Violence in Nursing

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    There's an epidemic of violence towards nurses, and a cultural acceptance of abusive behavior. Why is violence towards nurses so pervasive?

    Violence in Nursing

    Violence in Nursing

    When Ashley became a nurse, she dreamed about helping patients and relieving suffering. She never thought she’d be hurt, much less attacked. Her second day on the job, a patient threw a heavy tray across the room, splashing her with orange juice and bits of scrambled eggs. The tray hit a nearby wall, narrowly missing her ankles.

    The reason? “I told you I don’t like scrambled eggs!!”

    She froze, stunned and speechless. Nothing in her upbringing or training had prepared her for this. She could not understand why a patient who was receiving care (in this case, free care) would be abusive and not appreciative.

    The news has reported several horrific incidents of late. Recently a nurse at Delnor Hospital/Northwestern in Geneva IL was taken hostage in her own hospital on May 13, 2017.

    In another incident, also in Illinois, on June 6th at St. Joseph's in Joliet, an inmate used a makeshift weapon to take a nurse assistant and a guard hostage.

    On June 4th at Amita Medical in Bolingbrook, a nurse in the ED was punched in the face by a patient.

    We all heard of the incident that occurred in a New York hospital June 24th, where the perpetrator was a disgruntled fired physician (resigned due to alleged sexual assault against colleagues) who brought in an assault rifle, killing one physician and wounding 6 others.

    Type II Violence

    Abuse can include yelling, cursing, scratching, spitting, hitting, kicking, and verbal threats. Patients with behavioral health problems, alcohol intoxication, substance abuse, prolonged waiting times in the ED- all can contribute to violent behavior.

    Called type II violence, there is an epidemic of patient/visitor perpetrated violence towards nurses. Nurses (and nursing assistants in particular) are at highest risk for being injured through workplace violence.

    Hospitals have become hazardous workplaces. The ED setting, in particular, is prone to violence. Cognitive impairment and demanding to leave are documented causes as are situational catalysts such as the use of restraints. There’s extremely high stress, a dynamic workplace, and the violence can come from family members, or patients desperately seeking drugs.

    Increased Incidence

    “B****!” Where’s my pain medication?!!” The vast majority of nurses have been subjected to verbal abuse.

    In 2015, OSHA reported patient handling and workplace violence injury rates were highest in inpatient adult wards; these rates were also elevated in outpatient emergency departments, urgent care, and acute care centers and adult critical care departments.

    Culture of Acceptance

    There’s a culture of dismissing and minimizing violence towards nurses. Nurses believe in “doing no harm” and will put patient safety before their own.

    Teachers are not expected to tolerate violence. If the same patient who yells and hits a nurse acted out similarly in the DMV, in court, or even at a fast-food restaurant, they’d most likely be arrested.

    Culture of Non-Reporting

    There are barriers and attitudes towards reporting. Nurses themselves under-report violence. Nurses fail to report, believing it is just part of the job, and that managers may be non-responsive.

    Staff are not clear on what to report, or how to report it.


    For all these reasons, often traditional industrial injury reporting is bypassed in patient/visitor to worker violence. Organizations do not encourage reporting; they encourage a lack of reporting.

    Support and Safety

    What support is there for a nurse with an abusive patient? Not much. She can wait until the violence has escalated and call security. Security is often not well trained and I’ve seen them at a loss; well-meaning, but at a loss.

    In Ashley’s case, she called security, who responded and alternately tried to pacify the patient (egg and orange juice were still splattered all across the floor) and admonish him. The admonishment was in a “Hey buddy, no more of this naughtiness, OK” in a male-bonding manner.

    What’s Needed


    • More training for staff to recognize impending signs of violence. There are effective methods to mitigate escalating violence but they must be taught. In some states, OSHA requires training for staff working in violence-prone areas such as ED and Labor and Delivery
    • Legislation. Thirty-two states have made it a felony to attack nurses. Nurse need protection and support.
    • A zero tolerance for violence. Nurses are conditioned to accept violence.
    • Workplace violence surveillance to determine where interventions and resources need to be employed. Employers have a duty to provide a safe workplace for staff and patients.
    • Increased security.
    • Staff support and debriefing after a violent incident.
    • Encouragement of reporting. It should be clear that the expectation is to report violence and to clearly define the boundaries of unacceptable behavior.
    • *Public education about the proper use of emergency rooms.


