Harming the healers: violence against healthcare workers
The pervasive pandemic plaguing the medical community.
By Jennifer D’Angelo and Keith Docherty
Warning: discussion of sensitive material and some graphic imagery below.
In hospitals across the United States, healthcare workers are facing a growing threat — not from illness or infection, but from the patients they care for. The rates of workplace violence are rising at an alarming rate, and so is the toll it is taking on healthcare workers.
The Occupational Safety and Health Administration () defines workplace violence as any act or threat of harassment, intimidation, and verbal or physical violence. Reports from the have found that healthcare workers are five times more likely to suffer from a workplace violence injury than other workers overall.
For nurses who entered the profession in the wake of the COVID-19 pandemic, the challenges went far beyond clinical care. Juliet, whose last name will be withheld due to the sensitive nature of this story, is a registered nurse in New York City. When she began working in a Bronx hospital during this period, she recalled the post-pandemic reality.
“It was still kind of coming down off of COVID when I started, especially in the area that I was working in, because it was lower income… a lot of those people did not have access to primary care physicians and preventative medicine,” Juliet said.
The pandemic exacerbated pre-existing conditions like hypertension, diabetes, and mental health disorders, especially in underserved communities, leading to an overflow of complex cases in already overburdened hospital units.
Having worked in both the Bronx and the Upper East Side, Juliet noted stark contrasts in patient populations and institutional support.
“Part of working in the Bronx is that it doesn’t attract as many [healthcare professionals] as working in Manhattan does… The funds and the money that are spent to improve patient outcomes are not put to good use in communities that really need it.” Juliet said.
Initially assigned to a med-surg unit, Juliet described an unsafe working environment where critically ill patients, who should have been in intensive care, were placed on general floors due to ICU bed shortages and chronic understaffing.
“I didn’t think that it was a safe environment for me to be practicing nursing in,” Juliet said.
Eventually, Juliet moved to a telemetry stepdown unit in a different hospital, where staffing and escalation protocols were more strictly followed, allowing safer and more effective patient care.
There is currently no federal legislation that protects healthcare workers, though Congress has been pushed to enact the Safety from Violence for Healthcare Employees () Act, bipartisan legislation that grants healthcare workers federal protections from workplace violence.
Several states, including California, New York, and Illinois, have enacted legislation to protect healthcare workers from violence, including the implementation of workplace violence prevention plans, procedures for reporting incidents of violence and provided training for employees. However, Juliet explained that formal preparation in training is ultimately still lacking.
“We have yearly online modules that are kind of the same every year… I’ve never really had any formal training,” Juliet said.
Most of the skills to de-escalate dangerous situations were learned on the job. Despite the lack of formal training, Juliet has become a mentor to new grads, encouraging them to protect themselves with liability insurance and to advocate for safe staffing and legislative support.
Though hospitals have implemented protective initiatives, it does not mean they are successful in stopping the cycle of violence healthcare workers face, leaving the emotional and physical toll of workplace violence to persist.
“Well, where to begin… It’s happened so many times that it’s not even on my radar,” Juliet said, explaining experiences of being cursed at, groped, or physically attacked by patients in distress or altered mental states.
A 2022 report from the National Database of Nursing Quality Indicators () revealed that more than two nurses were assaulted every hour, amounting to approximately 57 assaults per day and 1,739 assaults per month.
One of Juliet’s earliest encounters involved a patient — injured while high on heroin — who threatened to have someone shoot up the hospital if staff didn’t allow contraband inside. In another incident, a nurse was struck over the head with a plastic lunch tray by a patient under constant observation for homicidal behavior. The hospital allegedly tried to discourage her from filing a police report.
The American College of Emergency Physicians () revealed in 2022 that 45% of physicians feel their hospitals’ responses to assaults were lackluster. The most common action of hospital administration is to mark the patient’s medical chart with a behavioral flag, which occurs in only 29% of cases. Other actions include restraining the patient or escorting them from the premises, but many physicians expressed that the most common action of hospital administration is to simply do nothing at all.
Physicians have also expressed concern over their hospital administration’s preference to appease patients and their families, rather than support the affected workers, and urged them not to pursue legal recourse to avoid harming the hospital’s reputation.
“While it is a very real part of health care, it’s still not a pretty one. For people to hear that nurses are assaulted on the job, and the hospital doesn’t do anything about it, doesn’t look good. In our healthcare system, unfortunately, their ultimate job is to make the hospital money. Bad press can lead to lower patient satisfaction, which affects patient numbers where they get funding,” Juliet said.
But beyond the medical challenges, what nurses weren’t always prepared for was the increase in aggression and violence from the very patients they were trying to help. Many, especially those battling untreated mental health or substance use disorders, were admitted under dire circumstances, but the inability to address their needs often led to erratic or violent behavior.
“They did not have access to medications like suboxone and methadone… and when you’re closed off from everyone, you’re more likely to fall into depression, suicidal tendencies, and addiction,” Juliet said.
While patient violence can occur in any hospital, institutional culture plays a crucial role in its handling.
“In the Bronx, it was much more like part of the job that you had to deal with… The language, environment, and culture that [a hospital] enforces really set the tone.” Juliet said.
