On the Other Side of the Rails


A Monumental Problem: The Silent Truth of Violence in Health Care

David Vickers Jr., RN, BSN, SRNA

I was new to nursing but with 13 years as an EMT and paramedic, this was not my first day in health care. During my years working in the field, I saw friends and colleagues injured on the job, spit on, cursed out, and threatened with their life. Despite that, I still retained a hope that nursing was a more stable environment. It was the beginning of my night shift in the emergency department, and I was getting report for an intoxicated male. As I walked into the room, I quietly introduced myself and was met with lots of loud cursing, a couple of loose threats, and a few jabs at my manhood at being a male nurse. Not a great start to a 12-hour shift. Over the next few years of my career, I would find out that this was par for the course, up to and including physical violence.

Cut scene to a few years later. I still remember the call. It was from a good co-worker who never called me outside of work. He wanted me to know that a friend and co-worker of ours was injured in a workplace violence incident. He explained that a family member of a patient was getting loud with their female nurse. Our colleague, a veteran male nurse, was walking by and noticed the commotion. He tried to interject and calm things down--which was one of his many assets in our emergency department. The family member then struck him and knocked him unconscious, and when he fell he fractured his arm. I immediately felt a heavy, helpless feeling wash over me. The injured nurse was a unit pillar, a trusted friend, a valued mentor, and a military veteran who in a previous life worked in the special operations community. If this assault could happen to this coworker, I thought to myself, it can happen to anyone. It can happen to me. That horrible feeling became a drive to learn more about this problem and its effect on both nursing and health care, leading me to speak out about this subject in the years that followed.

Violence against health care workers and in the health care setting occurs more than most people realize. So much so, I think many health care workers consider violence a normalized part of their job. The Bureau of Labor Statistics reported that health care workers experienced 73% of all workplace injuries and illnesses due to violence in 2018.1 Health care had 5 times the number of violent incidents compared to other large industries such as manufacturing and service.1 Facilities have also reported that 50% of verbal and physical abuse is not reported.2 This happens in many geographic areas. One study showed suburban hospital rates of emergency department violence were similar to those at urban and level I trauma centers.3 Risk factors for violence include long wait times, overcrowding, little access to food, bad news related to diagnosis or poor prognosis, poor socioeconomic status, the presence of weapons, and gang activity.3 Include an ineffective mental health system that boards patients for extended periods in busy emergency departments while waiting for their placement in a mental health facility, and you have an environment primed for violent acts.

Solutions to this problem have been difficult to establish. Research is lacking on exactly what tools are effective.4 Ultimately, the safety of health care workers lies on the health care employers; however, success will need to involve everyone. Solutions will need to cover many aspects at the same time. Measures such as cameras, improved security, and alarm buttons, along with regular staff training on warning signals and threat assessment, de-escalation techniques, and self-defense training need to be implemented.3,5 Patients and their families also need clear notices that violence against health care workers is not tolerated. Even more important is the idea of preventing root causes that initiate or aggravate health care violence.5 These root cause solutions include implementing hospital policies to improve staffing levels at times of high volume, decreasing wait times, encouraging employees to report violence, decreasing worker turnover, and having mental health workers on site.3,5 Involving all stakeholders and developing identified strategies via community advisory boards provide unique and encompassing perspectives that which may be more acceptable to hospital leadership.6

Enter the pandemic. Health care workers and resources are being strained in a COVID-19 workplace. Prior to COVID-19, the health care workplace was described as “more like factory work—work faster, patients sicker, do more with less, and deal with it.7 Due to the pandemic and its strain on resources, the situation is only getting worse. Patients are waiting longer, getting sicker, and getting more unhappy with the system as a whole. The general public needs to be aware of the violence nurses and health care workers have been presented with and grown accustomed to, and hospital leaders need to be reminded that no matter how rural or community-based their facility is they are not immune from health care worker violence. Lawmakers also need to hear about this issue. I urge readers to educate themselves on this problem. Explore organizations that are working to reduce nursing and health care violence such as stopedviolence.org, silentnomorefnd.com, and the American Nurses Association’s campaign, #EndNurseAbuse.8 Talk to a nurse and ask them about what they have experienced. Then take that information and contact not only your state and federal representatives but your hospital leadership. Let them know your concern and discuss with them ways to develop and implement violence prevention programs. The time is now to start reacting to this alarm to protect our already vulnerable health care workers.


  1. S. Bureau of Labor Statistics. (2020). Injuries, illnesses, and fatalities. U.S. Department of Labor. Retrieved from https://www.bls.gov/iif/oshwc/cfoi/workplace-violence-healthcare-2018.htm.
  1. Occupational Safety and Health Administration. (2015). Preventing workplace Violence in Healthcare: A road map for healthcare facilities. Retrieved from https://osha.gov/Publications/OSHA3827.pdf
  1. Philips (2016). Workplace violence against health care workers in the United States.New England Journal of Medicine, 374(1): 1661-1669. doi: 10.1056/NeJMra1501998.
  1. S. Government Accountability Office. (March 2016). Workplace safety and health: Additional efforts needed to help protect healthcare workers from workplace violence. Retrieved from https://www.gao.gov/assets/gao-16-11.pdf.
  1. Gillespie, G.L., & Palazzo, S.J. (March 2021). Violence should not be part of the job. My American Nurse. Retrieved from https://www.myamericannurse.com/workplace-violence-should-not-be-part-of-the-job/.
  1. Gillespie, G.L., Fisher, B., Kennebeck, S. et al. (2019). Leveraging a public health framework and community advisory board to innovate workplace violence intervention Advanced Emergency Nursing Journal, 41(4): 357-371. doi: 10.1097/TME.0000000000000263
  1. Stephens, W. (2019). Violence against healthcare workers: A rising epidemic. American Journal of Medical Care. Retrieved from https://www.ajmc.com/view/violence-against-healthcare-workers-a-rising-epidemic
  1. American Nurses Association. (n.d.). End nurse abuse. Retrieved from https://www.nursingworld.org/practice-policy/work-environment/end-nurse-abuse/


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Guest Contributor

David Vickers Jr., RN, BSN, SRNA

David Vickers Jr., RN, BSN, SRNA, has been a registered nurse for eight years. David is certified as an emergency and critical care nurse and has worked in facilities in both Philadelphia and surrounding communities. David will be graduating from the University of Pennsylvania in May 2021 with a doctor of nursing practice degree and will be working in nurse anesthesia. David can be reached via e-mail at [email protected].

How to contribute

We encourage submissions from any reader who has been touched by the healthcare system. Some contributors may be involved directly in patient care and might want to share the impact a patient, family, or colleague had on them. Others may want to write about life “on the other side of the rails” …those moments when the caregiver becomes the patient…or maybe sees healthcare from the vantage point of a family member. Inquiries can be sent to [email protected]

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