'There’s No Help': The Escalating Crisis of Workplace Violence in Healthcare

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Early in her career, Rita Manfredi, MD, was working a routine emergency room shift when two police officers brought in a woman for a psychological evaluation. As Manfredi leaned forward to speak with her, the patient launched a violent kick toward her neck. Manfredi, five months pregnant at the time, tucked her chin just in time to protect her trachea.

“I would have been a CPR case,” she recalls. Despite the trauma, no one debriefed her. No one followed up. Now a professor of clinical emergency medicine at George Washington University, Manfredi’s story is a chillingly common one in a field where “healing” is the mission, but “danger” is the daily reality.

According to data spanning the last 15 years, more than 70% of workplace assaults in the U.S. occur in healthcare settings. Healthcare workers are now five times more likely to experience violence than workers in any other industry. As of 2024, nearly all emergency room physicians report that they or a colleague have been victims of workplace violence.

This article explores the rising tide of aggression against medical staff, the psychological “invisible aftermath” that follows, and the systemic failures that leave providers feeling they must “fend for themselves” in the face of physical and verbal abuse.

The Spectrum of Danger: From Threats to Reconstructive Surgery

Violence in healthcare is not a monolith; it ranges from constant verbal harassment to life-altering physical assaults. Research led by Joanne DeSanto Iennaco, PhD, at Yale University, indicates that on-site healthcare staff face two to three aggressive incidents per day—averaging one every 40 hours of work.

While physical injury is the most visible threat, the psychological toll of “emotional armor” is equally taxing. Barbara White, PhD, RN, chief nurse administrator at Indiana University South Bend, describes a daily navigation of verbal assaults where nurses must decide when to stay alert and when to let their guard down.

For some, the violence leaves permanent physical marks. In 2021, ICU nurse Kelsey Springer, BSN, RN, was punched in the face by a patient, resulting in a shattered jaw that required reconstructive surgery. She now follows a restricted diet and faces a future total joint replacement.

“As nurses, we never want to harm a patient, but I didn’t think about my own safety the same way—until it happened to me,” Springer says.

The Rise of Weapons in Clinics

The threat is also evolving with the presence of weapons. Harry Severance, MD, adjunct assistant professor at Duke University School of Medicine, notes that he has seen multiple patients “open-carrying” guns in his clinic. “With one, I felt he was subtly implying, ‘If you don’t do what I need, I’ve got this gun on my hip,’” he explains.

The Invisible Aftermath: PTSD and Attrition

The impact of these incidents lingers long after the physical wounds heal. A significant portion of the workforce is operating under the weight of Post-Traumatic Stress Disorder (PTSD).

Flashbacks and Avoidance: Iennaco’s research shows that 68% of staff are bothered by memories of an assault, and 95% of those assaulted experience flashbacks.
Burnout and Suicide: Dr. Severance points out that rising rates of depression and suicide among healthcare workers are often symptoms of “bad workplaces” where violence is tolerated.
The Nursing Shortage: Up to half of all nurses leave the profession within three years, a trend heavily influenced by unsafe working conditions.

“You can be the most well person in the world, but if you go into an unwell workplace, you won’t be well anymore,” Manfredi says.

A Systemic Void: Why ‘Self-Care’ Isn’t Enough

While the American Hospital Association notes that most hospitals have violence prevention initiatives, many frontline workers argue these programs lack teeth or consistency.

Evidence-Based Solutions

Experts point to several strategies that have shown promise in reducing conflict:

The Six Core Strategies: Developed by Kevin Ann Huckshorn, PhD, this model uses trauma-informed care and staff debriefing to prevent the need for restraints.
The Safewards Model: This approach identifies “flashpoints” to defuse aggression before it escalates.
Risk Assessment Tools: Tools like the Brøset Violence Checklist help staff flag patients at high risk for aggression, allowing for proactive care plans.

Despite these models, many providers rely on informal networks—texting peers or joining social media support groups—because institutional leadership is perceived as unresponsive.

The Reporting Gap and Regulatory Hurdles

One of the greatest barriers to change is the “reporting gap.” Iennaco’s research suggests that 75% of violent incidents go unreported. Many staff members feel that unless there is a physical injury, the incident “doesn’t count,” or they fear that reporting will lead to blame rather than support.

Currently, the Occupational Safety and Health Administration (OSHA) provides only voluntary guidelines for preventing workplace violence. There is no national mandate requiring hospitals to provide standardized de-escalation training, a gap Springer compares to a lack of CPR training.

Legislative Efforts

On the policy front, the American College of Emergency Physicians (ACEP) is advocating for the Safety from Violence for Health Care Employees (SAVE) Act. If passed, this would make violence against clinicians a federal crime, similar to protections afforded to aircraft cabin crew members. While more than half of U.S. states have passed laws making the assault of a healthcare worker a felony, enforcement remains inconsistent.

Looking Ahead: What Needs to Change?

For the future of healthcare delivery to remain viable, experts argue that the culture of “growing a thicker skin” must end.

“What’s missing is a real commitment to respond with compassion and empathy,” says Manfredi. She is currently working with ACEP to develop peer-to-peer programs that offer structured outreach for clinicians who have experienced trauma.

Until hospitals prioritize safety with the same rigor they apply to clinical outcomes, the healthcare workforce will continue to shrink, leaving both providers and patients at risk.

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.