    I believe employers have a responsibility to provide a safe workplace. Not everything can be prevented, but it seems the signs are clear that violence against nurses is escalating. What do you think will help?


    Occupational traumatic injuries among workers in health care facilities—United States, 2012–2014. Health Care, 2012. Retrieved July 24, 2017 Occupational Traumatic Injuries Among Workers in Health Care Facilities — United States, 212–214
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    79 Comments

  3. by   spotangel
    Never tolerate any abuse at work or home. As a survivor of physical abuse at work,kicked when pregnant and losing a baby, take it from me. As a new nurse, working with an agency in a Hosp, I did not follow protocol and go to the ED or press charges. Now I speak up but it took years to get to this point. In my state it is a felony to hurt a health care worker. In the Hosp system I work we have a special code for violent pts and security responds along with administration. Staff also respond as a show of strength.
  4. by   DTWriter
    If there is a legal way to ban an unruly patient, I would like to read about it.
  5. by   evastone
    Great article but what are you supposed to do when a patient "only" spits at you? How about when they tell you "You are paid for me to treat you like garbage? " Or make biased comments about your race or religion and saying that "You are going to ****?" They can't get arrested for them. You can't press charges for these. I filled out paperwork for the spitting incident but nothing will ever come of it. Most of my abusive patients are not all there. Unless actual physical damage was done by someone too dumb to claim temporary insanity most of these people will get away with it.
  6. by   Joanie49
    Thank goodness my hospital has verses badges to hit in case of emergency... I have used mine many times. Our doctors and security and other staff members are alerted right away with our location in the hospital if this happens. Not to say this will always be able to help a situation but it helps to get others there to back you up.... :/
  7. by   3ringnursing
    Right after I was off orientation in my very first nursing job a class mate of mine and I worked on the same Med-Surg unit on night shift.

    One night my class mate turned coworker had a BH patient that was causing her problems that was escalating to violence. Security had been called many times, but when they came he was always calm and denied wrong doing.

    At some point during the shift I walked by the room and glanced in just in time to see the patient standing on the bed attempting to corner my coworker/friend.

    She stood frozen in terror (although we both were tiny things - 100 lb's each, she had been gently raised whereas I had not). I ran into the room grabbing her wrist - pulled her into the patient bathroom slamming the door behind us. I barricaded it holding the knob and planting my foot against the bottom of the door (this was in the days before cellphones: circa 1994). We had no way to call for help, so I started yelling like a banshee, pounding on the door.

    All the male staff members on the unit responded, and security arrived. The patient was too worked up to hide his nefarious intentions any longer.

    He was restrained, sedated and transferred to the locked down psych unit.

    I know I should be more compassionate and forgiving, but he had been terrorizing my friend all shift. Good riddance!
  8. by   zeeblebrox
    I unfortunately have experienced work place violence multiple times. I have been punched, kicked , scratched, spit at, purposely peed on, tele packs whipped at my head, strangled once with my stethoscope and once with a call light cord. Not one time did management ever even ask if I might need medical attention, on the contrary they treated it as if there was something wrong with me that these nut case patients attacked me. Never was anyone else at fault even when it wasn't my patient and the only reason I was anywhere near the patient was to save my co-workers from violence. There is definitely a culture of acceptance of violence toward healthcare workers, and unfortunately management helps to propagate it by discouraging even internal incident reports let alone attempting to press charges. Thankfully I no longer work at that acute care hospital. I haven't experienced any violence at the new hospital I work at but in discussions with management personal here they say if anything happens give them a call an report it immediately.
  9. by   matcha-cat
    Quote from 3ringnursing
    Right after I was off orientation in my very first nursing job a class mate of mine and I worked on the same Med-Surg unit on night shift.

