When Did Getting Assaulted Become Part of the Job Description for Nurses?

There is a statistic every nurse, healthcare leader, legislator, and patient should know: hospital workers are seven times more likely to be injured on the job by violence than workers in the general U.S. workforce. The statistic is based on Bureau of Labor Statistics injury data and was recently highlighted in Medical Daily. (Medical Daily)

Seven times! We would never accept an injury rate like that as simply “part of the job” in almost any other profession. Yet somewhere along the way, violence against nurses and other healthcare workers became something we almost expect. A patient punches a nurse. A family member threatens a nurse. A confused or agitated patient kicks, scratches, bites, spits, or shoves someone who is trying to provide care. Then, sometimes, instead of asking how the system failed to protect that nurse, we ask the nurse, “What could you have done differently?”

That is what I find so disturbing about this report. The seven-times figure only measures recorded injuries resulting from violent acts. It does not measure every threat, shove, grab, bite, kick, or frightening encounter that never makes it into an incident report. In fact, Medical Daily cites survey data in which 52% of nurses and technicians reported experiencing some form of workplace violence during the previous year, while 70% said they did not report every incident and 39% reported none of their incidents. (Medical Daily) In other words, the statistics may only be showing us part of the wound.

As nurses, think about how we would respond if we discovered that patients on a particular unit were seven times more likely to suffer an injury. We would not shrug our shoulders and say, “Well, that is what happens when you are hospitalized.” We would investigate. We would conduct a root-cause analysis. We would look at staffing, policies, environmental risks, security, training, response times, and leadership accountability. We would develop interventions and then measure whether those interventions worked. Yet when the person being injured is the nurse, the response too often seems to be another de-escalation class and a return to the floor.

De-escalation training has value, but we cannot educate our way out of a systems problem. Patients may be frightened, confused, intoxicated, withdrawing from substances, experiencing a psychiatric crisis, or suffering from cognitive impairment. Those clinical realities absolutely matter, and nurses understand them perhaps better than anyone. But understanding why someone becomes violent does not mean nurses should be expected to absorb that violence. Compassion and personal safety are not mutually exclusive.

We also need to talk about staffing. Medical Daily points to conditions that can contribute to violence, including staffing levels that leave healthcare workers alone with agitated patients, psychiatric patients remaining in emergency departments for days while awaiting appropriate placement, and long waits that increase frustration. Even worse, violence and understaffing can create a vicious cycle. Healthcare workers who are assaulted may leave, and those departures can

worsen the staffing conditions that increase the risk of future violence. It is the healthcare equivalent of trying to stop a hemorrhage while simultaneously pulling out the IV.

Many states have tried to address this problem through tougher criminal penalties. According to the report, at least 45 states have enacted enhanced penalties for assaulting healthcare workers. Yet the enormous injury disparity remains. Accountability is important, but increasing the punishment after a nurse has already been punched, bitten, kicked, or seriously injured is not the same as preventing the assault in the first place.

We need prevention as much as punishment. That means adequate staffing, appropriate security, systems for identifying known risks, rapid assistance when a nurse calls for help, meaningful workplace violence prevention programs, support after an assault, and leadership that takes incident reports seriously. It also means creating a culture where nurses are encouraged to report violence rather than being made to feel that being attacked is simply an occupational hazard.

For too long, nursing has had a culture of accepting things because “that is just nursing.” Missing lunch is just nursing. Working short is just nursing. Staying late is just nursing. Getting screamed at is just nursing. Being threatened is just nursing. Getting hit is just nursing.

No, it isn’t.

Being compassionate does not require becoming a punching bag. Being a patient advocate does not mean surrendering your own right to safety. Understanding that someone is sick, confused, frightened, or impaired does not mean preventable violence should be tolerated or normalized.

Nurses spend their careers protecting everyone else. They recognize changes in condition, prevent medication errors, catch problems before they become catastrophes, advocate when something does not look right, and stand between their patients and harm every single day. It is long past time for our healthcare system to become equally serious about protecting them.

Violence should never be considered part of the nursing job description. And perhaps the most disturbing part of this study is not simply that hospital workers are seven times more likely to suffer a workplace injury from violence. It is that we have allowed the problem to become so common that many nurses no longer believe an incident is even worth reporting.

That is the part we have to change.

Because nurses should never have to choose between caring for their patients and protecting themselves.