By Sophie Putka

On average, 57 nurses are assaulted every day in the U.S. That's two nurses attacked every hour, according to an analysis using data from 2022.

To some advocates for nurse safety, the persistence of violence against nurses is nothing new. "There's very few protections for nurses because it's a female-dominated profession," said Gerard Brogan, RN, director of nursing practice at National Nurses United. "But as we saw, as with a lot of stresses on the RN profession during the pandemic, it amplified everything."

Press Ganey's National Database of Nursing Quality Indicators revealed that in the 3-month period from April to June, an equivalent of 5,217 assaults occurred at the 483 included facilities. Nurses faced the highest number of assaults in psychiatric units and emergency departments. While patients were most likely to attack nurses, attacks were also initiated by family members, co-workers, visitors, and intruders, and most attackers were men.

Of note, nurses in pediatric burn, rehabilitation, and surgery units also face frequent assaults. "Again, no surprise to us," said Brogan, who added that families with children can get particularly frustrated. "You get a lot of heavy emotion, which sadly sometimes manifests itself in a lot of verbal violence for sure and sometimes, sadly, physical violence."

Violence against healthcare workers has long concerned nurse groups and advocates, but research suggests that what was already a dangerous pattern may be getting worse. According to a 2021 American Federation of Labor and Congress of Industrial Organizations report on worker safety, rates of workplace violence in healthcare and social assistance settings have almost doubled since 2010.

The report also noted that during the same decade, "workplace violence rates for hospitals increased 95% -- specifically, 98% in psychiatric hospitals, although this difference has fluctuated over time and last year was much higher at 149%."

Moreover, employees at hospitals, nursing homes, and residential care facilities missed work because of violent incidents far more than employees from any other industry.

"Anecdotally, we're hearing there's been more and more violence as more and more people distrust the healthcare system," said Brogan. "And who interacts with the patients? Nurses and nurses' aides."

Indeed, the "leading occupations" for workplace violence in 2019, according to the U.S. Bureau of Labor Statistics, were nursing assistants, orderlies, psychiatric aides, and home health and personal care aides, followed by registered nurses.

"Violence toward nurses has reached an alarming rate, nearing, if not already, an epidemic. We are calling on all healthcare leaders to declare zero tolerance for hostility toward healthcare workers, improve caregiver well-being and advance our shared commitment to zero harm," said Jeff Doucette, DNP, RN, chief nursing officer at Press Ganey, in a press release.

Press Ganey suggested steps that healthcare organizations can take to protect workers, including implementing reporting systems, formal policies to identify risks, response plans, post-incident support, and training programs that teach de-escalation techniques.

Brogan said that requiring better staffing ratios is key. "The more staff you have, the less likely you are to be a victim of violence," he noted. De-escalation training is also critical, he added -- things as small as body language can make a big difference.

In addition, hospital administrations must also support their staff, Brogan stressed, citing the disconnect between administrators and clinical staff. "The nurse will have an awful photograph of themselves bruised, battered," he said, explaining that nurses have reported going to management only to be encouraged to not press charges and asked what they could have done better. "The administrators are not being assaulted. They're just not."