In her current role, supportive management and clearly enforced boundaries have helped reduce the frequency and severity of such incidents. Yet, Juliet acknowledged that even in the best environments, systemic issues — such as delayed procedures, poor communication, or admitting patients for social rather than medical reasons — can fuel patient frustration and aggression.
Ultimately, what keeps Juliet going is the good — the grateful patients, the measurable progress, the moments that remind her why she chose this path.
“For 99% of healthcare workers, being able to see a positive impact with our work… that’s what keeps us going,” Juliet said.
nursing professor and clinician has over 20 years of experience in family and community health nursing. Over the course of her career, David has encountered instances of abuse and violence directed at healthcare workers.
“When working with developmentally disabled adults in a group home on a team of nurses, [we] were often abused, physically, verbally,” David said. “We were hit, we were spat on, we were kicked, pinched, everything.”
A survey from Medical Doctors, Value in Protection () revealed that 61% of Americans feel hassled by the current structure of the U.S. healthcare system. The agitations and apprehensions towards the healthcare system are significant contributors to violence against healthcare workers.
“People are frustrated with the health care system, and they don’t know who to lash out at other than the direct care professionals who are right in their face, who they can access readily,” David said.
As a professor of nursing, David teaches classes related to community health nursing and educates student nurses on how to handle the violence they may be subjected to once breaking into the field.
“We talk to them about it, and we tell them it’s important to be vigilant about situation events that could be predictors of a violent event occurring,” David said. “We tell them how to protect themselves from violence, from strangers as well as from their patients, how to protect themselves inside home settings, classrooms, nurses offices.”
Incidents of workplace violence directly correlate to healthcare burnout. The Agency for Healthcare Research and Quality () defines healthcare burnout as a long-term stress reaction, characterized by emotional exhaustion, depersonalization and lacking feelings of personal accomplishment.
“It causes them to have burnout, more quickly than they would. It causes them to have stress on the job knowing that it can happen. For those to whom it’s never happened, maybe they don’t have the same anxiety or angst that people who have experienced the violence would have,” David said. “They go to school for a long time, they sacrifice their families, and they give of themselves to help others and to be assaulted and to be abused is disappointing.”
Though healthcare institutions across the country are integrating protections into their policies to mitigate incidents of workplace violence, including increased security measures and stricter conduct regulations; for now, violence against healthcare workers is an issue that lies in the hearts and hands of the patients themselves.
“You can’t regulate morality,” David said. “You have to have patients who have to have an understanding that you don’t physically abuse your healthcare workers. It’s not an acceptable thing to do no matter how frustrated or angry or in pain you are.”
SUNY Brockport nursing professor and nurse practitioner practices at an urgent care, where hostility and aggression towards healthcare workers is all too common.
“I think it [aggression] occurs on a daily basis, multiple times a day in a given shift, especially in the more acute settings. I currently am a nurse practitioner in an urgent care, but if you talk about the emergency room, it happens much more frequently. It’s many times a day,” Biedlingmaier said.
The MDVIP survey also revealed that in the past five years, 51% of Americans have visited an urgent care or retail clinic, contributing to a rise in “convenience care”, as these healthcare facilities are made so readily accessible to the public. Convenience care has overcrowded urgent cares and emergency departments, leading to unthorough visits and longer wait times, which Biedlingmaier explained breeds hostility and aggression between patients and healthcare workers.
“I think our society expects instant help. We’re a generation, now that we do instant messaging, we’re used to getting what we want or need right away. The emergency department or even primary care can’t see people as timely as they used to. So, when people are not feeling well and they feel like they need help, they get grumpy pretty quickly.” Biedlingmaier said.
As a nursing professor, Biedlingmaier educates nursing students on how to approach potentially hostile patients, with compassion and clear communication at the forefront of successful patient interactions.
“We embed throughout our courses and the clinical courses to listen, to understand and not to respond or react. We really want to hear what the patients’ concerns are,” Biedlingmaier said. “And I think that a lot of times if we tell them what we can do for them instead of what we can’t do for them, it helps to bring their emotional elevation back down a bit.”
The brutality of workplace violence has made healthcare workers vulnerable to a variety of mental health issues, such as depression to anxiety, and caused many to be diagnosed with post-traumatic stress disorder ().
“I think that people who work in the higher intensity environments like the emergency department or even urgent care, I think [that] leads to fear of going to work. I’ve heard people talk about not being able to sleep. I do know of somebody who has literal PTSD diagnosis from violence,” Biedlingmaier said.
Healthcare workers do not just practice medicine; they also practice compassion and understanding for their patients as well. But violence has deprived healthcare workers of that reciprocal kindness.
“I just feel like the public needs to understand that we are managing many patients at the same time and we are doing our best to serve everybody’s needs. And we need a little compassion coming back the other way,” Biedlingmaier said.
Violence has become a pervasive pandemic plaguing healthcare workers. It is a systemic issue climbing every hospital department in rakes and vines, from the emergency room to psychiatric wards. Addressing it demands immediate action from hospital administration, lawmakers and the public, as workplace violence sharpens the once blurry reality for healthcare workers into crisp focus — safety on the job is no longer a given.