If you asked the average person to list professions with the highest rates of violent assault, few would put health care professionals high up on that list. But the reality is that when it comes to workplace violence, nurses, nursing aids, and paramedics have the dubious distinction of being very high up on the list; only police and correctional officers suffer a higher rate of on-the-job assaults. And many nurses say that the violence is only getting worse. In a fact sheet on violence, The International Council of Nurses, a federation of more than 130 national nurses associations representing the millions of nurses worldwide, says that:

• Health care workers are more likely to be attacked at work than prison guards or police officers.
• Nurses are the health care workers most at risk, with female nurses considered the most vulnerable.
• General patient rooms have replaced psychiatric units at the second most frequent area for assaults.
• Physical assault is almost exclusively perpetrated by patients.
• 97% of nurse respondents to a UK survey knew a nurse who had been physically assaulted during the past year.
• 72% of nurses don’t feel safe from assault in their workplace.
• Up to 95% of nurses reported having been bullied at work.
• Up to 75% of nurses reported having been subjected to sexual harassment at work.

The issue of safety for nurses and allied health professionals was brought to the forefront after the deaths of two California healthcare workers in separate incidents in a single week. Psychiatric technician Donna Gross was strangled to death and robbed at Napa State Hospital. Days later, nurse Cynthia Barraca Palomata died after being assaulted by an inmate at Contra Costa County’s correctional facility in Martinez. The deaths have sparked a new push for better security and stronger worker safeguards, particularly in settings treating prisoners and psychiatric patients.

While the occupational danger in environments like prisons and psychiatric hospitals is recognized and real, these are hardly the only high-hazard settings in which nurses work. Hospital emergency rooms are widely recognized as a hazardous environment, but violence occurs in other wards, too. The Well, a NY Times healthcare blog, featured an article by RN Theresa Brown entitled Violence on the Oncology Ward. And the CDC spotlighted research focusing on an increase in assaults on nursing assistants in nursing homes. In that study, 35% of nursing assistants reported physical injuries resulting from aggression by residents, and 12% reported experiencing a human bite during the year before the interview. There are no healthcare settings that are immune. Assaults routinely occur in general hospitals, in health clinics, and in patients’ homes.

And the Bureau of Labor Statistics reports:

Over the past ten years, healthcare workers have accounted for over half of the nonfatal workplace violence injuries involving days away from work across all industries.

The perpetrators of violence are varied: While many assaults are by patients, friend and family members of patients also can commit the assaults. There are also rapists or muggers who are targeting healthcare settings or solitary workers; drug addicts and robbers, who are looking for medications; and domestic violence also visits the workplace.

It’s unclear why violence is on the rise. Many point to staff shortages. Others see the preponderance of alcohol, drugs, and ready access to weapons as contributing factors; others think that hospital administrators do too little in the area of prevention.

One organization trying to help is the Emergency Nurses Association, which has issued a Workplace Violence Toolkit, targeted specifically at emergency department managers or designated team leaders.

Others are seeking legislative relief that would require hospitals and healthcare facilities to have safety and security plans and training in place.

As far back as 2008, the New Jersey legislature passed and enacted the Violence Prevention in Health Care Facilities Act, which states in part:

Within 6 months of the effective date of this act, a covered health care facility shall establish a violence prevention program for the purpose of protecting health care workers.

Although, writing in 2015, Ann Twomey, president of Health Professionals and Allied Employees (HPAE), New Jersey’s largest union of nurses and health care workers, opined:

Shockingly, the NJ Department of Health has failed to conduct any outreach to either employers or employees to inform them of their rights and responsibilities under the law. No surprise then that an informal survey of hospital staff HPAE conducted in 2013 found fewer than 50% of the respondents reporting their hospital was in full compliance with the law.

A bit biased? Perhaps, but the issue of workplace violence in New Jersey’s health care settings continues to be real and palpable. At Workers Compensation Psychological Network we have been privileged to assist a number of health care professionals  as they cope with PTSD and strive to return to work after suffering the trauma of a violent attack.

Sadly, we do not expect to see a rapid decline in that variety of patient.