Violence Against Nurses: How to Protect Yourself at Work

Violence against nurses is endemic in the United States, a persistent problem that’s gaining attention and increasing study:

According to National Nurses United’s (NNU) 2024 Workplace Violence Report:

8 out of 10 nurses experienced workplace violence in the past year.
68.7% were verbally threatened.
38.7% were physically threatened.
37.3% were pinched or scratched.
36.2% were punched, kicked, or slapped.
34.6% had objects thrown at them.
45.5% of nurses reported an increase in workplace violence in their unit.

According to the Centers for Disease Control and Prevention (CDC), healthcare workers make up just 10% of the nation’s workforce but experience 48% of reported nonfatal injuries due to workplace violence.

A 2021 study from the American Association of Critical-Care Nurses (AACN) found that only 47% of respondents agreed with the statement: “My organization values my health and safety.”

These data points highlight what working nurses already know from experience: workplace violence is not rare, it is not specific to a certain unit, and it is eroding nurse well-being.

It’s not your fault

First, this: Nurses are never at fault for the violence or threats they experience while working.

That’s true for new and experienced nurses alike. You may sometimes have a gut feeling, but aren’t entirely sure what’s triggering it. Trust your gut feeling, it’s often a warning, not an overreaction.

Know that your safety is always the priority if a patient’s or visitor’s behavior seems to be escalating quickly.

Nothing you did deserves a violent, threatening, or unsafe reaction.

Immediate safety comes first

Prioritize your personal safety over task completion. What does this mean?

Always have a way out of every room.
Call for support.
Activate unit safety protocols.
Use de-escalation tactics only if it feels safe to do so.

Use de-escalation tactics

If nurses feel they are in danger, they must get away as quickly and safely as possible.

They can also use de-escalation tactics if they feel that an individual can be managed, or if they’re trying to keep things calm long enough to stabilize the patient or get out of the room.

De-escalation tactics are not instinctual. They are learned skills.

As with any clinical skill, de-escalation can improve with training and support.

Learn the signs of potential violence

Unsafe, threatening, or violent behavior can come from both patients and visitors.

Nurses must know what they can do to spot potential threats, get help, and protect themselves as needed. While each facility has unique policies, a few tools can help nurses identify threats and stay safe.

STAMP

One tool is STAMP, which looks for the following indicators:

Staring
Tone and volume of voice that’s aggressive, agitated, or hostile
Anxiety
Mumbling
Pacing

This tool is particularly useful in emergency room (ER) environments where quick patient assessment is required.

Modified Overt Aggression Scale (MOAS)

MOAS can be used for both pediatric and adult inpatient care, which considers cues from:

Verbal aggression: Like cursing at staff
Property aggression: Slamming doors or kicking furniture
Auto-aggression: Intensive scratching and picking, or self-harm
Physical aggression: Threatening movements or intended violence against others

Brøset Violence Checklist (BVC)

The BVC is also a good option for inpatient psychiatric facilities, which can track patient risk during each shift by looking at factors like confusion, verbal threats, and boisterous behavior.

Speak up

Unfortunately, workplace violence against nurses is underreported.

One study found that of the 74% healthcare staff who experienced workplace violence, only 30% reported it.

According to the AACN, a lack of reporting is a significant barrier to research, regulatory action, and legal action surrounding violence against nurses. The 3 most common reasons for not reporting violent incidents are:

Fear of retaliation
Lack of a clear reporting method
A belief that nothing will be done

Reporting incidents of workplace violence must be normalized. What can you do to normalize it?

Learn the reporting procedures of your facility.
Report when you experience, observe, or hear of workplace violence.
Encourage and support others in reporting.
Talk to your nurse leaders.

Training for violence prevention

Training is another step nurses can take to protect their safety at work. Violence prevention trainings are specifically designed to help nurses:

Recognize early warning signs
Respond without increasing risk
Maintain personal safety while providing patient care

Courses focused on behavioral health, trauma-informed care, and de-escalation techniques can improve confidence in high-stress encounters and reduce the likelihood of harm to both nurses and patients.

Resources that help nurses build resilience can be especially valuable, helping clinicians process difficult encounters and avoid long-term burnout.

Through it all, don’t forget about self-care. Incorporate habits into your daily routine that prioritize your well-being.

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