Attacks on nurses ‘can’t be normalized’

Nurses have endured more violence and aggressive behavior in recent years.

Nursing leaders and nurses offer their own perspectives on the uptick of violence they are facing, but there’s data to illustrate the problem as well.

The number of assaults on nurses rose from more than 14,000 in 2019 to more than 23,000 in 2023, according to a study published in Nurse Leader. More than half of all emergency nurses say they have been assaulted or faced aggressive behavior within the past month, according to a survey by the Emergency Nurses Association.

While nurses in all areas of the hospital face the threat of violence, emergency nurses are especially at risk. Dustin Bass, president of the Emergency Nurses Association, tells Chief Healthcare Executive® that violence in the emergency department should not be considered part of the job.

“It's still a major problem,” Bass says. “I think that we're talking about it more, which is great, but … violence can't be normalized as part of the job, and the more we talk about it, the more awareness we bring to it. But also I think that we have to be careful to not normalize it.”

“It happens all the time. It really does. And I think that what we're doing is, we are also encouraging people, nurses, to press charges, to bring things forward, to not be silent whenever small things happen, so that we can address them in real time,” Bass says.

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‘We have seen it worsen’

In the past, some nurses have been expected to understand that assaults or abusive behavior is part of the role of being a nurse, particularly in an emergency department. Bass says that should never be the case.

Nurses should understand that patients with mental or behavioral health conditions aren’t given a “free pass” when it comes to striking or assaulting a nurse.

“What we're trying to do is teach our emergency nurses that that's not the case, that just because someone is having a mental health crisis doesn't necessarily mean that they can do whatever they want,” Bass says.

“I think that that is where we are, encouraging reporting, encouraging people to press charges, so that the right experts at the right time can really look into those things,” he adds.

In rare cases, some patients aren’t responsible for their actions, he says, but in most cases, patients who assault a nurse are making a choice, he says.

Theresa McDonnell, the chief nurse executive and senior vice president at Duke Health, told Chief Healthcare Executive® in a recent interview that her system has seen more attacks on nurses.

“We are most definitely seeing increased untreated mental health disorders,” McDonnell says. “Add to that, we're seeing an increase in anxiety in the general population around economics, food insecurity, housing insecurity. We are seeing increasing crime, and we do, as a health system, we do everything we can to try and give back to the community and support our community.

“But the reality is … we have seen it worsen. And you know, as with everything, the pendulum always shifts. At least we hope. Right now we're in a period of time where we're seeing numbers of workplace violence events across the country that we never saw before.”

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Pushing for a federal law

Emergency nurses and other healthcare groups have been pressing Congress to pass legislation that would make it a federal crime to attack healthcare workers. They’re looking to gain protections similar to those afforded employees in the airline industry.

While thirty states have similar laws, healthcare organizations say their workers deserve a federal law that calls for tougher penalties for assaulting healthcare workers.

Noting the protections for airline employees, Bass says it’s time for similar protections.

“It is not a federal crime across the United States to assault your nurse in the emergency room,” Bass says.

Dr. Eric E. Howell, the CEO of the Society of Hospital Medicine, wrote in a recent op-ed for Chief Healthcare Executive that hospitals have bolstered security measures, but argues that a federal law would make a difference.

“My own hospital has installed panic buttons, trained staff in de-escalation techniques, and enhanced security,” Howell wrote. “However, we also know these efforts alone are not enough to stop the increasing rates of violence against doctors, nurses, and other hospital staff. For that, we need the support of our leaders in Washington.”

The American Hospital Association, the American Nurses Association, and other groups issued a joint violence last month condemning attacks on healthcare workers, noting that they experience workplace violence at higher rates than any other industry.

“Workplace violence erodes the safety and dignity of health care environments, directly contributes to workforce burnout and turnover, and compromises the quality of care for patients,” the groups said. “This violence undermines our health care system’s ability to provide safe, healing environments for all.”

Speaking up

Hospitals need to take steps to make sure that they are protecting their nurses and that their safety is a high priority.

Health systems can help nurses, Bass says, by “supporting them whenever there is an unfortunate violent act and pressing charges or doing the right thing in order to ensure that it potentially doesn't happen again.”

Bass also suggests ensuring that hospitals have the training that they need to deal with aggressive patients and skills in de-escalating tense situations.

“It's a multifaceted approach, really, because you want people to feel safe and supported,” Bass says.

Claire Zangerle, chief executive officer of the American Organization for Nursing Leadership, says that younger nurses are much more verbal about not tolerating violence.

“With the increase in violence, we have more systems in place that encourage them to be more verbal about not tolerating this and reporting the violent acts,” Zangerle tells Chief Healthcare Executive®.

Other generations of nurses have dealt with physical assaults and viewed it as a reality of the nursing profession. Zangerle says she is glad that younger nurses don’t have that perspective.

“We have beat the drums to say: This is not just part of your job,” Zangerle says. “And the Gen Z's are listening to us, and they're being verbal about it.”

• Read more: Emergency doctors urge Congress to help with violence