Patient Assaults on Nurses: 5 Things Nurses Should Do

Violence against nurses is common and getting more so. It happens most often in emergency departments and long-term care, and most often with patients who are mentally unstable or under the influence of alcohol or drugs. Nurses have a higher rate of work-related assault than police officers, yet most incidents never get reported.

The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as any physical assault, threatening behavior, or verbal abuse in the workplace. It runs the full range, from open aggression to hidden aggression, from a verbal threat to homicide.

Major nursing bodies have stopped treating this as background noise. In 2015 the American Nurses Association issued a position statement, Incivility, Bullying, and Workplace Violence, calling for evidence-based strategies to prevent it and to limit the harm when it happens. The Emergency Nurses Association names violence against nurses a serious occupational risk that demands action from employers, law enforcement, and the community. Here is what to do.

1. Never accept violence as part of the job

Most assaults on nurses go unreported. Part of the reason is that nurses excuse the behavior as part of the patient's condition: "He couldn't help it," "She was drunk." Part of it is the fear, real or imagined, that management does not care or that speaking up puts your job at risk. Drop that framing. When a nurse is injured in an assault, treat it like any other workplace injury covered under health and safety law: report it, investigate it, and get the nurse proper treatment, including trauma counseling.

2. Take action after an assault

If you are assaulted, get to a safe area and have a coworker cover for you. Call security or police as needed. Report the assault to your supervisor and your union. You can start verbally, but put it in writing too. You have the civil right to file a police report; use it.

Ask your supervisor to arrange medical attention under your facility's injury-on-duty policy, and ask for trauma counseling to head off PTSD. This is not precautionary paperwork. Nurses have left the profession over assaults. One nurse with more than 30 years in the ER stayed through repeated attacks, but after a patient strangled her with her own stethoscope she ended her career, with no support from coworkers or management and no one who seemed to care when she resigned. Another said after an attack, "I don't think I can go back there. I have nightmares. I have anxiety when people get too close behind me."

Keep personal copies of every report, photos of your injuries, and a dated log of events (who, what, when, where, how) before, during, and after. Go back to work only when you feel safe and ready.

3. Support coworkers who have been assaulted

An assault leaves the nurse shaken, fearful, and stripped of confidence, and that impact is often missed by everyone around them. Be the person in their corner: help them report to management, write up the incident and police reports, and go with them to the doctor or to court. Push your unit to build a peer-support system. It works, and it makes the assaulted nurse feel safe, valued, and respected.

4. Advocate for adequate organizational policy

Every organization should have real policy and real measures for handling violence. Many do not, because they weigh the visible incident counts and miss the hidden costs. Nurses can push for better. Good policy covers incident reporting and followup investigation that surfaces root causes like understaffing, de-escalation training, and flagging the records of patients with a history of violence. It also spells out how incidents get managed and how the affected staff member gets supported, with HR accountable for carrying it out. Your union or association can help you deal with the employer, and the strongest moment to push is right after an incident, while it still has attention.

5. Join nursing groups advocating for legislation

Nursing organizations worldwide are treating workplace violence as a priority and lobbying for stricter laws and stiffer penalties. Support that fight wherever you have influence.