No safe space: violence against healthcare workers

Healthcare heroes bleed too.

The Growing Problem:

In addition to the attacks on science and healthcare now, there is an ongoing epidemic of violence in healthcare. This is not a story of isolated incidents, but a reflection of a growing trend, spectacularly demonstrated in February by three horrific situations.

An intensive care unit can feel like an alien landscape - a landscape of humming machines and beeping monitors, a place of tenuous life. In February, a gunman entered an intensive care unit at UPMC Memorial hospital, held staff hostage and ultimately killed a police officer and injured five other people (including a custodian, nurse and doctor). The motive: the gunman felt the hospital staff in the intensive care unit failed to save his family member. If you’ve spent any time in an intensive care unit, you know that this is a place in a hospital where everything is done until there is nothing left to offer. How does staff return to that place of fragile hope while haunted by the memory of this event? How do they return to save another life?

A Florida nurse, Leelamma Lal, was attacked by a patient in a hospital (a patient who had recently been designated as a “Baker Act,” which requires involuntary examination for individuals who pose harm to themselves or others due to mental illness). The patient should have had an observer and security to prevent harm to himself and staff. The especially damning part of the story is the 911 call from the hospital CEO, Jason Kimbrell:

CEO: "We had a Baker Act beat a staff member unconscious, now running around the building."

Operator: "You’re saying they beat an employee until they passed out?"

CEO: "Yes, knocked them unconscious. I’m not worried about that part. I need the Baker Act dealt with."

Operator: "Do you have the name of the Baker Act?"

CEO: "No. It doesn’t matter. I just need crews here."

Just to be clear, Leelamma Lal, a veteran nurse at Palms West has extensive facial fractures, a brain bleed and might lose her eyesight. And while the hospital claims that it was following all appropriate measures, the perpetrator was able to leave the hospital and was found outside running on a local road which begs the question, where was security? By virtue of the Baker Act, this patient should not be allowed to leave the hospital, let alone have the opportunity to attack Ms. Lal. Furthermore, in subsequent public statements that seem ironic given the 911 call, the very same CEO Jason Kimbrell is calling for more action to keep healthcare employees safer. If you are inspired by Leela’s bravery, consider contributing to her GoFundMe to support her long road to recovery.

In Chicago, in a busy emergency department, a man being treated for an infection stabbed one of the emergency physicians with a stainless steel kitchen knife in the chest and thigh. The physicians were sitting in an administrative area of the department completing charting and the myriad of tasks required caring for patients. Another physician intervened to put a chair between the victim and the suspect for their safety until security arrived. The physician had to be taken to a different trauma center for treatment as the emergency department there did not have the resources to treat a trauma victim. If you are wondering why did a patient in an emergency department have a kitchen knife along for the trip, you’re not alone.

Photo by Mulyadi on Unsplash

Even in my small slice of anecdotal evidence (though the body of literature is vast), there have been many incidents. A patient who didn’t agree with my plan of care first tried to swing an IV pole at me and when that didn’t work, changed tacts to use it as a javelin to hit me as I retreated. Colleagues have been face-to-face with a knife-wielding teenager in the pediatric ED. Colleagues have suffered concussions from medical equipment turned weaponry. Security told Dr. Vicky that they couldn't intervene until someone was "physically assaulted"—as if we're supposed to use our bodies as the tripwire for security response.

These harrowing events are not isolated anomalies. They represent a deeply troubling pattern of violence that permeates healthcare settings across the country. What constitutes workplace violence? It's not limited to physical assaults. It encompasses a spectrum of behaviors, including verbal abuse, threats, and intimidation, all of which have a devastating impact on healthcare professionals. Healthcare workers, by the very nature of our profession, are uniquely vulnerable to violence. We interact with individuals who are often experiencing heightened emotions, pain, and distress, which can escalate into aggression. The consequences of this violence extend far beyond the immediate physical and emotional harm inflicted on individual workers. It erodes morale, contributes to burnout, and ultimately compromises patient safety.

Scope of the problem:

The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence (WPV) as violent acts (whether assault or threat of assault) directed towards someone at work. The most common type in healthcare violence is violence perpetrated by someone receiving services: patient, client or customer.

In general, workplace violence across other industries is decreasing but the rate of violence in healthcare is rising. Healthcare workers are estimated to be 4-5x more likely to be victims, but the Joint Commission estimates significant underreporting. Healthcare workers are approximately 14% of the workforce in the US but experience >60% of all workplace assaults. Most studies showed that violence against healthcare workers increased during the COVID-19 pandemic. In the emergency department, a poll in 2024 of the American College of Emergency Physicians noted that 91% of emergency physicians or one of their colleagues was a victim of violence in the past year. Additionally, 85% of emergency physicians think the rate of violence in the ED is increasing.

Seeking care or supporting a loved one in the hospital is often a fraught experience. Yet, the notion of harming those dedicated to healing is a profound betrayal. The emotional toll on healthcare providers is devastating including: increased depression, anxiety, and a pervasive fear that erodes job satisfaction and performance. Compounding this trauma is the insidious normalization of violence, the dismissal of assaults as 'just part of the job.' This trivialization silences victims and perpetuates a cycle of harm, ultimately compromising the very foundation of compassionate care.

What is being done? Not much…

In April of 2021, Congress introduced the Workplace Violence Prevention for Health Care and Social Service Workers Act to create federal workplace violence prevention standards which would require employers to:

1. Implement a risk assessment and prevention plan (things we should already by doing)

2. Provide workplace violence prevention training (beyond bob and weave)

3. Investigate occurrences of workplace violence and administer corrective actions (fill out this form after you regain consciousness)

The Senate promptly referred it to the Committee on Health, Education, Labor and Pensions, where it has peacefully resided for FOUR YEARS without passing. This will surely become easier with recent moves to abolish OSHA (sarcasm). And given that current federal law doesn't require states to regulate workplace safety, who will take responsibility? Probably the same people who thought "thoughts and prayers" was an adequate response to the last crisis.

