Hospital violence cost more than $18 billion, and the price tag could be higher

Hospitals are losing staff members who are tired of being assaulted when they try to care for patients, and they’re finding that it’s costing them a great deal of money as well.

Violence in hospitals cost health systems an estimated $18 billion in 2023, according to a new report released by the American Hospital Association.

The cost of hospital violence was estimated at $18.27 billion in 2023, according to a report released Monday morning by the American Hospital Association. Researchers at the University of University of Washington School of Medicine’s Harborview Injury and Prevention Research Center performed the analysis.

Aaron Wesolowski, the American Hospital Association’s vice president of policy research and analytics, tells Chief Healthcare Executive® that there was no expectation on the anticipated cost. But he said it is “a really large number.”

“I don't think it's a surprise to anyone in the hospital community,” Wesolowski says. “It really just recognizes the reality that hospital leaders have been facing for a few years.”

The report also aims to help document the higher levels of violence in hospitals since the COVID-19 pandemic began in 2020.

“We've seen very real increases in violence and threatening behavior aimed at healthcare workers in the last five years, really, since the pandemic,” Wesolowski says.

Most of the costs ($14.65 billion) were described as “post-event costs,” including treating victims, losses in staff productivity and repairs to facilities after violent incidents.

Researchers estimated hospitals spent $3.62 billion in efforts to prevent violence, such as training, improving security and buying new technology.

The cost analysis does not include projections on how much hospitals are spending to recruit staff members to replace employees who have left their jobs due to violence. Wesolowski says it’s conceivable the cost of violence is higher than the report’s estimate.

“The report talks about sort of the pressures that the violence puts on recruitment and retention, but that's really difficult to quantify,” Wesolowski says. “So when you roll that in, the effects are likely even larger than what we've seen here.”

The report clearly doesn’t capture some costs, including the emotional trauma of attacks on victims and those who witnessed the violence, researchers say.

The study also doesn’t include the impact on patient care if treatment is delayed because staff are focused on subduing a violent individual and restoring order, Wesolowski says.

“There's no easy way to quantify that,” he says, adding, “It's absolutely happening … disentangling that piece and putting a number on that is really difficult.”

In addition to the estimated cost, researchers also compiled other data shedding more light on the impact of violent incidents in hospitals.

An estimated 16,990 hospital workers had an injury or illness related to a violent incident that required days away from work in 2022.

Hospital trade groups and other healthcare organizations have been pushing Congress to pass federal legislation to offer more protections for healthcare workers. Hospital and clinician advocates have urged Congress to pass legislation that would impose greater penalties for those who assault hospital workers, similar to federal protections offered for those working in the airline industry.

Members of Congress have introduced such legislation in the past, and despite bipartisan support, lawmakers haven’t managed to get a bill to the president’s desk. Lawmakers have recently re-introduced similar bills in the House and Senate and the American Hospital Association is backing the legislation.

“We think it's really sort of a fundamental need to make sure that there are consistent consequences for assaulting healthcare workers,” Wesolowski says.

Nursing leaders tell Chief Healthcare Executive® that violence in hospitals hasn’t dropped in recent years, even with greater attention to the issue.

“If anything, it's getting worse,” Ryan Oglesby, president of the Emergency Nurses Association, said in a recent interview. “I think it's getting more and more common.”

More than half of all emergency nurses say they have been physically assaulted, verbally harassed or threatened with violence in the past 30 days, according to a survey by the Emergency Nurses Association.

Hospital and nursing leaders say staff in all areas of the hospital are seeing more violence and hostility.

The violence in hospitals is making it harder to retain good nurses, and it’s deterring some nurses from pursuing jobs in hospitals, says Claire Zangerle, CEO of the American Organization for Nursing Leadership.

“The people that are driven away have influence on those people who potentially could come into the healthcare system,” Zangerle says. “They see what they've gone through, and they're like, ‘Yeah, I don't think I want to do what they've gone through.”

While organizations representing nurses are also pushing for greater federal protection for staff, they also say hospitals need to take a closer look at what they can do to protect employees and patients. Hospital leaders can also make headway by talking to their staff to find out more about potential security vulnerabilities and problems employees are facing.

Jennifer Mensik Kennedy, president of the American Nurses Association, says hospitals can look and focus on even one priority “without any type of regulation.”

“I'd encourage people to look at wellness and look at well-being, workplace violence in their own organizations,” she says.

• Read more: Special report: Nursing leaders cite problems that aren’t being fixed