Hospital workplace violence escalates financial and workforce pressures

Incidents of violence in U.S. workplaces are disproportionately common in healthcare settings, especially in hospital emergency departments (EDs), and new data helps quantify the toll.

It’s long been known that healthcare and social service workers are significantly more likely than workers overall to suffer a workplace violence injury. Bureau of Labor Statistics data suggest the incidence is more than four times greater for registered nurses (RNs) than for all occupations.

Based on a survey of more than 1,000 healthcare staff and leaders, the healthcare safety solutions company Canopy recently reported (registration required) that nearly 85% experienced a safety event in their careers, and 76% described it as a daily concern. More than a quarter experienced incidents at least weekly, and more than 20% were involved in incidents that escalated to violence.

“We were just blown away and frankly sad [about] how prevalent the problem is,” said Shan Sinha, co-founder and CEO of Canopy. “Imagine if you went into your office and you were, every day, afraid that your customers were going to kick you. That is the environment they are going into, and that is certainly not what you learn about when you’re going through nursing school.”

The problem is not new, as suggested by Occupational Safety and Health Administration statistics showing violence was four times as likely to take place in healthcare settings as in other workplace environments in 2002-2013.

But “anecdotally,” the issue is worsening, Sinha said, “as we’ve become a more polarized country, as the healthcare system is harder to deal with. We’ve got a mental health crisis that certainly got worse during the pandemic. There was an opioid crisis for a very long time, [although] we see some signs of improvement.”

Workplace violence creates financial and workforce pressures for hospitals

More than one in three survey respondents left their healthcare jobs or seriously considered leaving due to workplace safety concerns. With an average cost of $61,000 to replace an RN (relative to keeping the position filled), and an average recruitment timeline of 83 days, “this is not just a workforce issue. It is a financial liability,” the report states.

A partial link thus can be drawn between safety incidents and average annual RN turnover costs of between $4.2 million and $6.2 million per hospital, figures that were included in a 2026 NSI Nursing Solutions report (which puts the average turnover cost at $60,000).

“There’s a new emphasis on people not accepting poor conditions to practice medicine and to work in those situations,” said Imamu Tomlinson, MD, MBA, the CEO of Vituity, a physician-owned partnership that provides staffing, management and operational support in hospital settings such as EDs and critical care units.

“People are pushing back and saying, ‘If you don’t create a safe environment for me to see patients or for me to work with people, I’m just not going to work there,’” Tomlinson added.

Hospitals expand violence prevention and deescalation strategies

Hospitals are shifting their approaches in the effort to promote a safe working environment, Tomlinson said.

Not long ago, the primary emphasis was on tactics such as ramping up a security presence or restraining patients who acted belligerently.

“More recently, and I think more effectively, people have focused on deescalation,” Tomlinson said, “communicating with these patients in ways that give them that level of support [and] compassion to make sure they don’t escalate into something that could be potentially violent.”

Hospital investments include EmPATH (emergency psychiatric assessment, treatment and healing) units, essentially an updated version of psychiatric EDs, with a focus on immediate psychotherapy.

In some hospitals, the units are self-contained sections within the ED, whereas in others they are stand-alone structures.

“The environment is more aesthetic,” Tomlinson said. “It actually is calming, instead of a typical ER with lights and sirens going off all the time. They’ve found great success with using less medications and also [having fewer] incidences of violence.”

Hospitals implement staffing protocols and rapid-response teams

Hospitals without EmPATH units can still establish protocols such as ensuring clinicians always stand between a potentially belligerent patient and the door, allowing for a quick exit if needed, Tomlinson said. Another basic step is to enter a patient’s room in pairs whenever there is the possibility of a violent incident.

They also can have standby teams who respond to alerts, offering both deescalation and physical support as needed.

A staff position known as a sitter provides continuous, one-on-one observation of at-risk patients and can be utilized “to alert medical individuals when there’s something going wrong,” Tomlinson said. “A lot of times they’re not fully interactive with the patient, but they’re definitely attuned to what may be signs that the patient is getting agitated or aggravated.”

Looking forward, AI brings intriguing potential to monitor patients’ behavior and detect the possibility of a violent incident in advance. Such tools are in the investigatory stage, Tomlinson said.

But privacy issues need to be navigated in the context of implementation, as is the case with deployment of similar technology to help prevent falls in hospitals.

“Those situations are ripe with lots of other rules where people really have to be thoughtful about how you monitor people and get permission to do so,” Tomlinson said. “I think in the future, those will be solutions, but they’ll have to be vetted and go through a process before that happens.”

Aside from reimbursement through workers’ compensation, hospitals typically aren’t liable when a patient lashes out against clinical staff, as long as the facility has implemented reasonable protections and precautions in units with a high risk of violent incidents.

State and federal policymakers increase focus on healthcare worker safety

Among legislation proposed in Congress, one bill would set minimum penalties of 10 years for assault and 20 years for using a dangerous weapon against hospital personnel. Another bill focuses on preventive measures, requiring healthcare and social service employers to develop comprehensive workplace violence prevention plans. Concerns about the latter bill have included the imposition of potentially burdensome rules on healthcare employers.

Implementation of such policies appears more likely at the state level, where almost every state has some type of law on the books. Roughly 20 states require hospitals to perform site-specific risk assessments and maintain formal prevention plans.

It would be worth considering legislative provisions that offer supportive funding, not just punitive measures, Sinha said.

“Investing in the healthcare system’s ability to support themselves and adopt policies, processes, training, technology that can help protect and keep themselves safe — it would be a very meaningful investment in one of our elemental aspects of vital infrastructure that the country and all of us would benefit from,” he said.