Violence in the Workplace: What’s Being Done to Protect our Nation’s Healthcare Workforce

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Reviewed by Abbie Jacobs, RN, BSN

Workplace violence can occur anywhere. However, a number of studies have found that workers who provide services that involve a great deal of contact with the public are at a greater risk of encountering violence in the workplace. The U.S. Department of Labor, Occupational Safety and Health Administration (OSHA) identifies healthcare workers – including nurses, social workers, and psychiatric evaluators – as being one of the most at-risk groups.

Research conducted by the US Bureau of Labor Statistics (BLS) revealed similar findings showing that healthcare workers experience some of the highest rates of workplace violence when compared to all other professional categories. In fact, the BLS found that nearly 70 percent of all nonfatal workplace assaults were perpetrated against healthcare workers.

A December 2014 Scientific American article referred to the rise in violence against healthcare workers as nothing short of an epidemic, citing a 2014 Journal of Emergency Nursing survey, which found that almost 80 percent of nurses reported being attacked while at work in the past 12 months.

What are we doing to protect our country’s healthcare workforce, and what more can be done?

Workplace Violence Among Healthcare Workers: What to Know

Workplace violence is a fairly broad term, although the National Institute for Occupational Safety and Health (NIOSH) defines it as any “violent act directed toward persons at work or duty.” This may include:

  • Acts of aggression
  • Physical assault
  • Threatening behaviors
  • Behaviors that cause emotional or physical harm

In the healthcare environment, violence against workers refers to a broad spectrum of behaviors perpetrated by patients, visitors, or coworkers that threaten a staff member’s personal safety.

There’s little question that workplace violence against healthcare workers remains a pervasive problem. For example, the Emergency Nurses Association (ENA) published a landmark study in 2009 detailing the experiences of emergency nurses who encountered violent incidents in U.S. emergency departments. The ENA found that of the 3,465 nurses surveyed:

  • About 25 percent experienced more than 20 acts of physical violence in the previous three years
  • Nearly 20 percent reported encountering verbal abuse more than 200 times in the previous three years

The study also found that many respondents failed to report episodes of verbal abuse and/or physical violence out of fear of retaliation and/or lack of support from their employer.

In addition to causing physical and/or emotional harm to healthcare workers, a number of negative consequences may result from workplace violence:

  • Healthcare workers may need time off or leave due to injury or the threat of injury, leaving healthcare facilities persistently understaffed.
  • Healthcare employers may face significant liability and litigation costs.

Putting an End to Workplace Violence

There are a number of actions healthcare workers, employers, and legislative bodies can do to stop workplace violence:

Healthcare Workers

Incident reporting remains the single most effective tool healthcare workers can use to put an end to workplace violence. Underreporting remains a chronic problem, and it often plays a large role in exacerbating the problem. Reporting workplace violence raises awareness and shines a light on potential or existing problems. It also puts positive changes in place regarding practices, policies, and legislation and can stop the violence from occurring again.

Reporting must encompass all incidents involving threats, intimidation, assault, stalking, harassment, and physical/emotional harm.


Employers must remain vigilant regarding workplace violence. According to Stop Healthcare Violence, a grassroots organization created to stop assaults on healthcare workers, employers should document all reports of workplace violence and raise awareness of the topic in the workplace by:

  • Instituting a zero-tolerance policy regarding workplace violence
  • Establishing and implementing a workplace violence prevention and training program
  • Ensuring all healthcare workers understand the policies regarding workplace violence
  • Ensuring all healthcare workers understand that all claims of workplace violence will be promptly investigated and remedied

Employers should also assess their worksites and identify methods for reducing the likelihood of incidents. In addition to implementing a workplace violence prevention program, OSHA recommends that employers consider administrative controls and employee training.

Legislative Bodies

Legislative bodies take steps to help prevent workplace violence against healthcare workers by enacting laws, but the protections currently in place vary significantly from one state to the next.

For example, some states – including Arizona, Ohio, North Carolina, and Florida – have sweeping laws with harsh penalties for those that perpetrate assaults on healthcare workers, while other state laws tend to be less proactive in establishing laws and less punitive when enforcing them. For example, penalties in Louisiana apply only to emergency room personnel, while in Kansas, penalties apply only to mental health personnel.

Some states – including Washington State, Oregon, California, and Illinois – have made significant strides to put an end to workplace violence by requiring that employers implement workplace violence prevention programs, although this is limited to public sector employers only. On the other hand, Texas, Kentucky, Pennsylvania, and Maine currently have no programs or laws in place to protect healthcare workers.

Advocating for Change                                    

The Occupational Safety and Health Administration (OSHA) issues guidelines for violence-prevention programs. Additionally, a number of professional associations at the state and national levels, including the American Association of Critical-Care Nurses, the American Psychiatric Nurses Association, and the Society of Trauma Nurses, support and lobby for federal workplace standards and legislative and regulatory protections.

The organization, Stop Healthcare Violence, created by three career nurses that experienced assault in the workplace, provides a number of services for both healthcare workers and healthcare employers:

  • Education and outreach programs, including individual/group consultations, speaking engagements, and presentations
  • Education and guidance on the legal process and on how to file criminal charges
  • Lobbying for legislative change