By Jodi Helmer

Terry Bartmus, DNP, has been bitten, hit, choked, and threatened since she started working in the emergency department in Las Vegas in 2009. Worse, there’s been no improvement in the violence.

“I noticed a significant change during COVID, especially when we were on lockdown, of people…lashing out at [hospital] staff,” said Bartmus, a nurse practitioner in the emergency department and assistant professor at Touro University Nevada in Henderson, Nevada. “I definitely have seen more [workplace violence] in the last 5 years.”

The latest data from National Nurses United showed that 8 in 10 nurses have experienced at least one incident of workplace violence, and 45% reported an increase in workplace violence on their unit in the past year. The violence registered nurses (RNs) experience includes verbal and physical threats of being pinched, scratched, slapped, punched, and kicked.

“It’s sad to me that the violence has [become] just a part of the career,” Bartmus said. “There are just some facilities that don’t take it seriously.”

Underreporting Violence Is Common

The perpetrators of violence against nurses can range from patients who are under the influence of drugs or alcohol or experiencing mental health issues to grieving families. The hospital experience, including long wait times, unmet expectations, and feelings of anger and powerlessness, can also contribute to violence. Regardless of the cause, workplace violence takes a toll on nurses.

As a result of rising rates of workplace violence, nurses often experience increased job stress, absenteeism, burnout, fear, and posttraumatic stress disorder. Workplace violence has become such an epidemic in healthcare that 26% of nurses are considering leaving the profession.

The issue has even been highlighted on primetime television. In the medical drama The Pitt, a patient frustrated with long wait times in the emergency department of the fictional Pennsylvania hospital in Pittsburgh violently punches a charge nurse in the face, knocking her to the ground. The nurse goes home after that shift, knowing she likely won’t return.

Despite the toll that workplace violence takes on nurses, incidents often go unreported. Issues include poor or nonexistent hospital policies and procedures, complex reporting procedures, and beliefs that patients cannot be held accountable for their actions as reasons that up to 80% of workplace violence against nurses is never documented. Bartmus pointed to a “lack of consequences” for patients as another reason that nurses are often reluctant to report violent incidents.

“In aviation, even a verbal threat is grounds for being removed from a plane, being reported, and oftentimes the police are called,” she said. “That’s not necessarily the case in the hospital.”

In fact, the Emergency Medical Treatment and Labor Act mandates that healthcare providers screen all patients who come into the emergency department and provide stabilizing treatment. The legislation expects that hospitals will have protocols in place to manage violent patients and can enact those protocols while following the legal requirement to provide screening and treatment.

Bartmus admitted that she once didn’t report a violent incident that happened while she was working the night shift because she didn’t want to call her nurse manager or deal with the paperwork; she has also heard from peers who decided not to press charges because of the hassle of a court hearing or an unwillingness to bog down the police department.

Gordon L. Gillespie, PhD, DNP, adjunct professor at the University of Cincinnati College of Nursing, Cincinnati, and chief program officer for the National League for Nursing, Washington, DC, was often the target of violence when he worked in the emergency department of a community-based hospital from 1998 to 2012. Even nurses who don’t want to file reports with law enforcement should still report physical violence, verbal aggression, and threats internally.

“Institutions should make it required,” he said. “Increased reporting [provides] measurable data that you can act on.”

Internal reporting would make it possible to document violent incidents in the electronic health record, triggering a risk flag that would alert nurses to a higher risk for violence the next time the patient seeks care.

Curbing Workplace Violence

Unfortunately, many hospitals fall short when it comes to addressing workplace violence. A recent healthcare workplace report found that 43% of nurses said hospitals ignored their complaint of workplace violence and 12% said that administrators sided with the perpetrators. Moreover, 74% of healthcare organizations fall below the benchmark for a safe work environment and have “notable gaps” in workplace safety and preparedness, putting nurses at risk.

“We get annual inspections by local departments of health and the fire marshal, but we don’t have…comprehensive safety assessments,” said Nora Warshawsky, PhD, RN, nurse scientist at Press Ganey in Chicago.

“We talk about zero harm for our patients…but we also need to have a zero-harm culture for our staff.”

Implementing violence prevention programs, investing in de-escalation training, and enhancing security measures can help create safer work environments, she added. Warshawsky also believes that technologies like wearable panic buttons, video monitoring, and weapons screening could help nurses feel more secure and lead to faster incident response.

Legislation could help address the issue. The bipartisan Workplace Violence Prevention for Health Care and Social Service Workers Act was reintroduced in both the Senate and House in April 2025, and it would require healthcare organizations to implement comprehensive workplace violence prevention plans. It will also establish a set of minimum standards that all healthcare organizations must follow, ensuring there is continuity in violence prevention even when there is staff or leadership turnover.

A previous version of the bill introduced in 2023 did not pass. Gillespie is hopeful that the reintroduced legislation will pass, but regardless of the outcome, he encourages nurses to report workplace violence.

“Violence is not in your job description; violence is not ‘other duties as assigned,’” he said. “Violence is a problem of a troubled community and a healthcare system that needs to evolve, and one of the first steps to doing that is to report 100% of those problem behaviors because that puts the healthcare system on notice that they must act.”

Jodi Helmer is a freelance journalist who writes about health and wellness.