Research| Volume 40, ISSUE 3, P218-228, May 2014

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Incidence and Cost of Nurse Workplace Violence Perpetrated by Hospital Patients or Patient Visitors

Published:September 19, 2013DOI:



      Workplace violence against nurses is a serious problem. Nurses from a US urban/community hospital system employing more than 5,000 nurses researched the incidence of workplace violence against nurses perpetrated by patients or visitors in their hospital system.


      Survey research and retrospective database review methods were used. Nurse participants (all system-employed nurse types) completed a 34-item validated survey in electronic format. Retrospective database review provided annual nurse workplace violence injury treatment and indemnity charges. Institutional review board approval was received.


      Survey research participants (N = 762) were primarily white female registered nurses, aged 26 to 64 years, with more than 10 years of experience. Over the past year, 76.0% experienced violence (verbal abuse by patients, 54.2%; physical abuse by patients, 29.9%; verbal abuse by visitors, 32.9%; and physical by visitors, 3.5%), such as shouting or yelling (60.0% by patients and 35.8% by visitors), swearing or cursing (53.5% by patients and 24.9% by visitors), grabbing (37.8% by patients and 1.1% by visitors), and scratching or kicking (27.4% by patients and 0.8% by visitors). Emergency nurses (12.1%) experienced a significantly greater number of incidents (P < .001). Nurses noted more than 50 verbal (24.3%) and physical (7.3%) patient/visitor violence incidents over their careers. Most serious career violence incidents (n = 595, 78.1%) were physical (63.7%) (60.8% by patients and 2.9% by visitors), verbal (25.4%) (18.3% by patients and 7.1% by visitors), and threatened physical assault (10.9%) (6.9% by patients and 4.0% by visitors). Perpetrators were primarily white male patients, aged 26 to 35 years, who were confused or influenced by alcohol or drugs. Per database review, annual workplace violence charges for the 2.1% of nurses reporting injuries were $94,156 ($78,924 for treatment and $15,232 for indemnity).


      Nurses are too commonly exposed to workplace violence. Hospitals should enhance programs for training and incident reporting, particularly for nurses at higher risk of exposure, caring for patients with dementia or Alzheimer disease, patients with drug-seeking behavior, or drug- or alcohol-influenced patients.

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      Karen Gabel Speroni is Nursing Research Scientist, Inova Loudoun Hospital, Leesburg, VA.


      Tammy Fitch, Member, Metropolitan Baltimore Chapter, is Direct Care Nurse, Emergency Department, Inova Loudoun Hospital, Leesburg, VA.


      Elaine Dawson is Employee Health & Safety, Inova Loudoun Hospital, Leesburg, VA.


      Lisa Dugan, Member, Northern Virginia Chapter, is Chief Nurse Officer, Inova Loudoun Hospital, Leesburg, VA.


      Martin Atherton is Statistician, Inova Loudoun Hospital, Leesburg, VA.

      Linked Article

      • Incidence and Cost of Workplace Violence
        Journal of Emergency NursingVol. 41Issue 1
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          I wanted to comment on the article “Incidence and Cost of Nurse Workplace Violence Perpetrated by Hospital Patients or Patient Visitors.”1 I have spent 26 years as a paramedic and nurse in the emergency department. I am very familiar with workplace violence (WPV). Statistics from the 2011 US Bureau of Justice indicated that the rate of nurse WPV was 3.9%. The estimated cost associated with WPV was $4.2 billion. I believe that both of these numbers are woefully lower than the actual numbers. I agree with the reported precipitating factors for WPV in the emergency department, such as large volumes of patients, along with drug-seeking behavior, alcohol intoxication, and drug use.
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