Workplace violence in health care settings is on the rise, significantly affecting physicians and nurses. According to the U.S. Bureau of Labor Statistics, health care professionals, particularly nurses, face a risk of violence that is 16 times greater than workers in other industries. In the U.S., health care workers face a workplace violence injury rate of 7.8 per 1,000 workers annually, markedly higher than the rate of less than 2.0 per 1,000 in other private industries. In 2015, assaults accounted for 27 out of 100 workplace fatalities among health care workers. In 2016, in-facility violence costs across the U.S. reached $428.5 million, according to the American Hospital Association.
A 2018 survey by the American College of Emergency Physicians of 3,500 emergency physicians found that almost half reported having been physically assaulted at work, with 60% of those incidents occurring in the previous year. Of these assaults, 97% were perpetrated by patients. Among assaulted physicians, half indicated that at least 50% of these incidents were linked to individuals either seeking drugs or under the influence of drugs or alcohol. More than 80% of emergency physicians reported having been threatened by a patient who expressed intent to return and harm them or staff.
Global Insights: Prevalence and Impact of Violence on Health Workers
A comprehensive review published in Aggressive and Violent Behavior analyzed over 100 studies examining the frequency of aggressive behavior and violence toward physicians in hospital settings. The findings indicated healthcare workers experience violence at varying levels globally, with prevalence rates ranging from 23.9% to 87.5% during their careers. This violence includes aggression from patients, as well as their patients' friends and family, and can be classified as verbal (47%-96.8%), physical (17.2%-51%), and sexual harassment (0.9%-21.8%). Research indicates younger physicians experience higher levels of aggression from patients and their patients' friends and family. The aftereffects of such encounters can be severe, with reported minor or moderate injuries ranging from 10.6% to 34.8%. Additionally, physicians may experience psychological impacts, including depression (25.2%-75%) and fear.
In Current Psychiatry Reports, it is noted that violence stems from both psychiatric and non-psychiatric patients. Approximately 48% of non-fatal workplace violence occurs in healthcare settings, with around 50% of healthcare workers experiencing workplace violence at some point in their careers. The U.S. Bureau of Labor Statistics reports that nearly 75% of the 24,000 workplace assaults recorded each year from 2011 to 2013 took place in health care. Among emergency department staff, fewer than half of psychiatrists (40%) reported experiencing physical assaults throughout their careers. A survey in Germany indicated that 90% of physicians experienced aggression, with 70% encountering it in the prior year. In India, approximately 75% of physicians report violence in their practice, particularly those with less than five years of experience. The violence is linked to mental health issues and burnout, and a significant portion remains underreported, with only about 16% of assaulted workers in some countries disclosing these encounters.
Violence Can Vary Across Health Care Settings
Earlier this year, gynecologist Steven Silvers, DO, was assaulted following a procedure he performed on Carolina Perez and the subsequent prescription of opioids. Perez's son confronted Dr. Silvers at Mount Sinai Medical Center in Florida. In court, Dr. Silvers recalled, “I was going to my office and, at 8:15 in the morning, I briefly had an interaction with this gentleman and then I turned to walk away, and he jumped me from the back and beat me …” Surveillance footage captured what the judge later described as a “savage” attack. Dr. Silvers sustained serious injuries, including fractures to his sinus, face, skull, collarbone, and ribs, as well as a concussion and brain bleed.
In Virginia, Latisha Shannon, RN, was attacked by a patient on a psychiatric floor. Recounting the incident, Shannon stated, “He pulled me down to the ground and he started dragging me. As he's dragging me, he's punching me in my face, in my head, over and over and over again. And I'm just screaming, ‘Please get him, help me, help me.’” With 25 years of nursing experience, Shannon had only recently joined the facility. She sustained bruises and injuries to her shoulder, neck, face, and jaw. Due to the facility’s cameras providing only a live feed, the incident was not recorded. Expressing concerns over safety, Shannon questioned, “How is that safe for us and the patients?” Beyond physical injuries, she has been diagnosed with post-traumatic stress disorder. “Do they think that when something like this happens that its just physical? It's not,” she added.
In October, three emergency room nurses at Penn Presbyterian Medical Hospital in Pennsylvania were injured while attending to a gunshot victim dropped off at the hospital. The driver of the vehicle struck all three nurses as they were assisting the patient. Two nurses were left in stable condition, while one was in critical condition. A hospital spokesperson stated, “Our heroic staff continued to save the gunshot victim and care for all our other patients even as their own colleagues were suffering and being treated.” Jennifer Potchen, president of the Emergency Nurses Association, Philadelphia chapter, commended the nurses’ selflessness, stating, “These nurses are going out selflessly. They aren't thinking about themselves. They are going directly out to save a life …”
The increase in violence against health care professionals can be attributed to inadequate security measures in facilities, as well as insufficient education and training on violence prevention and de-escalation techniques. Enhancing security protocols, such as weapon screening and controlled access points, may mitigate risks. Implementing violence reporting systems and conducting patient risk assessments can further protect health care workers from violence perpetrated by patients.
