What You Can Do to Address Workplace Violence in Nursing

Have you felt unsafe while taking care of a patient or interacting with family members? Maybe you’ve heard of a coworker who was assaulted at work, and now you feel scared for your own safety. Physical, verbal, and sexual violence against nurses has been on the rise, and some scholars even call it a pandemic. Workplace violence in nursing increases stress, burnout, and fear. What can individual nurses like you do about this problem?

You’ve got a lot to deal with during your shift. Passing medications, performing assessments, charting, and communicating with the medical team is more than enough to keep you busy. You shouldn’t have to think about your safety on top of these responsibilities. But the reality is that between 44.4% and 67.8% of nurses experience physical violence at work, and the rates of verbal violence are likely much higher.

It’s not fair that you have to worry about protecting yourself and your coworkers. But learning about ways to stay safe can help you empower yourself at work, and help you feel confident speaking up when you need to.

What Is Workplace Violence in Nursing?

Workplace violence is any harmful act committed against nurses in the workplace by a patient, visitor, or coworker. The CDC details four types of workplace violence:

1. Criminal intent: The perpetrator has no legitimate reason to be at your facility and is committing a crime in conjunction with violence. For example, an assault in a hospital parking garage. This is less common in healthcare settings than other types of violence.

2. Patient violence: This is the most common form of violence against nurses, and happens when a patient or family member verbally, physically, or sexually assaults a nurse. This happens most frequently in psychiatric and emergency settings, waiting rooms, and geriatric care, although it can happen anywhere.

3. Lateral violence: A deliberate and harmful behavior from one employee against another. This may include bullying, harassment, or humiliation, and is most commonly directed at coworkers who are considered “lower on the food chain.” It can also occur between peers.

4. Personal relationship: This is when a person with a relationship with a nurse comes to their place of work with violent intent. This is not as common as patient or lateral violence.

If you’ve experienced one or more of these forms of workplace violence, you’re not alone. Unfortunately, healthcare workers are five times as likely to experience workplace violence as workers in other fields. But why is that?

Causes of Workplace Violence in Nursing

The first thing you should know about nurse abuse is that it’s not your fault. Experts have posited a few reasons violence against nurses has risen:

• The COVID-19 spotlight: Nurses and other healthcare workers have long been dealing with violence at work. Pre-pandemic, healthcare workers accounted for 73% of all nonfatal workplace violence incidents. The pandemic put healthcare under a magnifying glass, leading to an increase in public knowledge of this problem.
• Facility priorities: Hospital restructuring, as well as short-staffing amidst the pandemic, led to unsafe conditions in hospitals and other facilities. Lack of planning and response to the pandemic meant that frontline workers were left with few resources to deal with systemic healthcare problems.
• Enforcement failures: Unfortunately, some facilities failed to protect healthcare workers during the pandemic, and may still fail to prevent workplace violence. Nurses may be asked to overlook a patient’s behavior to do their jobs, and a lack of enforcement has allowed bad behaviors to continue unchecked.

The Impact of Workplace Violence on Nurses

Some of the consequences of workplace violence in nursing are obvious — no one wants to feel unsafe at work. Violence against nursing professionals also has downstream effects that are system-wide, impacting everyone who works in or seeks medical care.

Effects on Individuals

• Temporary and/or permanent disabilities
• Avoiding work or being unable to return to work
• Post-traumatic stress disorder
• Low morale and burnout
• Lack of trust in management
• Increased job stress
• Family turmoil
• Financial impact from medical bills and/or being unable to work
• Emotional and psychological trauma from witnessing violence

Effects on the Healthcare System

• Increased turnover
• Compromised patient safety and quality of care
• Financial loss
• Reduced productivity
• Increased potential for medical errors and adverse events

How to Prevent Workplace Violence in Nursing: 5 Things You Can Do

You have the right to feel safe at work. It’s not fair that you have to worry about your safety while caring for patients. It’s your employer’s responsibility to protect you at work, but there are things you can do to protect yourself and your coworkers.

1. Take De-Escalation Training

Enrolling in a course or class on de-escalation can help you prevent violence at work. De-escalation training has been shown to reduce the incidence and severity of aggression in patients. Sometimes called talk-down, conflict management, or defusing, these skills can help you mediate problems with patients and families before they turn violent. De-escalation courses help you respond to stressful situations with skills like:

• Using nonconfrontation communication.
• Responding with respect and authenticity.
• Nonthreatening body language.
• Boundary setting.
• Remaining calm.

2. Plan to Protect

If a patient has a history of aggressive behavior, plan accordingly. This history should be included in the chart as a warning to other healthcare providers. Ways to plan to protect yourself and other staff include:

• Sharing history of patient violence in reports and at shift change so that everyone on the unit is aware.
• Alerting security if a patient has displayed alarming behavior.
• Partnering with another nurse or nurse aide when entering a patient’s room.
• Keeping the patient’s door or curtain open when possible, and having another staff member in the room for procedures.
• Switching up assignments or sharing a patient if they’ve shown aggression towards a specific staff member.
• Using alarm systems, which may help deter potential violence.

3. See It, Report It (Repeatedly, If Necessary)

Despite the high rates of workplace violence in nursing, experts believe that these statistics are low due to underreporting. If you experience or see someone else experience violence at work, report the problem up the chain of command until it is formally addressed. Reporting measures may include:

• Documenting the incident thoroughly, including who was there, what happened, the time, and any precipitating incidents. This can be included in the patient’s chart if you feel comfortable, and/or in an email.
• Telling your supervisor, and, if nothing happens, tell their supervisor. They should also report the incident to security. Follow this chain of command until action is taken:
  • Charge nurse
  • Clinical supervisor
  • Unit manager
  • Assistant director of nursing
  • Director of nursing
  • Head of medical services
  • Facility administrator

• Reporting the incident to the police to make a formal charge. In many states, it’s a felony to assault a healthcare worker, and you may be entitled to compensation.

4. Support Your Teammates

While some nurses tend to accept workplace incivility from other nurses as part of the job, it shouldn’t be this way. Creating a positive work culture is everyone’s job, and can help prevent bullying at work. When you feel comfortable with your teammates, you all feel safer. Here’s how you can address lateral violence on your unit:

• Speak up when you see it happen.
• Don’t be a safe space for harassment.
• Voice your boundaries.
• Report bullying behavior to your supervisor.

For more details about lateral violence and what you can do about it, see our guide on incivility in nursing.

5. Advocate for Protective Legislation and Policies

Advocacy is a core value in nursing professionalism, and it’s one way you can contribute to better safety for nurses. Changes in state policy and hospital rules can help punish workplace violence in nursing at the system level, and your actions can help move these changes forward.

For example, Mass General Brigham implemented a new patient code of conduct in 2022, which explicitly states that patients who violate the code may be asked to make other plans for their nonemergent care. Several other hospital systems across the country have implemented similar programs, pushed forward by nurse advocacy groups. There are currently no federal protections for healthcare workers, but your action could help change that.

If you’re interested in advocating to prevent violence against nurses, check out one or more of these groups:

• National Nurses United
• The American Nurses Association
• Your hospital’s shared governance organizations

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Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.