With disturbing regularity, nurses in hospitals and other healthcare settings are being physically assaulted and verbally harassed.

More than half of emergency nurses say they’ve been assaulted or threatened within the past 30 days, according to the Emergency Nurses Association. In a separate study, researchers found that healthcare workers faced at least one violent or aggressive incident every 40 hours worked, according to findings published by The Joint Commission Journal on Quality and Patient Safety.

With the observance of National Nursing Week, we can't ignore the increased violence in healthcare. Nursing leaders point out that regular exposure to violence or threatening behavior adds to the stress and burnout of nurses and, in some cases, spurs them to seek new jobs.

Nursing leaders cite another element adding to the strain on nurses. Too many nurses feel that their employers are blaming them for the violent incidents taking place, they say.

Jennifer Mensik Kennedy, president of the American Nurses Association, says nurses often feel their organizations fault them for not doing enough to calm their attackers down.

“What I hear from nurses is that when they reported an act of violence, reported that they were hurt, oftentimes, they're sat down, and the first thing is not, ‘Are you okay?’, but what could you have done to prevent this? So we've almost made it their fault for being a victim. And so we really need to change our focus and mindset.”

Many nurses are worn down by the physical and verbal abuse they encounter.

“It is a very serious problem and nurses are afraid, particularly on the frontlines,” Mensik Kennedy says.

Supporting Nurses

Joanne DeSanto Iennaco, professor of nursing and psychiatry at Yale University School of Nursing and School of Medicine and the lead researcher on The Joint Commission study, says healthcare organizations can do more to support workers.

Hospitals and health systems need to recognize the impact of an assault on an employee, including psychological symptoms. In a recent interview with the Chief Healthcare Executive, she says many healthcare workers can be bothered by thoughts and images of the event and even struggle with flashbacks.

“The answer isn't really blaming the nurse,” Iennaco says. “It’s, how can we help to support nurses in these situations?”

She adds, “That really requires our leaders to step in, and take a look at the situation and figure out with the team, what are the best ways we can support in this environment?”

Researchers have found that some nurses don’t report violent incidents because they fear being blamed for not doing enough to defuse the situation, which may explain why some incidents are not coming to light.“Underreporting may stem from the nurse’s perception that they will be blamed for the event,” researchers wrote in an April 2023 article in BMC Nursing.

“The nurse may fear a lack of collegial support or even judgment from peers, feel pressure to not report if peers do not, or fear being blamed for the event,” the researchers wrote. “Fears related to management include the fear of losing their job, managerial reprisal, poor job performance appraisals, or legal consequences if the nurse reports.”

Violence Rising

Nurses have seen more violent incidents, mainly since the COVID-19 pandemic, nursing leaders and hospital executives say.

“People feel it's okay to literally physically and verbally assault people, and any respect has gone out the window,” Mensik Kennedy says.

The number of reported assaults against nurses rose 5% from last year, according to a recent Press Ganey report. There are 2.71 assaults per 100 nurses, up from 2.59 the previous year, the report stated. In another view, nurses experience two assaults every hour.

The threat of being attacked is causing some nurses to leave the bedside or the nursing profession.

Nearly one in three nurses (30%) said they were at least somewhat likely to leave their positions in the next six months, according to a survey released by the American Nurses Foundation in partnership with McKinsey & Company in late March.

“Nurses have to be vigilant to not be attacked and, you know, they feel for what they're experiencing, they can go somewhere else, and even leave nursing,” Mensik Kennedy says. “And you know, the pay isn't worth it. So we really need to provide the best environment so that people are safe, so that they at least feel like they could do the care that they're there to do.”

Nursing advocacy groups and hospitals have been pushing Congress to strengthen protections for healthcare workers. They have backed legislation imposing stricter penalties for individuals who attack healthcare staff, similar to federal protections for airline employees.

But hospitals and healthcare organizations need to take action to protect their nurses, Mensik Kennedy says.

“Organizations regardless of where you are, hospitals, clinics, nursing homes, need to have strategies in place,” she says. “So we don't need to wait for legislation, federal legislation or state legislation, to deal with this. Organizations can do what they can now to make sure the environment is safe.”

Some hospitals invest more in security to improve safety and reduce violence, but healthcare organizations can take other steps that don’t require significant financial investments.

“The best organizations have clear processes and policies on reporting violence,” Mensik Kennedy says.

Too often, she adds, “Nurses don't actually know the process to report, they don't think there's a process to report or it's unclear how they report an act of violence.”

Nurses often don’t know the resources available to them, including social workers with experience in de-escalation. Hospitals also need to develop action plans for those patients who have assaulted staff previously so that nurses can take care of those patients safely.

Ultimately, leaders need to tell and remind nurses and all healthcare workers to report any violent incidents.

“The hospital needs to own recognizing and supporting the nurses and all of their employees in reporting it,” Mensik Kennedy says.