Moving beyond the belief that violence is just part of the job.

Despite the growing number of violent incidents in hospitals, healthcare workers have historically viewed it as part of the job. As a result, the number of unreported incidents dwarfs reported incidents. And as the number of reported incidents increases it becomes even more urgent that violence against healthcare workers be addressed.

Understandably, nurses site threats in the workplace as one of the reasons they consider leaving the profession. According to an Ulrich report, 20% of nurses plan to leave their job in the next 12 months, and over 28% plan to leave within the next 3 years. [1] This comes at a time when we are experiencing a shortage of nurses.

In a Minnesota survey of 6,300 nurses, the annual rate of physical violence against nurses was 13% and 39% for nonviolent incidents. [2] “Approximately 77% of cases agreed or strongly agreed that they expected assault as a possible consequence of the job.”

What steps can hospitals take to address violence on staff? The article “Rising violence in the emergency department” in the Association of American Medical Colleges suggest 6 steps.[3]

  1. Establish clear policies
  2. Enforce policies consistently
  3. Offer training
  4. Increase security
  5. Study your space
  6. Protect against cyber stalking

The CDC makes free online training available, “Workplace Violence Prevention for Nurses” (CDC Course No. WB2908 – NIOSH Pub. No. 2013-155). The course takes 3 hours to complete, and students can earn credit by answering 10 multiple choice questions. The course addresses the following topics.

  • Definition, types, and prevalence
  • Workplace violence consequences
  • Risk factors for type II and III violence
  • Prevention strategies for organizations
  • Prevention strategies for nurses
  • Post event response

As a clinician, what can you do?

  • Encourage your peers to take the course.
  • B4nAsk your Security team for a copy of your organization’s violence prevention plan.
  • Consider panic button solutions such as AiRISTA’s Staff Safety Tag as part of a deterrent/response .
  • Write to your Senator asking for support of the House Bill H.R. 1195 “Workplace Violence Prevention for Health Care and Social Service Workers Act”.
  • Training needs to be mandatory and ongoing.

“These things need to be practiced,” says Pat Finan, MD, a third-year resident at MedStar Georgetown University Hospital. “It can help us work on de-escalating and noticing things we say that might be inflammatory and exacerbating the problem rather than solving it.”



[1] Ulrich BT, Lavandero R, Hart KA, Woods D, Leggett J, Taylor D (2006) Critical Care Nurses’ Work Environments: a baseline status report, Crit Care Nurs 26, 46-57

[2] Nachreiner NM, Gerberich SG, Ryan AD, McGovern PM. Minnesota nurses’ study: perceptions of violence and the work environment. Ind Health. 2007 Oct;45(5):672-8. doi: 10.2486/indhealth.45.672. PMID: 18057810.

[3] Budd, Ken, “Rising violence in the emergency department”, AAMC, February 2020