My foot slid on something wet as I entered the medical/surgical unit. Glancing down, I wondered vaguely who had spilled cranberry juice before registering the red droplets for what they were: blood.
I looked over my shoulder and froze. A patient stood in the deserted hallway, blood streaking his arm from where he appeared to have ripped out an IV. A pair of bandage scissors hung loosely in his hand.
I ran to the rehabilitation office across the hall, the room already filled with staff hiding from the patient. One of them was hunched over a phone, repeatedly calling security. No one was answering.
A nurse screamed as the patient began pounding against the door, making it shake in its frame. When the pounding ceased, a physical therapist exited the office and grabbed the patient from behind as more staff members scrambled to help. The same look was mirrored on every face: the stunned appearance of successfully trapping a wasp under a glass without a fully conceived plan. The failed hospital protocol had revealed an alarming truth: We didn’t have a plan. We didn’t know what to do next.
Real physician voices, twice a week
Free, and one click to unsubscribe.
When security finally arrived, they took over a violent incident hospital staff shouldn’t have been forced to handle. Administration’s response was that, though shift change had caused a security delay, the situation had been handled appropriately. Yet when existing protocols fail, a favorable outcome achieved by staff improvisation should not be treated as evidence the protocols themselves were adequate.
Recent national attention to workplace violence indicates it remains an ongoing issue within U.S. health care. On September 17, a Capitol Hill briefing titled “Protecting Those Who Care: Addressing Workplace Violence Against Healthcare Workers” was hosted by eleven national health care organizations. During the briefing, these organizations called workplace violence an epidemic and pressed for improved prevention and response within health care. The next day, on September 18, New York’s new health care violence-prevention law took effect, establishing statewide standards to improve workplace safety in health care. Had similar protections already been implemented nationwide, perhaps my own experience would have been handled differently.
I had thought the odds of experiencing a violent patient encounter were exceptionally slim, perhaps akin to a winning lottery ticket. Unfortunately, I was wrong. As a clinician, my chances of experiencing workplace violence were, unlike my Powerball prospects, strikingly high. According to a 2025 American Hospital Association report, as many as 76 percent of U.S. health care workers report experiencing some form of workplace violence. Though not every violent encounter can be prevented, preparation and response should be standardized and strengthened across U.S. health care.
Under New York’s new violence-prevention law, covered general hospitals are required to maintain continuous security presence and must establish workplace violence prevention programs within the next twelve months. Beginning January 1, 2027, general hospitals must also conduct annual workplace safety and security assessments and develop individualized plans to manage known workplace-violence hazards.
My experience didn’t include that type of standardized approach. After the violent incident, I went back to patient care. My coworkers did the same, though one of them removed her Apple Watch due to repeated high heart rate alerts. It was a spectacular demonstration of resilience, the kind too often necessitated by chronic systemic failures. Though administration praised our response, no changes to safety protocols were communicated to employees. A June 2026 National Nurses United report on workplace violence mirrors my experience: Almost half of surveyed nurses reported that no changes in practices to reduce the risk of violence were made by their employer. The Joint Commission highlights the importance of mitigation of identified risks, incident analysis, and adequate follow-up within its workplace-violence standards. When employees experience and even successfully compensate for a failure in safety response, the incident should expose, rather than obscure, those vulnerabilities.
The nature of patient care makes it unrealistic to mitigate every risk factor for violence. Patient agitation can occur for many reasons, including various medical conditions like head trauma and infection, psychiatric illness, substance use and withdrawal, and medication-related effects. The National Institute for Occupational Safety and Health identifies inadequate security procedures and protocols and lack of staff training and preparedness as organizational risk factors for workplace violence, underscoring the importance of institutional preparedness.
Though New York’s new law establishes similar safeguards, these violence-prevention policies are not universal within U.S. health care. A recent 2026 study shows that workplace violence prevention and response requirements vary widely by state. This type of patchwork approach, while acceptable for most quilting projects, should not be viewed as adequate for workplace safety. The state where a health care worker is employed should not dictate whether they receive appropriate protection from a nationally recognized occupational safety concern.
For decades, the Occupational Safety and Health Administration (OSHA) has recognized the risks of workplace violence in health care and has been considering a national violence-prevention standard since 2016. However, none currently exists. Despite recent renewed calls for a national standard, a 2025 federal bill, the Workplace Violence Prevention for Health Care and Social Service Workers Act, that would require OSHA to establish one remains stalled. Representative Joe Courtney (D-Conn.), who introduced the bill and also spoke at the September 17 briefing, continues to advocate for Congress to act.
Congress should pass legislation requiring OSHA to establish a national minimum standard to prevent workplace violence in health care, with baseline requirements for safety and security assessments, staff training, reliable emergency-response protocols, and retrospective review processes. In the end, a frontline staff member’s ability to improvise should not serve as a substitute for adequate safety protocols.
My sincere hope is that, should one find themselves standing in a dubious scarlet puddle in a hospital hallway, the explanation is a benign one: spilled cranberry juice.
Isabella Hower is a neonatal occupational therapist and Certified Neonatal Therapist practicing in a Level IV neonatal intensive care unit (NICU), where she specializes in neurodevelopmental and family-centered care for medically complex and premature infants. She earned her master’s degree in occupational therapy from the University of Florida, where she conducted graduate research as part of a faculty-led team affiliated with the university’s Institute on Aging.
Her clinical experience spans adult acute care and neonatal intensive care. She provides education on neonatal developmental care to new nursing staff and is the lead author of peer-reviewed research on circadian rhythms, exercise, and cardiovascular health published in the Journal of Circadian Rhythms. Her writing explores the experiences of frontline health care workers, the systems in which they practice, and the intersection of health care policy and clinical care.
