Violence in Health Care
Trigger warning: Workplace violence
While all eyes in the world seem to be glued on Luigi Mangione, the young man accused of killing the UnitedHealthcare CEO, Brian Thompson, few people seem to know that violence in health care is not a new phenomenon.
A personal example.
In the mid-1970’s I was the supervisor of an Intravenous Therapy Team (IV Team) at a large (1200 bed) teaching hospital in upstate New York. In addition to scheduling staff, signing timecards, drawing bloodwork, and starting and re-starting IVs, I managed IV therapists 24/7 and any problems that arose on their shift. One of the members of my team submitted a written incident report that while working in the Intensive Care Unit (ICU), a surgical resident verbally assaulted her causing her to be fearful of bodily harm.
When I went to the ICU to have a conversation with this person about the incident report, he screamed at me, grabbed my arms, lifted me up, and threw me into a dirty utility room. I was terrified and he was enraged. He screamed at me some more, then turned and left saying he had “more important things to do than to deal with this crap.”
What did I do? As soon as I was able, I went to my supervisor, wrote an incident report and completed my shift. Yes, I had been assaulted on the job and no one sent me to the ER or to Employee Wellness. I finished my shift.
What happened to him? Nothing.
Why? Because he was a physician and I was just an IV therapist. Now, you’re reading this and thinking that it was almost 50 years ago! That can’t be true any longer, can it?
While this level of physician hostility against nurses is anecdotal (my n of 1)—nurses are still targets for aggression in healthcare settings.
A Press Ganey analysis found, on average, two nurses are assaulted every hour.
A National Nurses United (NNU) survey found that over half of the surveyed RNs had experienced some form of violence in the healthcare setting and on the grounds and in the parking lots belonging to the healthcare organization. The American Nurses’ Association found one in four nurses had experienced violence in the workplace and called for enforceable Occupational Safety and Health Administration (OSHA) standards to implemented.
Workplace violence can take many forms: verbal assault as in my IV therapist’s original incident report, physical assault as in my experience; bullying and harassment; stalking; sexual assault; rape; and homicide. The incidents reported in the NNU survey provide additional examples of many of these forms of violence.
Who is the perpetrator? Anyone who is in a healthcare setting can become a perpetrator of violence: someone with no association with the workplace or its employees; a customer or patient; a former employee; or, someone with a personal relationship with the employees, but not the workplace. In the last example, think about an angry spouse coming to the workplace. The National Institute for Occupational Safety and Health (NIOSH) reported that “16% of female worker homicides are victims of domestic violence that spills over into the workplace” (para. 1).
What can be done? Some RNs think it’s “part of the job” and don’t want to complain out of fear of retaliation. This culture of fear and silencing the victim cannot continue. The NNU and the ANA offer recommendations for how to address violence in healthcare settings. The Joint Commission (TJC) considers violence in the healthcare setting to be a sentinel event and has published prevention standards.
Organizations must take precautions against violence in what is considered by many to be a sanctuary.
What can you do? H.R.2663 - Workplace Violence Prevention for Health Care and Social Service Workers Act was introduced in April 18, 2023 and was referred to the Subcommittee on Work and Welfare on December 17, 2024. It has 173 cosponsors from both sides of the aisle. Senator Tammy Baldwin’s one-page overview of the legislation is excellent. It includes usable fast facts and a list of healthcare workers’ organizations that support this legislation. You can call, email, and text your legislators to tell them to get this bill moved into law. What’s at stake? Tell them every day they delay this bill, 12 nurses are assaulted in the workplace. The costs are not only in dollars lost due to injuries, but also in human capital when nurses leave the profession due to their injuries.
Nurses and other healthcare workers need advocates, too.
References for this post along with other resources
American Nurses’ Association. (n.d.) 1 in 4 nurses are abused: OSHA standards needed to end workplace violence. https://www.nursingworld.org/practice-policy/work-environment/end-nurse-abuse/
Baldwin, T. (2023, April 18). One pager: Workplace violence prevention for health care and social service workers act. https://www.baldwin.senate.gov/download/workplace-violence-prevention-act-of-2023-one-pager
Buchbinder, S.B., Shanks, N.H. & Kite, B. (2019) Introduction to health care management, 4th Ed. Jones & Bartlett. https://www.amazon.com/dp/1284156567
Buchbinder, S.B., Shanks, N. H., Buchbinder, D., & Kite, B. (Eds). (2022) Cases in health care management 2nd Ed. Jones & Bartlett. https://www.amazon.com/dp/1284180395
Buchbinder, S.B., Shanks, N.H., Rogers, R.K. (Releasing February 12, 2025). Introduction to healthcare management, 5th Ed. https://www.amazon.com/Introduction-Health-Management-Sharon-Buchbinder-dp-1284276104/dp/1284276104
Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH). (2001). Women’s safety and health issues at work. http://www.cdc.gov/niosh/docs/2001-123/pdfs/2001-123.pdf
National Nurses United (NNU). (2024, February 5). High and rising rates of workplace violence and employer failure to implement effective prevention strategies is contributing to the staffing crisis. https://www.nationalnursesunited.org/sites/default/files/nnu/documents/0224_Workplace_Violence_Report.pdf
Phillips, J. P. (2016). Workplace violence against health care workers in the United States. New England Journal of Medicine, 374(17), 1661–1669. https://www.nejm.org/doi/10.1056/NEJMra1501998
The Joint Commission (TJC). (2010, April 13). Preventing violence in the health care setting. Issue 45. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea-45-preventing-violence-in-hcos-rev2-5-20-21.pdf
The Joint Commission (TJC). (2021, June 18). Workplace violence prevention standards. R3 report: Requirement, rational, reference. https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/wpvp-r3-30_revised_06302021.pdf
U.S. Department of Labor (DOL). (n.d.). DOL workplace violence program: Appendices. https://www.dol.gov/oasam/hrc/policies/dol-workplace-violence-program-appendices.htm#definitions
Who are the most common assailants?
Sharon Buchbinder: Whew! I never imagined a medical doctor or resident physician would become violent with a nurse.
Since my dear Mom (from near Charleroi in Belgium) -- who practiced in her home town hospital during the occupation of Belgium by the Third Reich -- was a career nurse, I grew up with a love of the medical profession and a reverence for nurses and medical doctors.
The incident you cite may have been years ago but it could easily, as you say, be this morning.
I know some patients and families can be evil tempered and violent, and want our health care personnel and professionals protected.
But the violence from within is a shocker and a revelation to me.
Thank you so very, very much for sharing in this important, critically important matter.
The nurses, the health care personnel -- all of them, by far not just the medical doctors -- deserve our support and encouragement.
What you did as a healthcare supporter was a humane and wonderful work and you deserve, as do the ones who work for you, our respect and care and gratitude.