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Violence Against Nurses: A Timeline and a Blueprint for Increased Workplace Safety

Jane Nam
Updated December 8, 2023
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    Violence against nurses is on the rise. Find out the most recent incidents to make headlines and the steps healthcare centers can take to provide a safer workplace.
    Medical team meeting togetherCredit: Getty Images
    • Healthcare workers, especially those working in the emergency department, experience high rates of workplace violence.
    • Addressing the issue of patient-to-staff physical assaults can be as simple as implementing screening processes, which have been shown to decrease assault incidents.
    • In one case, the rate of 0.265 patient-to-staff assaults per 1,000 patient visits decreased to 0.146 per 1,000 patient visits.

    In October 2023, emergency room nurse Tristin Kate Smith took her own life after what she described as abuses she experienced at her work. The 28-year-old openly titled her final note, “Letter to my abuser,” in which she detailed the times she saw colleagues get hit, criminally charged, and exploited.

    Sadly, Smith is not an outlier. According to the World Health Organization, up to 38% of health workers experienced physical violence at some point in their careers. In addition, nurses die by suicide more frequently than people in the general population.

    A 2018 American College of Emergency Physicians survey found that workplace abuse topped 70% for emergency room (ER) nurses. (Note: Nurses were not asked the same question for the 2022 survey).

    Violence against nurses is on the rise, but this does not have to be the reality. In this report, we give a timeline of recent incidents of violence against nurses. Finally, we provide some solutions for how healthcare centers can respond to increase workplace safety.

    Violence Against Nurses: A Recent Timeline

    The following events are recent incidents of violence against nurses to make national headlines. It is not an exhaustive list of all occurrences.

    July 2023 | Washington State

    In July 2023, nurse Brad Rathke of Virginia Mason Medical Center in Seattle, Washington was stabbed in the jaw with a metal butter knife by a patient. Allison Smith, a nurse from the same hospital, was punched in the face by a patient less than a year after she started working at the hospital.

    September 8, 2023 | Rhode Island

    Thirty-seven-year-old George Bower attacked a nurse after being told he could not use a phone at the Rhode Island Hospital where he was a patient.

    Rhode Island Department of Health spokesperson Joseph Wendelken said the state does not track incidents in which healthcare workers are attacked. He told Target 12 news via email, “We do not collect data on patient acts of violence against staff,” while they do “collect instances of staff aggression against patients.”

    September 23, 2023 | Arkansas

    A nurse at St. Bernards Medical Center in Jonesboro, Arkansas, was choked by a man trying to get past hospital staff. According to police reports, the nurse lost her voice for several hours as a result of the assault.

    September 30, 2023 | New York

    Two nurses were stabbed by an ICU patient at Saratoga Hospital in Saratoga Springs, New York. The injuries for both nurses were reported to be non-life threatening, and the nurses were expected to fully recover. Sixty-year-old Hudson Falls resident Scott W. Williams was taken into custody and charged with two counts of assault on the following Sunday.

    October 14, 2023 | Idaho

    Thirty-three-year-old Ignacio Ortiz Garibay was charged with battery for physically assaulting a healthcare worker at Portneuf Medical Center in Pocatello, Idaho. According to witnesses and backed by security footage, Garibay punched a nurse three times in the arm.

    Potential Solutions for Workplace Violence Against Nurses

    What is the best way to address workplace violence against nurses? One possibility is to enact laws that will protect hospital staff.

    For example, North Carolina passed a new law that requires hospitals with emergency departments to have a law enforcement officer on-site at all times. The new state law takes effect in 2025.

    In April 2023, the governor of Kansas signed a bill that increased penalties for individuals who commit battery towards a healthcare provider.

    But how can healthcare institutions enact their own violence prevention plans? According to Sheila Mallett-Smith, the clinical nursing director at LA General Medical Center, any hospital or healthcare facility looking to design and implement its assault prevention plan should include some key elements:

    1. Identify patient risk characteristics at the facility and in literature
    2. Early screening to identify patients at risk of aggression/violence
    3. Alert system to flag patients who have physically assaulted staff on previous visits
    4. Training staff on de-escalation techniques, injury prevention, and assault prevention strategies for patients identified at risk upon arrival
    5. Behavioral response team of experts in de-escalation and restraint application
    6. Workplace Violence Committee to monitor, track, trend and adjust strategies to reduce and sustain reduced verbal and physical assaults
    7. Implementation of procedures to mitigate common triggers of violence
    8. Strong and visible leadership support for zero violence
    9. Policies and procedures that support aggression/violence reduction

    Mallett-Smith is also the first author of a 2023 article in the Journal of Nursing Care Quality, in which the authors present the effectiveness of an assault intervention initiative used in the emergency department.

    Prior to the implementation of the workplace violence prevention model, there was a rate of 0.265 incidents of physical assaults for every 1,000 patient visits by patients towards staff.

    After the utilization of “Plan-Do-Study-Act” prevention systems, which incorporated risk for violence screenings (RVST) of adult patients in the emergency department, the rate of assaults decreased to 0.146 per 1,000 patient visits.

    Some states have implemented workplace violence policies.

    In October 2023, Massachusetts lawmakers held a hearing on legislation requiring hospitals to design and implement policies that would better prevent violence against healthcare workers.

    Part of the bill required employers to perform annual risk assessments and identify factors that threaten worker safety (e.g., time of day, staffing levels).

    Page last reviewed on November 19, 2023