A Timeline Of Violence Against Nurses In The Workplace

Healthcare workers, especially in the emergency department, face high rates of workplace violence. The encouraging part: screening processes have been shown to cut patient-to-staff assaults. In one emergency department, assaults dropped from 0.265 to 0.146 per 1,000 patient visits after a prevention program.

In October 2023, emergency room nurse Tristin Kate Smith took her own life after what she described as abuse at work. The 28-year-old titled her final note "Letter to my abuser" and detailed watching colleagues get hit, criminally charged, and exploited.

Smith is not an outlier. The World Health Organization reports that up to 38% of health workers experience physical violence at some point in their careers, and nurses die by suicide more often than the general population. A 2018 American College of Emergency Physicians survey found workplace abuse topped 70% for ER nurses. (Nurses were not asked the same question in the 2022 survey.)

Violence against nurses is rising, but it is not inevitable. Below is a timeline of recent incidents that made national headlines, followed by solutions healthcare centers can put in place.

Violence Against Nurses: A Recent Timeline

These are recent incidents that drew national attention, not an exhaustive list.

July 2023 | Washington State

Nurse Brad Rathke of Virginia Mason Medical Center in Seattle was stabbed in the jaw with a metal butter knife by a patient. Allison Smith, a nurse at the same hospital, was punched in the face by a patient less than a year into the job.

September 8, 2023 | Rhode Island

Thirty-seven-year-old George Bower attacked a nurse after being told he could not use a phone at the Rhode Island hospital where he was a patient. State health department spokesperson Joseph Wendelken said Rhode Island does not track attacks on healthcare workers: "We do not collect data on patient acts of violence against staff," though the state does collect instances of staff aggression against patients.

September 23, 2023 | Arkansas

A nurse at St. Bernards Medical Center in Jonesboro was choked by a man trying to get past hospital staff. Police reports say the nurse lost her voice for several hours.

September 30, 2023 | New York

Two nurses were stabbed by an ICU patient at Saratoga Hospital in Saratoga Springs. Both injuries were non-life-threatening, and the nurses were expected to fully recover. Sixty-year-old Scott W. Williams of Hudson Falls was taken into custody and charged with two counts of assault.

October 14, 2023 | Idaho

Thirty-three-year-old Ignacio Ortiz Garibay was charged with battery for assaulting a healthcare worker at Portneuf Medical Center in Pocatello. Witnesses and security footage showed Garibay punching a nurse three times in the arm.

Solutions for Workplace Violence Against Nurses

One answer is legislation that protects hospital staff. North Carolina passed a law requiring hospitals with emergency departments to keep a law enforcement officer onsite at all times; it took effect in 2025. In April 2023, the governor of Kansas signed a bill increasing penalties for battery against a healthcare provider.

Hospitals can also build their own prevention plans. Sheila Mallett-Smith, clinical nursing director at LA General Medical Center, lists the key elements of an assault prevention plan:

1. Identify patient risk characteristics at the facility and in the literature
2. Screen early to flag patients at risk of aggression or violence
3. Use an alert system for patients who have assaulted staff on previous visits
4. Train staff on de-escalation, injury prevention, and assault prevention for at-risk patients on arrival
5. Maintain a behavioral response team skilled in de-escalation and restraint
6. Run a workplace violence committee to track and adjust strategies
7. Build procedures to defuse common triggers of violence
8. Provide strong, visible leadership support for zero violence
9. Adopt policies and procedures that support violence reduction

Mallett-Smith is first author of a 2023 article in the Journal of Nursing Care Quality presenting the results of an assault intervention in the emergency department. Before the prevention model, the department saw 0.265 physical assaults per 1,000 patient visits. After using "Plan-Do-Study-Act" prevention systems with risk-for-violence screenings of adult ER patients, the rate fell to 0.146 per 1,000 visits.

Some states are moving on policy too. In October 2023, Massachusetts lawmakers held a hearing on legislation requiring hospitals to design and implement violence prevention policies, including annual risk assessments that identify threats to worker safety such as time of day and staffing levels.

If you or a colleague is struggling with thoughts of self-harm, support is available. In the U.S., the 988 Suicide and Crisis Lifeline can be reached by call or text at 988, 24 hours a day.

Mallet-Smith S, et al. (2023). Implementation of an Assault Prevention Quality Improvement Initiative in an Urban Emergency Department. Journal of Nursing Care Quality

Preventing violence against health workers. (2023). WHO