‘Epidemic’ of Violence Against Healthcare Workers Continues

• Violence against healthcare workers has continued into the new year, despite legislation aimed at prevention. 
• The healthcare and social assistance industry is most affected by workplace violence, according to the most recent U.S. Bureau of Labor Statistics data. 
• The Occupational Safety and Health Administration was expected to propose new rules in December related to violence against healthcare workers. 

Just days into the new year, a nurse in North Carolina was allegedly attacked by a patient, who has since been charged with assault on emergency personnel. 

“Anyone can look at the news and get the sense that workplace violence against healthcare workers is on the rise,” Jasmin Orange, BSN, RN, CCRN, said in a recent conversation with the American Association of Critical-Care Nurses. “It’s an epidemic in our field, and it’s something that’s going to take a big team and a strong voice to combat.” 

Between 2021 and 2022, healthcare and social assistance were most affected by workplace violence, with nearly 42,000 nonfatal cases, according to the U.S. Bureau of Labor Statistics (BLS). 

Workplace Violence Against Healthcare Workers Legislation

The North Carolina attack occurred mere months after a state law that requires a police officer to be stationed in hospital emergency departments went into effect. Moore County Hospital’s FirstHealth said in a statement to ABC 11 that a public safety officer was in the department and responded immediately. 

However, North Carolina Nurses Association CEO Tina Gordon said the attack is “yet another example of a worsening trend of violence against nurses.” 

“Violence is not simply ‘part of the job,’ nor should it even be a reasonable concern,” Gordon said. “Nurses have every right to be angry that these types of incidents have become all too common — often without any consequences. We are grateful that law enforcement is pursuing a felony in this case.” 

Bolstering Gordon’s view is BLS data that shows incidents of nonfatal violence against healthcare and social assistance workers accounted for 72.8% of all private industry cases between 2021 and 2022. 

Earlier this year, Ohio Gov. Mike DeWine signed into law the Healthcare Workplace Safety Act, which requires hospitals to have a violence prevention security plan and an incident reporting system. Rick Lucas, BSN, RN, CCRN, ONA President and Executive Director said in a statement that the law is an “important step” toward safer workplaces. 

“While more must be done to ensure healthcare providers can focus on delivering quality care without the constant threat of violence, this victory is a reminder of what we can accomplish when nurses and health professionals unite and use their collective voice,” he said.

Non-Legislative Methods to Combat Workplace Violence 

In addition to legislative advocacy, nurses are also taking the matter into their own hands. Orange, for instance, was involved in piloting use of the Dynamic Appraisal of Situational Aggression (DASA), which she said screen patients on seven behaviors. Patients who are determined to meet criteria for more than three of the behaviors are considered “high risk” for aggression. 

“Once a nurse realizes a patient is at high risk for aggression, we develop a care plan,” she said. “We flag the patient in our electronic medical record, so anyone who accesses the record knows this patient is potentially violent. From that flagging, they’re also referred to the Interdisciplinary Plan of Care (IPOC), which has interventions tailored to keep nurses safe.” 

However, she noted that DASA is not meant to be used in isolation. 

At an industrywide level, the Occupational Safety and Health Administration (OSHA) was expected to propose a new rule in December related to workplace violence in healthcare settings. The rule could include the following criteria: 

• Develop and implement a written workplace violence prevention program. 
• Perform regular hazard assessments. 
• Implement controls to mitigate the hazards identified. 
• Train and educate all staff members on potential hazards and how to protect themselves and their co-workers. 
• Maintain a specific workplace violence recordkeeping log and perform incident investigation procedures. 
• Inform employees of their rights to the protections under the new rule. 

The American Nurses Association (ANA) has created the #EndNurseAbuse campaign to advocate for “enforceable federal standards” related to violence in healthcare settings. 

“Though useful in the most egregious cases, OSHA’s general authority leaves healthcare employers without needed clarity on expectations for reducing risks of workplace violence,” the ANA stated. 

The Bottom Line

U.S. Bureau of Labor Statistics data shows healthcare is the leading industry for nonfatal workplace violence. Some states, like North Carolina and Ohio, have enacted legislation to help support the healthcare industry. However, nurse leaders and advocacy groups believe more can be done to protect workers. 

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