1. Worthington, Karen RN
  2. Franklin, Patty RN

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Recently, a patient threatened me, saying, "I'll come back with a gun and hurt you if I'm not the next patient seen." What actions can nurses take if they're assaulted in the workplace?

Both waiting rooms and patient treatment areas have risk factors for violence. Long waiting times, confined spaces, and the presence of family and visitors can aggravate assaultive or violent tendencies. Emergency treatment environments are often dangerous due to the presence of people with known risk factors consistently associated with violent behavior: intoxication from alcohol or drugs, a history of assaultive behavior, and dementia. Inexperienced personnel and inadequate staffing patterns can add to the potential for violence. According to a 1996 study by the National Institute for Occupational Safety and Health (NIOSH) on workplace violence, the service sector leads all U.S. industries in the number of reported assaults, and 38% of those occur in health care facilities.


There are currently no national regulations addressing workplace violence. The Occupational Safety and Health Administration (OSHA) has published prevention guidelines geared toward health care and social service workers; however, compliance by health care employers is voluntary. And while the Joint Commission on Accreditation of Healthcare Organizations now requires hospitals to incorporate a plan for worker safety into their safety and security management plan, it doesn't specify what this plan should include. The ANA continues to advocate for an OSHA violence standard.


Although NIOSH documents that health care patients commit nearly half of all assaults, visitors, colleagues, intruders, and even other employees may also be involved. Violent actions range from verbal abuse to physical assault and, at the extreme, homicide. Any fatality resulting from workplace violence must be reported immediately to OSHA.


While such incidents get a lot of attention, nonfatal assaults tend to be overlooked. It's important to note that an assault may be committed without actually touching, striking, or doing bodily harm to another. NIOSH states that "violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty" constitute workplace violence. The threat made by your patient "to come back with a gun and hurt you if I'm not the next patient seen" is an example of workplace violence that needs to be reported.


If you're a victim of workplace assault or you're threatened in any way, report the incident immediately to your facility's security office and your occupational health office or worker's compensation clinic. Health care safety and security personnel are obliged to report "crimes against person," to the local police department.


Depending on the circumstances surrounding the incident, as well as state and local laws, you may choose to file criminal charges. Contact your local police or prosecutor's office to learn about your individual rights. In addition, the National Center for Victims of Crime can direct you to advocacy services in your community. Also, contact your state nurses association for information on legal professionals familiar with both nursing issues and your state legal system.


OSHA recommends that health care employers make counseling and treatment available to address the common psychological consequences of assault, including posttraumatic stress disorder, impaired immune and endocrine function, and substance abuse. Employee assistance programs may be used for this purpose.



National Center for Victims of Crime: (800) FYI-CALL


OSHA Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers: (202) 693-1888


National Institute for Occupational Safety and Health. 1996 Current Intelligence Bulletin 57: Violence in the Workplace; Risk Factors and Prevention Strategies: (800) 35-NIOSH


International Association for Healthcare Security & Safety:


Infolink: Workplace Violence; Employee Information:


Infolink: Victim Services in Hospitals: