Editor’s note: Andrew Thum, is the director of nursing workforce operations at Jefferson Health in Philadelphia. He’s also a doctor of nursing practice candidate in the School of Nursing at the University of Pennsylvania, concentrating in executive leadership.
Every May, the U.S. acknowledges and honors nurses across the country with National Nurses Month. Front-line healthcare workers — in particular nurses — were hailed as healthcare heroes at the height of the COVID-19 pandemic. And Americans consistently rank nurses as the nation’s most trusted professional.
They also rank among the most likely to sustain a workplace violence injury in the U.S.
The Bureau of Labor Statistics estimates that workers in healthcare and social services are five times more likely to suffer from a workplace violence injury than workers overall. The rate increased 63% between 2011 and 2018. The most recent data available shows that 76% of all U.S. workplace violence injuries in 2020 were inflicted on healthcare workers.
The most common type of workplace violence in healthcare is committed by patients or their visitors, including family members or friends. Nurses are most at risk for this violence because their work involves more direct time with patients than any other healthcare worker. In fact, a survey conducted by the American Nurses Association in 2019 found that one in four nurses have been physically attacked.
The violence that nurses and other healthcare workers experience does not always result in injury, so these statistics only demonstrate one part of the full problem.
Verbal abuse, such as yelling, cursing, intimidation and sexual remarks, is the most common form of violence that impacts nurses, while common forms of physical assault include hitting, spitting, pushing, scratching and kicking. The rate of violence that does not result in injury is more difficult to measure and yet, it is hard to find a nurse who has not recently experienced verbal or physical violence while at work.
The impact of violence on nurses is serious. Violence prevents nurses, doctors and other professionals from providing uninterrupted, quality patient care. Encountering violence at work can result in burn out, absenteeism, turnover, workplace anxiety and depression.
Many healthcare organizations and advocacy groups stand united against workplace violence and provide wellness resources and training to staff, but it is easy to see how some nurses may perceive this as all bark and no bite. At the end of the day, intentionally violent patients, and their visitors (even repeat offenders) are still admitted to hospitals and receive care from vulnerable staff.
The consequences for perpetrators of violence in healthcare are negligible: security intervention and scolding by an administrator. If a serious physical assault occurs, then local authorities may become involved, but not frequent enough to become a true deterrent.
Acknowledging the danger that nurses face and the need for improved working conditions, the Joint Commission — an agency approved by the CMS to inspect and accredit healthcare facilities — published new standards to prevent workplace violence in January 2022. Among these standards are requirements that hospitals develop a process for continually monitoring and reporting violence, and provide violence de-escalation training to staff. While this push to formalize the accounting and management of violence at the organization level is an improvement, it is not enough.
Recognizing that policies and standards are insufficient to combat workplace violence, some states have enacted legislation to hold offenders responsible. In July 2020, then-Pennsylvania Gov. Tom Wolf signed into law a bill making assaults with a physical injury against a healthcare worker a felony instead of a misdemeanor.
In June 2022, U.S. Rep. Madeleine Dean, D.-Penn., introduced the Safety From Violence for Healthcare Employees, or SAVE Act. The bill offers the first opportunity to deliver federal legislation to combat healthcare workplace violence with consequences by establishing a new criminal offense for knowingly assaulting or intimidating hospital staff, similar to the protection afforded airline workers. The legislation also provides grants for programs to help reduce the incidence of violence.
The American Organization for Nursing Leadership, an affiliate of the American Hospital Association, is advocating for federal protection for healthcare workers this year. And since a new Congress was sworn into office in 2023, the SAVE Act will need to be reconsidered before moving forward. The passage of the bill would mark major progress by nurses and other victims of workplace violence.
More concrete actions are needed to protect healthcare staff, especially nurses, from violent patients and visitors. Often celebrated as the heart of healthcare, nurses share in some of our most vulnerable life moments. Violence should not be a part of their job. As a society, we can do a better job caring for those who care for us.