Massachusetts lawmakers are now working to reconcile House and Senate versions of legislation that would require health care employers to develop and implement workplace violence prevention programs. It is an issue that those of us who have spent our careers in health care know well.
I’ve been a nurse for a long time. Long enough to know that violence can happen quickly and unexpectedly, in the middle of caring for another human being. That’s the part nurses recognize. That’s the part we carry.
A 2024 National Nurses United report, based on 2023 survey data, found that 81.6 percent of nurses experienced at least one form of workplace violence in the previous year. Here in Massachusetts, the Massachusetts Health & Hospital Association reports that a hospital worker is subjected to an act of violence or a threat every 36 minutes.
The violence doesn’t stay in the emergency department, either. The ED is the most visible flashpoint, but this is a whole-hospital, health care-wide problem. Behavioral health, medical units, obstetrics, long-term care, and even outpatient PCP offices struggle to address the safety of the staff from verbal abuse up to physical assaults.
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Workplace safety is foundational to patient safety. Those of us working in health care know that we often meet our patients and their loved ones under some of the most challenging circumstances, and possibly on the “worst day” of their life. We understand that under this kind of stress people cope in different ways. But violence in all its forms is not acceptable. We can’t deliver compassionate, safe, quality care if part of our thoughts are always calculating our personal safety and watching out for the safety of the rest of our team. We want to be fully present for our patients, but we need our safety first.
Here’s what I think about, in my role overseeing both patient safety and health equity: Who is often absorbing this violence. In my experience, it is frequently women, people of color, and workers who have the least institutional power and the fewest options when something goes wrong.
Some of the violent events arise from special populations of disabilities and dementia that require time, staffing, and space to ensure safety. The staffing challenges that put health care workers alone in rooms with high-risk patients do not happen in a vacuum. They reflect years of pressure to do more with less, and the tension between efficiency and the time, staffing, and space that intentional care requires.
I don’t think most hospital leaders are indifferent to this. I think they’re overwhelmed, and I think the problem very often feels too big and too diffuse to solve with the tools they have. But some of this is not complicated. It’s about training, intentional design, proactive plans, and what happens institutionally when a health care worker files a report. It’s about whether leadership treats that report as a data point or recognizes the human cost impacting their team.
What happens after an act of violence depends a lot on the culture of an organization. There are places where the nurse who survives goes right back to work, frequently without anyone asking what needed to change. There are moments that sadly become a career-ending injury, not because of the physical injury but because that trauma can leave people shaken to the core.
But there are also places where teams stop, care for the wounded, and step back to learn and change. There are organizations that stand united against violence of all kinds within their walls. Places where limits are set on incivility as well as assault. We can make changes that improve safety, and we owe our people that.
Christi Barney is a health care executive.