Enter The Safety from Violence for Healthcare Employees (SAVE) Act, the newest bipartisan legislation that would establish first-ever federal protections against violence for healthcare workers, making it a federal crime to intentionally assault a health care worker and interfere with their ability to carry out duties. This has been compared to the legal protections for frontline airline members which increased fines for interfering with crew member instructions and expanded protections against passenger assaults through new requirements on carriers.

Meanwhile, as we wait for these bills to gather dust, healthcare workers continue to play a real-life version of “what bad thing might happen today” on our shifts. While we can get a patient from the ED to the OR in minutes for a life-threatening condition, the legislation to protect the people providing that care moves with the glacial pace we’ve come to expect from our deeply divided legislature.

The Hospitals Against Violence (HAV) host a #HAVHope day (this year June 6, 2025) is an initiative to reduce violence in the hospitals. While the graphics are snazzy, it’s hard not to feel like these are like the required wellness programs from hospitals targeting burnout or moral injury. Good in theory, limited in practicality.

Courtesy of AHA.org, Hospitals Against Violence

On a yearly basis, I have a refresher assigned to me for AVADE training, that purports to create a culture of safety in my workplace through modules that are targeted towards “preventing conflict, violence, aggression through clear communication and de-escalation techniques”. However, many interventions designed to prevent aggression have not been shown to be beneficial. I can’t say that sitting through videos or the one in-person workshop which could be summarized by saying “invest in some self-defense classes” left me with any confidence that I would be able to defend myself, colleagues and/or other patients should a situation escalate.

This might seem wild to anyone who doesn't work in healthcare, but it's unfortunately become commonplace. And who's going to prevent this from occurring? Hospital security guards—often expected to handle dangerous situations with minimal training—earn just $16-$21/hour in Boston. That's $34,000-$46,000 annually in one of America's most expensive cities. For context, that's about the price of treating one moderate concussion from a flying Mayo stand.

Surprisingly, only one-third of U.S. hospitals use metal detectors to screen patients and visitors. The excuses are predictable: concerns about patient flow, negative perceptions, space requirements. Yet when actually implemented, both staff and patients overwhelmingly support these measures. Additionally, universal screening reduces the likelihood of inappropriate patient and visitor profiling. At a San Diego trauma center, universal screening with metal detectors led to confiscating an arsenal that would make TSA blush: knives, firearms, stun guns, box cutters, screwdrivers, and even sterno (because nothing says "get well soon" like bringing flammable cooking fuel to a hospital visit).

Maybe I'm biased from my experiences, but even as a patient, I'd feel safer knowing the person next to me in the waiting room isn't packing heat or a box cutter. Healthcare workers already wear invisible armor every day—compassion despite exhaustion, focus despite chaos. The least we deserve is not having to dodge actual weapons while trying to save lives.

What does violence against healthcare workers mean for you as a patient?

The ripple effect of violence in healthcare sectors has a significant impact on the delivery of healthcare. The atmosphere of the therapeutic space is fundamentally changed when fear of violence enters. It has been shown to cause a decline in the quality of care (medication errors, patient infections), increased absenteeism and healthcare workers’ decisions to leave their jobs. In the United States, the healthcare workforce is already at a breaking point after the COVID19 pandemic in which burnout, long working hours and the emotional toll has profoundly changed the landscape of the job. Experiences of workplace violence has been shown to increase the likelihood of intention to change jobs in both nurses and physicians.

What Can YOU Do? (Because Legislators Are Moving at the Speed of Hospital Jell-O)

1. Be Alert: If you're a patient in the ED, be alert. We are sorry that amongst your own medical emergency you even have to think about the environment as other than healing. While we don't expect you to tackle anyone, if something feels off—like that guy twirling a scalpel he definitely didn't get from the gift shop—alert staff. Your "see something, say something" might prevent a situation from getting out of hand.

2. Leverage those Surveys: Hospitals worship at the altar of Press Ganey scores. When asked "How was your care?" write "Great, except for the lack of metal detectors!" Nothing motivates healthcare administrators like the threat of losing their precious patient satisfaction metrics. Let's use that customer-is-always-right energy for good.

   

3. Contact Your Representatives: Call, email, or carrier pigeon your lawmakers about supporting the SAVE Act. If your state has local legislation to protect healthcare workers, advocate for it. Remind them that in the time it took to read this article, another healthcare worker probably dodged being assaulted.

4. Vote for Gun Control: We said what we said, less guns in the community mean less guns in hospitals. If you have a gun, leave it at home, it does not belong in a hospital.

5. Practice Patience: If your provider seems rushed or distracted, remember they might have just watched a colleague get concussed by medical equipment or been told that verbal threats "don't count" as requiring security intervention. We are human too and sometimes need a minute to regroup and refocus. At the end of the day, we’d rather focus on your medical care than our survival instincts.

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Have you experienced or witnessed violence in the healthcare setting? Drop a comment about what you’ve seen, what helped (or didn’t) or how it affected your care experience.

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Disclaimer: The content provided in Couch Nap is for educational and entertainment purposes only. It is not intended as medical advice, diagnosis, or treatment. It does not establish a doctor-patient relationship. Always consult with your healthcare professional regarding any medical concerns or decisions. The views and opinions expressed here are our own and do not represent the positions, policies, or opinions of our employers or any affiliated organizations. While we strive for accuracy, the information presented here may not apply to your unique situation.