Opinion | Time to Stop Violence in the Healthcare Work Environment

Earlier this month, Patient Safety Awareness Week called on patients as well as healthcare providers to remain vigilant in preventing avoidable medical errors that occur in hospitals and other healthcare facilities. I’d like to call attention to a different but no less threatening safety issue – the recent surge in violence in the healthcare workspace.

Hospitals routinely deal with emotionally charged situations that can trigger violent responses from patients, visitors and even staff members. Healthcare workers often bear the brunt of these responses, and surveys show that the highest number of assaults occur in psychiatric units, emergency departments, and pediatric units. In the spring of 2020, a Bureau of Labor Statistics report revealed that healthcare workers’ risk of injury due to workplace violence was five times greater than that of workers in other industries during the period from 2011 to 2018.

We now know that, as the onset of the COVID-19 pandemic compounded stress levels in healthcare facilities, the incidence of verbal and physical abuse of healthcare workers by patients and family members rose precipitously:

• According to the American Hospital Association, 44% of nurses reported an uptick in physical violence since 2020; 68% reported an increase in verbal abuse.
• An American College of Emergency Physicians 2022 survey of more than 30,000 emergency physicians reported that violence rose 24% compared with a similar survey in 2018.
• A National Nurses United survey of nearly 1,000 nurses in 48 states and the District of Columbia regarding recent (January 1, 2023-December 31, 2023) experiences of workplace violence showed that 81.6% experienced at least one type of workplace violence in the previous year, and 45.5% reported an increase in violence on their unit. Types of violence reported included verbal threats (57.8%), physically threatening events (38.7%), and being pinched or scratched (37.3%).
• A 2022 Press Ganey survey estimated that two nurses are assaulted every hour; such incidents have been associated with long-term mental and emotional consequences (e.g., post-traumatic stress disorder).

Headlining a recent article was a particularly chilling statement from a Philadelphia nurse; “I went home with blood all over me.” Noting that violence at Philadelphia hospitals is a “microcosm of a nationwide pattern,” author Aubrey Whelan put a “face” on the violence experienced routinely by healthcare workers. Between January 2022 and early December 2023, the city’s four major trauma centers collectively reported 85 assaults involving hospital staff; however, the number of hospital safety incidents reported to local police is likely a gross underestimation of the number and frequency of assaults on healthcare workers.

Some of Philadelphia’s large hospitals have made progress in addressing workplace violence by: enacting additional security measures (e.g., metal detectors at entrances to buildings, cameras in parking lots, additional security officers who circulate regularly in patient areas), and providing staff training on tactics to de-escalate potentially violent encounters with patients and visitors. However, in the absence of federal laws protecting healthcare employees from assaults and intimidation, most facilities’ options are limited.

In Pennsylvania, as in many other states, healthcare professional organizations, hospital administrators, and staff are pressing for federal legislation that would protect workers from violence in much the same way as existing laws criminalize such acts against airline employees. Two proposals are in the works:

The bipartisan Safety From Violence for Healthcare Employees (SAVE) Act introduced last year by Rep. Larry Bucshon, MD (R-Ind.), and Rep. Madeleine Dean (D-Pa.) includes protections similar to those adopted for aircraft and airport employees, along with stiff penalties for offenders. The bill would also authorize $25 million per year (2023-2032) in funding for grants to: train employees in de-escalation techniques, facilitate coordination with state and local law enforcement, and provide security technology (e.g., video surveillance, metal detectors).

The Workplace Violence Prevention for Health Care and Social Service Workers Act, introduced in the Senate by Sen. Tammy Baldwin (D-Wis.) and in the House by Rep. Joe Courtney (D-Conn.), aims to protect nurses and other healthcare workers and their patients from workplace violence by mandating the federal Occupational Safety and Health Administration to develop a standard requiring social service employers to create, implement, and maintain effective workplace violence prevention plans. The proposed act would make intentional assault of a hospital worker a federal crime and provide grants to hospitals for improving security at their facilities.

Ensuring the safety of healthcare workers should be a priority for every facility in every community and state. I propose that we all unite in support of these important, potentially life-saving pieces of legislation!

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