Rising Workplace Violence in Healthcare: Trends and Risks

While workplace violence affects all sectors, the healthcare sector faces unique challenges. According to a federal government report from 2018, U.S. healthcare workers account for 73% of all nonfatal workplace injuries and illnesses due to violence. Healthcare professionals, particularly nurses, face a risk of workplace violence 16 times higher than workers in other sectors.  

Across the globe, workplace violence against nurses, doctors, and other healthcare workers has reached dire levels, with some researchers referring to it as a ‘viral epidemic’ or ‘pandemic.’ Heightened violence against healthcare workers produces immediate consequences of serious injury or death and negative long-term effects, including increased turnover and burnout, resulting in diminished quality of care. 

Healthcare professionals have seen a sharp increase in violence during and in the years following the COVID-19 pandemic. Though initially popular cultural movements celebrated health workers as heroes, a high degree of politicization, disinformation, and the implementation of strict prevention and control measures complicated the public’s relationship with healthcare workers. 

Underreporting of Hospital Violence  

The full scope of violence is difficult to capture due to underreporting, but a survey of the American College of Emergency Physicians found that 8% of respondents felt an increase in violence over the past 5 years, and 91% of respondents said they’d been victims of violence in recent years. A 2024 survey conducted by National Nurses United (NNU) found that 81.6% of responding nurses had experienced at least one type of workplace violence within the last year.

An annual survey by the International Association for Healthcare Security and Safety Foundation (IAHSSF) received responses from 192 hospitals across the United States and found that disorderly conduct was the most common criminal offense at a rate of 52.2 per 100 beds. The next most common crime was assault at a rate of 22 per 100 beds. 

The IAHSSF survey found the rate of violent crimes, including homicide, rape, robbery, and aggravated assault, rose from 1.4 per 100 beds in 2019 to an 8-year high of 2.5 per 100 beds in 2021. Simple assault reached a 10-year high with a rate of 22 per 100 beds in 2022. 

Many believe that the actual numbers of violence incidents targeting healthcare workers is higher due to underreporting — which can prevent meaningful interventions. Underreporting from healthcare workers is associated with prior experiences where reporting violence resulted in no fundamental changes, fear of consequences for reporting, or a perceived lack of managerial support. 

The NNU survey found that only 62.8% of nurses reported that their employer provided training specific to workplace violence, and only 31.7% reported that their employer had a clear way of reporting incidents. Distressingly, only 29.5% of nurses responding to the survey reported that their employer had staff available at all times to respond to workplace violence. 

International Hospital Violence Trends

Most violence in the healthcare sector is classified as type-2 workplace violence, client-on-worker violence. This includes violence enacted on healthcare workers by the families of patients, as well as violence perpetrated by patients and former patients. 

Within the healthcare sector, workers in emergency departments, intensive care units, and psychiatric and mental health units face greater exposure to violence. 

The scope of this problem is not unique to America. Investigations from around the world highlight challenges faced by healthcare professionals. A German study consulting with more than 800 doctors found that about 90% of them had faced violence or aggression during their career and 70% had experienced it within the last year. A review of violence against healthcare professionals in India found that approximately 75% of healthcare professionals will be subject to violence during their career. In Turkey, more than 70% of specialty physicians reported exposure to some form of violence. A study of mental health professionals in the Sudan reported that 33% of doctors reported physical assaults in the last year and 73% reported assaults throughout their whole career. 

International hospital violence trends show that young physicians and female physicians experience greater exposure to violence. Researchers have found employee-related factors —including communication skills, a perceived lack of empathy — can exacerbate patient tension and produce violence. Training initiatives in self-awareness, communication, de-escalation, and improvement of workplace relationships have been associated with improved workplace safety outcomes. 

Patient factors — including mental illness, a history of violence, intoxication, high levels of stress, and an accumulation of negative life events — can produce escalation to violent behaviors. Individuals who perpetrate violence usually display behavioral warning signs leading to violent actions. Training for staff to recognize these behaviors can have a significant impact on outcomes.

Healthcare Sector Security Challenges 

Research has determined several key institutional factors contributing to violence in healthcare workplaces. Long waiting times and a lack of information explaining these waiting times have been documented as a consistent catalyst for instances of violence. This can be improved by using leaflets and other clear and transparent communication methods to inform about daily operations at healthcare centers and explain wait times.

Hospitals that feature comforts and amenities such as private rooms, air conditioning systems, and televisions show lower rates of patient-initiated violence.

Public attitudes towards healthcare became more complex during the pandemic, where highly charged convergences of public health policy and controversial political and social issues could produce violence targeting healthcare workers. Today, contention around masking policies, abortion, and gender reassignment are politicized topics that can result in healthcare workers becoming targets of violence. 

Long-Term Effects of Workplace Violence in Healthcare 

Workplace violence in healthcare has many long-term consequences. It has impacted mental health and been associated with insomnia, post-traumatic stress symptoms, avoidance and hypervigilance, anxiety, absenteeism, and decisions to quit the medical professions. In addition to the negative impacts on hospital workers, it has also been associated with a diminished standard of care, including changes in decision-making, defensive medicine behavior such as excessive prescriptions of drugs, inappropriate referrals, and increased consultation requests.  

Pinkerton is here to help healthcare providers tackle workplace violence with confidence. Our Pinkerton Crime Index offers a detailed look at neighborhood crime patterns, helping you make informed resource decisions. Our seasoned team can conduct hospital security risk assessments to identify gaps and suggest practical solutions, from upgrading technology to adjusting staffing. Plus, when your key personnel face threats of violence, our team works with you to rapidly deploy the right tactical solutions and coordinate threat management services as high-risk situations unfold.