Workplace Violence Prevention Plan: How Nurses and Legislators are Taking Action

• Most nurses aren’t familiar with their employer’s workplace violence prevention plan, according to a recent study. 
• With an increase in incidents of violence against healthcare workers, both nurses and legislators are advocating for change. 
• In several reported instances of violence against nurses, the patient alleged to have committed the violence has been arrested and formally charged.  

Imagine coming to work for your shift. You’re chatting with coworkers, getting organized for your day, and you start seeing your patients. During your rounds, a patient becomes combative, grabs your stethoscope, pulls hard on it, and causes neck injury requiring hospital assessment.  

That happened to a nurse at the Grand Nursing Facility in Utica, New York, last July. The police were called, and the resident was charged with assault. The workplace violence part might sound familiar to nurses, but police arresting the patient? That’s a new one. And it’s about time.  

Nurses are not tolerating workplace violence like they used to. Nurses are speaking out, demanding change, and taking action.  

Nursing is one of the most trusted professions, and during the COVID-19 pandemic, the public had a refreshed realization of how critical nurses are. Despite this, assaults against nurses are on the rise. Nurses are leaving the bedside at an alarming rate due to personal safety concerns. Combative and disorderly patients (and sometimes their families) are not new, but the frequency of incidents is trending up.

Why is workplace violence increasing, and what is being done about it? 

Issues Contributing to Workplace Violence

One factor contributing to increased workplace violence is staffing problems. Nurses become stressed, and patients are made to wait longer, making situations more tense than necessary. Increased patient morbidity also contributes to the problem, according to the Centers for Disease Control and Prevention (CDC).  

Another factor is the lack of response from workplace administrators. One study found that most nurses were not familiar with their employer’s policy on workplace violence, and an alarming number of incidents warranted no response from administrators. Lack of programs to prevent workplace violence and insufficient protective regulations are also to blame. These workplace violence prevention plans will soon be the norm for nurses, thanks to some regulatory and legislative changes. 

A 2023 National Nurses United (NNU) survey found that eight in 10 nurses reported at least one type of workplace violence in the past year. In the same survey, close to half of the nurses reported an increase in violence in their work setting. Unfortunately, many incidents of workplace violence against nurses are not reported because many nurses feel it has just become part of the job. I don’t know about you, but that wasn’t covered in nursing school. 

The top types of workplace violence reported were verbal threats, physical threats, and pinching/scratching. Researchers found that 74% of all workplace violence occurred against healthcare workers, and those working with older adults were at the highest risk, followed by pediatrics, maternity units, psychiatric units, and emergency care. The impact on nurses is fear, anxiety, humiliation, guilt, headaches, irritability, workplace performance, decreased job satisfaction, burnout, absenteeism, increased turnover, sleep problems, anger, guilt, apathy, and helplessness. That’s a long list of issues that nurses shouldn’t have to experience. 

Employers and the Workplace Violence Prevention Plan

Employers are trying. Well, some of them. Only 62.8% of nurses in the NNU survey reported that their employer provided workplace violence training, and only about one-third said their employer had a straightforward way to report workplace violence.  

Just 38 states have legislation that explicitly outlines penalties for the assault of nurses, according to the American Nurses Association. In seven states, the law only applies to emergency and psychiatric care settings. Most of the time, only physical violence counts. In general, state laws do not cover emotional or non-physical abuse, even though verbal abuse, threats, and sexual harassment are the leading forms of abuse against nurses, according to the World Health Organization (WHO). Shout out to Missouri, though, which has laws that increase the penalty for repeated patient offenses against healthcare workers.  

It’s a Joint Commission standard that leaders create and maintain a culture of safety. In 2022, the Joint Commission released more specific guidelines for organizations on how to address workplace violence. WHO also published guidelines to help employers prevent workplace violence, such as appropriate staffing ratios, decreasing patient wait times, security measures, training for nurses, and access to alert others if help is needed. 

However, more could be done to respond to events that do occur. WHO recommends employers encourage reporting of incidents, make the process of reporting simple, and that they monitor occurrences. Complaints should be able to be made confidentially. A timely response is warranted for any incident. 

Nurse Advocacy

Nurses are getting involved in legislation to help combat workplace violence. Right now, the focus on workplace violence is mainly limited to prevention rather than response. Of course, prevention is best, but the response needs to not only support the healthcare worker but also hold the offending patient or family member accountable.  

Some have said, “You can’t charge the patient because they weren’t aware of their actions,” but I would argue that in any other setting, the offender would be charged, and the court system would determine if the offender can be held accountable.  

In recent years, a few states have introduced legislation that increases the level of offense, in some cases, to a felony for assault against a healthcare worker. 

A patient in Pennsylvania was arrested in January 2024 and charged with felony assault after he allegedly placed a female nurse in a headlock and had to be forcefully removed from the nurse. In February 2024, a woman was charged with assault and aggravated disorderly conduct following an “incident” at the Cleveland (Ohio) Clinic.  

The case at Grand Nursing Facility in New York is another example of how nurses fight back and hold these offenders accountable. The hope is that workplace violence will decrease, and healthcare employers, legislators, and law enforcement will support nurses as they hold violent patients responsible for their bad behavior. 

The Bottom Line

Workplace violence against nurses is increasing, but hope is on the horizon. Many states have enacted legislation to address violence against healthcare workers. Due to recent cases covered in the news media, nurses should be able to rely on the support of their employer to prosecute patients or family members who assault them in the workplace. With legislative and employer policy changes, nurses are counting on a decrease in workplace violence soon. 

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