered mental state. The COVID-19 pandemic exacerbated pre-existing risk factors and caused new ones: Increased mental illness, scarce resources, pandemic regulations and misinformation, and overall fatigue all led to significant rises in healthcare violence.

How to Protect Yourself and Your Patients

Nurses’ personal safety starts with the things we do before interacting with a patient. My colleague Chris Snyder, health security manager for the University Safety Division at the University of Utah in Salt Lake City, advises that nurses must “know before you go,” meaning that we should use background information to prepare before visiting a patient. Some simple questions to answer before meeting a patient include:

  • What is their history?
  • Why are they receiving care?
  • Have they been disruptive during a previous visit?
  • If not, is there any reason to suspect that they might misbehave?

Upon entering a patient’s room, Snyder tells nurses to activate our situational awareness. I think of this concept as “channeling your inner Jason Borne.” Quickly scan the environment and note details like where the exits are, any trip hazards, and items the patient could weaponize. Be mindful of the patient’s body language and yours as well. Finally, Snyder advises nurses to trust their intuition and take precautions if something doesn’t feel right.

Nurses also need to know that it is okay to leave when a patient or caregiver becomes violent. Sometimes we stay because we don’t want the patient to hurt themselves or leave their room, but if you’re worried about your safety, leave the space and get help. Getting help from someone who can assist with de-escalation, such as a security officer or lead shift worker, is crucial. The University of Utah Health Hospitals and Clinics has resources to support de-escalation, such as a number to call for help from trained experts.

Programs and Policies Promote Safer Workplaces

To address the problem systemically, healthcare institutions must clearly define what violence looks like and how employees should respond and establish a zero-tolerance policy toward workplace violence. They can then develop and promote the use of resources for reporting violence. One reason nurses cite for failing to report violence at work is because they believe their employer won’t do anything about it or may even retaliate against them. Combating those fears by fostering a culture of safety and reporting can be very beneficial.

As a healthcare administrator, I helped to design and pilot a nonviolent patient de-escalation program for our nursing department. Investing in programs that promote nonviolent de-escalation is a critical step for institutions, such as implementing behavioral emergency response teams. At the same time, employees may need safety training beyond nonviolent de-escalation techniques, such as how to break holds or safely restrain an escalating patient. National programs are available to support training, such as those through the Crisis Prevention Institute and MOAB® Training International, Inc.

The most important ways that nurses can contribute are being mindful of their safety, reporting when they experience violence, and working with their leaders to help prevent violence in nursing. We cannot accept violence as a normal part of our job, but together we change our workplace culture.