Violence Against Nurses: The Silent Epidemic

Recent data from the U.S. Bureau of Labor Statistics showed that health care workers and those who work in social assistance are five times more likely to experience workplace violence than other workers. Unfortunately, many experienced nurses have spent decades dealing with abusive language, threats and violence, viewing it as part of the job. But organizations, like the American Nurses Association, are actively fighting back, demanding more from health care facilities and state legislation.

“This issue took center stage throughout the pandemic, making the public more aware of the threats facing health care employees, but the problem has been present long before COVID-19 was part of the equation,” said Lisa Strader, Senior Medical Manager at Safety National. “It’s not just enough that nurses are trained on escaping a violent encounter, but facilities need to have prevention standards to protect their employees, especially with staffing shortages being another major concern.”

Why does reporting impact action?

Effective research and regulatory action to prevent further violent acts require a clear picture of what is actually happening. However, many health care workers choose not to report for fear of retaliation, lack of a reporting process and a belief that it will not change anything. While hospitals are consistently listed as some of the most dangerous workplaces in the country, better reporting could change that by identifying what locations and what departments require better mitigation efforts. The U.S. does not currently have a standardized process for reporting, so each facility has its own set of policies and procedures. This fragmented system narrows the scope for researchers to truly understand the problem and makes it increasingly difficult to collect all available data.

What progress has been made in legislation?

H.R. 1195, known as the Workplace Violence Prevention for Health Care and Social Service Workers Act, would require the Secretary of Labor to create enforceable safety standards, which shall be at minimum based on the Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers published by OSHA, and health care and social service employers to enact comprehensive workplace violence prevention plans to protect personnel. Additionally, employers would need to investigate all incidents and risks, meet record keeping requirements, and prohibit acts of discrimination or retaliation against employees for reporting violent incidents, threats or concerns. The House passed H.R. 1195 in 2021 and it is currently in review by the Senate Committee on Health, Education, Labor and Pensions.

How can health care institutions help?

Most hospitals have implemented procedures to prevent and respond to violence, but a 2020 systematic review titled, Workplace Violence Against Nurses and the Role of Human Resource Management (HRM), concluded that hospital HRM worldwide lacks effective practices to prevent violence in the workplace and mitigate its effects on nurses’ mental health. The American Association of Critical-Care Nurses suggests that facilities start by:

• Educating staff on recognizing, preventing and responding to incidents
• Establishing a clear and consistent reporting structure
• Evaluating staffing and patient classification systems that could increase or reduce the risk of violence
• Ensuring reliable security systems, including alarms, emergency response and security personnel

Hospitals also benefit from retaining nurses when the estimated cost is $27,000 to $103,000 to replace a nurse. This cost includes separation, recruiting, hiring, orientation, and training. Some estimates also account for lost productivity while hiring and training a replacement.