    One night my class mate turned coworker had a BH patient that was causing her problems that was escalating to violence. Security had been called many times, but when they came he was always calm and denied wrong doing.

    At some point during the shift I walked by the room and glanced in just in time to see the patient standing on the bed attempting to corner my coworker/friend.

    She stood frozen in terror (although we both were tiny things - 100 lb's each, she had been gently raised whereas I had not). I ran into the room grabbing her wrist - pulled her into the patient bathroom slamming the door behind us. I barricaded it holding the knob and planting my foot against the bottom of the door (this was in the days before cellphones: circa 1994). We had no way to call for help, so I started yelling like a banshee, pounding on the door.

    All the male staff members on the unit responded, and security arrived. The patient was too worked up to hide his nefarious intentions any longer.

    He was restrained, sedated and transferred to the locked down psych unit.

    I know I should be more compassionate and forgiving, but he had been terrorizing my friend all shift. Good riddance!
    Dang, quick thinking!
  10. by   JKL33
    Thank you for the excellent article. To expand on your zero-tolerance idea, I believe we have to stop making and accepting excuses for threatening and violent behavior. For many years we have been taught that the "stress" (of hospitalization, of illness, of social factors) manifests in many different ways, some of which may not be our own personal style. While that's true, "stress" can not continue to excuse the types of behaviors being discussed here.

    People all over the world experiences stressor of the worst kind (things a far cry worse than having temporary illness or being temporarily hospitalized) and do not react with violence or threatening behaviors towards others. It is not a given that one "might" act that way. Most people do not.
  11. by   fibroblast
    I think that nurses are easy targets. It is one of the 'safest' professions and they are held to a certain standard
  12. by   Nurse Beth
    Quote from JKL33
    Thank you for the excellent article. To expand on your zero-tolerance idea, I believe we have to stop making and accepting excuses for threatening and violent behavior. For many years we have been taught that the "stress" (of hospitalization, of illness, of social factors) manifests in many different ways, some of which may not be our own personal style. While that's true, "stress" can not continue to excuse the types of behaviors being discussed here.

    People all over the world experiences stressor of the worst kind (things a far cry worse than having temporary illness or being temporarily hospitalized) and do not react with violence or threatening behaviors towards others. It is not a given that one "might" act that way. Most people do not.
    Exactly! I don't act that way when I'm sick or stressed.
    Last edit by Nurse Beth on Aug 4
  13. by   JKL33
    Beth, just clarifying that I completely got that you don't condone it....and sorry for the distracting typos above.

    I've thought of a practical suggestion for this part of the problem: Those tasked with incorporating Patient Satisfaction initiatives should probably be required to spend significant time, regularly, on the front lines in order to stay informed about the kinds of issues that lead to dissatisfaction the different ways that patients respond. When we hear about patient satisfaction (such as through inservices, for example), we are often told about rather compelling stories and there is a lot of collective murmuring about how that [bad thing nursing did] shouldn't have happened. We don't hear as much about patients becoming dissatisfied or even abusive about more mundane things - - which happens quite frequently. We can't continue to pretend that it doesn't happen. "Appearances" and patient satisfaction concerns have been things that have inhibited progress on this issue. I think spending time in EDs especially would help advance initiatives to empower staff. All different types of units, really.
  14. by   jk0805
    My very first clinical of nursing school I was assigned a violent patient. The hour before we came in he bit a CNA.
    Prior to that first clinical, the instructors told us we would always be safe. If we felt uncomfortable in any situation we just needed to tell the clinical instructor.
    I told my clinical instructor I was uncomfortable taking care of this patient because I was a survivor of an abuse marriage.
    I was told that I could either care for this patient or fail my very first clinical. She went on to tell me that in my career I would have to care for plenty of men that abuse or have abused there wives. She went on to say that I could not let my history effect my care.
    The patient was never physically abusive to me that day but he was verbally abusive. My instructor used me and my story, without my permission, at our debrief that day. She saw it as a success that "I got over my fear of abusive patients."
    I did not get over my fear that day. The only thing this taught me was abuse towards nurses is tolerated.

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