After dedicating 31 years of my life to nursing, I've seen firsthand the incredible resilience and compassion of my colleagues. We've weathered storms, both literal and figurative, always putting our patients' needs first. But there's a dark undercurrent that has plagued our profession for far too long: workplace violence.

It's important to acknowledge the reality of workplace violence for nurses. According to a Press Ganey report, the rate of reported assaults against nurses hit an all-time high in 2023, reaching 2.71 per 100 personnel. In a 2023 National Nurses United survey, 8 in 10 nurses reported experiencing violence in the past year. This includes verbal abuse, threats, and even physical assault. The Emergency Nurses Association found a similar trend, with 56% of their members reporting violence within a 30-day period.

The consequences are devastating. Aside from the obvious physical harm, the psychological toll is immense. We're talking about PTSD, burnout, anxiety, and depression. This is driving nurses away from the bedside at an alarming rate. In fact, a staggering 10% of nurses surveyed by the ENA are contemplating leaving the profession due to violence. This exacerbates an already dire staffing shortage, compromising patient care and creating a vicious cycle.

I've personally witnessed the impact of workplace violence on my colleagues. I've seen the fear in their eyes after a patient lashes out, the tears shed after a verbal/physical assault, the resignation in their voices as they consider leaving a career they once loved. It's heartbreaking, and it's unacceptable.

But I refuse to give up hope and hospitals and legislators are taking action.

The top hospitals in the US are adopting a multi-faceted approach to reduce workplace violence against nurses, focusing on prevention, intervention, and post-incident support:

Proactive Risk Assessment and Mitigation

The fight against violence in hospitals is evolving, with data-driven strategies, innovative design, and proactive interventions taking center stage in protecting both healthcare workers and patients.

• Data-Driven Identification: Leading hospitals utilize advanced data analytics to identify patterns and predictors of violent behavior. This allows for proactive intervention and targeted security measures.
• Environmental Design: Hospitals are redesigning spaces to minimize blind spots, improve visibility, and provide safe areas for staff to retreat in case of escalation.
• Patient Screening: Some hospitals implement screening tools to identify patients with a history of violence or aggressive behavior, enabling them to take precautionary measures.
• Show of support (SOS): policies and procedures that support early identification of potential issues and allow staff to call out to colleagues to support them before situations escalate to verbal or physical violence.

Comprehensive Training and Education

Empowering nurses to navigate challenging interactions is crucial for maintaining a safe and respectful healthcare environment, and a multi-faceted approach that includes the following can be instrumental in achieving this goal:

• De-escalation Techniques: Comprehensive training programs teach nurses how to recognize escalating behaviors and use verbal and non-verbal communication to defuse tense situations.
• Self-Defense Training: Some hospitals offer basic self-defense training to empower nurses with skills to protect themselves if necessary.
• Cultural Competence Training: This helps staff understand and effectively communicate with patients from diverse backgrounds, reducing misunderstandings that could lead to conflict.

Robust Reporting and Response Systems

Beyond training, hospitals are fostering a culture of safety and support by implementing streamlined reporting, post-incident support, and zero-tolerance policies.  This support looks like:

• Streamlined Reporting: Hospitals are simplifying reporting processes, encouraging nurses to report all incidents, no matter how minor.
• Post-Incident Support: Comprehensive support is provided to victims and witnesses of violence, including counseling, medical care, and legal assistance.
• Zero Tolerance Policies: Clearly defined policies with swift consequences for perpetrators send a strong message that violence will not be tolerated.

Technology Solutions

In addition to staff training, hospitals are increasingly implementing technological safeguards to enhance nurse safety. These include:

• Panic Buttons: Many hospitals have equipped nurses with panic buttons or wearable alarms that can be activated discreetly to summon security personnel.
• Real-Time Location Systems: These systems can track the location of staff, enabling a quick response in case of an emergency.
• Video Surveillance: Strategically placed cameras can deter potential aggressors and provide evidence if an incident occurs.

Culture of Safety

Within a culture of safety, open communication channels and visible leadership commitment are fundamental for fostering a safe environment for both staff and patients.

• Open Communication: Hospitals are fostering a culture where staff feel safe reporting incidents without fear of retaliation.
• Leadership Commitment: Top-down support for safety initiatives is crucial, with hospital leaders actively participating in and promoting violence prevention programs.

Hospitals and Lawmakers Taking Action

I applaud hospitals like The Cleveland Clinic, for instance, which has introduced a system that uses data analytics to identify high-risk patients and situations, allowing for proactive intervention and prevention. Other hospitals, like Massachusetts General, have implemented buddy systems and increased security personnel in high-risk areas.

In California, hospitals like UC Davis Medical Center in Sacramento have begun proactively identifying high-risk patients and situations, allowing for early intervention and de-escalation. Additionally, they've expanded security technology with more cameras and panic alarms, while equipping security officers with body cameras and tasers.

The fight against workplace violence in healthcare isn't just a local issue. Legislators nationwide are recognizing the need for action, and California is at the forefront. In 2014, the state became a trailblazer by enacting comprehensive workplace violence prevention legislation, setting a powerful precedent for the nation.

A new bill in Oregon aims to crack down on violence against hospital workers while strengthening workplace safety. Led by Rep. Travis Nelson, a nurse with 20 years of experience, H.B. 4088 proposes tougher penalties for assaults, mandatory violence prevention plans for hospitals, and state-funded grants for security upgrades.

This legislation comes after years of healthcare workers feeling unsafe on the job, with Rep. Nelson himself recounting being "hit, spit on, and punched" multiple times.

If passed, the bill would require hospitals to submit violence reports to the state and prominently display warnings about the consequences of assaulting healthcare staff. It would also allocate funds for staff training and protective equipment like metal detectors.

And there's even more legislative hope on the horizon. In 2023, the Workplace Violence Prevention for Health Care and Social Service Workers Act, S.1176, was introduced in Congress by Senators Tammy Baldwin (D-WI) and Rep. Joe Courtney (D-CT) to prevent violence in healthcare settings. This bill, if passed, would require the Occupational Safety and Health Administration (OSHA) to create a federal standard for healthcare and social service employees to develop and implement comprehensive workplace violence prevention plans.

These are big steps forward by both hospital systems and legislative authorities towards creating safer workplaces for nurses and other healthcare professionals, acknowledging the unique risks they face and advocating for their protection. And we can do more. We need to change the culture. We need zero tolerance for violence against nurses, both in policy and in practice. We need to empower nurses to speak up without fear of retaliation, and we need to support them when they do. And we need to ensure safe staffing levels to protect both nurses and patients.

As a veteran nurse, I urge you to join me in advocating for change. Report every incident, no matter how small. Support your colleagues who are speaking out. Demand that your hospital prioritizes your safety and well-being.

We stand at a pivotal moment. The stories of nurses facing violence on the job are no longer whispers in the breakroom; they're echoing through legislative halls and hospital boardrooms. While the data on assaults and emotional trauma paints a grim reality, it serves as a catalyst for change rather than a cause for despair. We are united in care, and these distressing statistics fuel our determination to create a safer and more respectful healthcare environment.