Violence is Not "Just Part of the Job"

by WalterWho WalterWho

Specializes in Intensive Care and Perianesthesia Care. Has 5 years experience.

As Healthcare Violence garners the attention it deserves, as Nurses we're called upon to grapple the increasingly complex boundary between providing quality care and increasing workplace safety.

What can we do about increasing workplace violence?

Violence is Not "Just Part of the Job"

“I’m gonna kill you” Is what he said just before grabbing Ashley Schade’s neck with both hands during her shift in a Washington ICU. She detailed the event in a social media post: “having a strong individual’s hands around your neck, the inability to breathe, let alone call for help, to the point where you can’t see a thing and can only hear an emergency “staff assist” tone going off, is one of the absolutely gut-wrenching, most terrifying feelings anyone could ever imagine”

How Much is Too Much?

Although Ashley’s encounter was extreme, violence against healthcare workers happens all too often. A 2001 study by the Department of Justice found that out of all workers across all industries 16.6 per 1,000 were the victims of violent acts, compared to 21.9 per 1000 nurses. Furthermore, according to the Occupational Safety and Health Administration (OSHA), approximately 75% of nearly 25,000 workplace assaults reported annually occurred in the healthcare and social services settings.

The statistics are staggering, especially when you take into account that violence in healthcare is often under reported, as most healthcare workers contribute violent acts to “just being part of the job”. In some circumstances, nurses and assistive personnel forgo reporting such incidents all together in fear of negatively affecting Centers for Medicare and Medicaid Services (CMS) scores, however most facilities lack a formal reporting protocol to do so.

We’re Here to Heal, So Why all the Violence?

Its safe to assume that the vast majority of nurses did not get into the field out of a desire to fight people, so why all the fighting? A study performed by the Emergency Nurses Association (ENA) detailed contributing factors of healthcare associated violence in emergency departments across the nation. Most factors were directly related to patient conditions such as an increase in the prevalence of mental health disorders and patients or their family being under the influence of drugs or alcohol, while other factors were related to facility shortfalls like under staffing and the lack of safe visitor policies.

What Can We Do About It?

While a large portion of workplace violence in the healthcare setting stems from factors which are difficult to control for, there are measures we can take to increase safety for nurses and other healthcare personnel, and arguably the most important is awareness. As the phenomenon of healthcare violence gains public attention, more and more nurses and other healthcare professionals are becoming vocal and sharing their experiences, most notably through the trending hashtag #silentnomore often broadcasted by popular social media personalities such as “ZDoggMd”.

While awareness may be necessary for change, understanding is how solutions are made. The lack of effective reporting protocols in facilities across the U.S. may potentially be the largest inhibitor of increased workplace safety. How can we possibly solve the problem when we don’t fully understand it? Furthermore, in order for reporting tools to collect accurate and useful data, nurses must be encouraged or inspired to report the incidents in the first place. That is why the notion that violence is “just part of the job” is so dangerous and counter to what we pledged as nurses: to do all in our power to maintain and elevate the standard of our profession.

So, while we continue to be healers and provide exceptional care to our patients despite what they may say or do to us, it is of utmost importance for the sake of safety and the progress of our profession, to maintain the belief that violence is not okay, no matter what.

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7 Comment(s)

Hoosier_RN, MSN

Specializes in dialysis. Has 29 years experience. 3,588 Posts

Most find that the problem lies with employers. Fear of reprisal when reporting, and it does happen. It began with the satisfaction surveys, that allow patients to walk all over us, that are used for reimbursement, as opposed to metrics of return to best function able. Administrators are afraid of losing $$ if they make a patient/family member upset, as opposed to protecting staff.

In 2010, I was beaten by a patient who was coming down off meth, to the point that I was sent to the ER for fear he had broken my jaw (luckily, no). Our CNO called me the next day and demanded that write an apology letter for upsetting him--I had only told him that I needed to disconnect his pain pump while he went out to smoke, which was a no-no too, he went ballistic and beat me to a pulp while security stood and watched. This same patient had been caught trying to steal a pain pump the month prior from a supply closet and got mad when he found it wasn't loaded, and became belligerent with staff...the only letter I wrote was my resignation. I've never worked in a hospital since...

Hoosier_RN, MSN

Specializes in dialysis. Has 29 years experience. 3,588 Posts

I want to add to my PP, that the year before, the same CNO wanted me to write an apology letter to someone (family member) who wanted sodas for pt and family while I was literally doing compressions during a code, and got mad and gave a bad score because I yelled at someone to get him out of the's these administrators that are giving the entitled attitudes to pts that allow them to think we are punching bags


Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 25 years experience. 20,962 Posts

I am pretty darn sick of learning how to "de-escalate" the situation. Situations like this are already escalated too fast. Employers who do nothing or worse, punish the employee harmed----- need to be prosecuted, along with the offender. ENOUGH ENOUGH ENOUGH already!!! Stop putting it all on us. Enough with guilting, shaming, causing PTSD and contributing to the further harm to the employee attacked. Enough is enough


Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 25 years experience. 20,962 Posts

And I am with ZDogg be #silentnomore.

jodyangel, RN

Specializes in L&D. 687 Posts

Yes! #silentnomore



3 Posts

We as Nurses are NOT protected by any one entity. It allows the Hospitals to treat us like we just don't matter. They are more concerned about the patient then the Nurses who are harmed. There is absolutely nowhere for Nurses to turn to when these issues arise. Hospitals are never held accountable and retaliation is huge. So that silences a lot of us. Until this changes the abuse will continue and the Nurses will continue to leave the bedside.


walkingon, CNA, LPN

Specializes in LTC, Assisted Living, Surgical Clinic. Has 11 years experience. 108 Posts

As a memory care nurse, my co-workers and I work under a shadow of threat of violence daily. How do you fight back when you’re fighting restraint-free cognitive impairment? How do you deal when you’re getting your a** kicked by a delusional person who will hurt themselves or someone else without your intervention? The really bad ones we can send out to geri psych, but it’s the ones that “only” hit while having care provided that management doesn’t seem to care about, as long as said hitting is going on in the privacy of the resident’s room and CNAs and nurses are the ones being hit. I find it interesting that if a resident becomes agitated and hits another resident, it’s a state reportable huge deal, but it’s just another day at the office for staff getting hit. I can certainly understand that these people have dementia and don’t know what they’re doing, but that doesn’t keep our CNAs working when they get tired of it and find jobs elsewhere, which just exacerbates the problems of continuity of care. The violence generally gets worse during GDR attempts, which is a whole other ball of wax. I feel there is no recourse for us due to the nature of this particular beast.