Hospitals lost $18.27 billion to workplace violence in 2023. Nurses are assaulted at a rate of two per hour. Yet 88% of incidents go unreported. We’ve pulled the most current data from the Bureau of Labor Statistics, OSHA, AHA, and frontline surveys to give facility leaders the numbers they need to assess risk factors and justify prevention budgets.
Key Takeaways
- Healthcare workers absorb 73% of all nonfatal workplace violence injuries in the U.S. private industry, despite making up a fraction of the workforce.
- The American Hospital Association estimates that workplace violence costs U.S. hospitals $18.27 billion in 2023 — $14.65 billion in post-event costs and $3.62 billion in pre-event prevention costs.
- 91% of emergency physicians were attacked or threatened in the past year (ACEP 2024). 81.6% of nurses experienced workplace violence in 2023 (NNU).
- An estimated 88% of workplace violence incidents go unreported, meaning published data understates the real scale.
- California’s AB 2975 requires hospitals to deploy automated weapons detection at main entrances, EDs, and L&D entrances by March 2027 — a model other states are likely to follow.
- Verbal abuse, threats, and physical assaults concentrate in emergency departments, behavioral health units, geriatric care, and ICUs.
How Common Is Workplace Violence in Healthcare?
Workplace violence in healthcare is widespread, escalating, and disproportionate to every other U.S. industry. Below are the headline numbers that quantify the scale.
1. Healthcare workers absorb 73% of all nonfatal workplace violence injuries.
In 2018, healthcare workers accounted for nearly three-quarters of all nonfatal occupational injuries from violence in private industry, per Bureau of Labor Statistics data. The healthcare and social assistance sector is more than five times as likely to suffer a workplace violence injury as workers overall.
2. 72.8% of nonfatal workplace violence cases occurred in healthcare in 2021–2022.
The most recent BLS data reinforces the same trend: healthcare continues to represent an outsized share of nonfatal workplace injuries and illnesses involving days away from work, job restrictions, or transfers.
3. Healthcare workers are 4–5x more likely to suffer a workplace violence injury than other workers.
The Joint Commission cites this multiplier across its hospital workplace violence prevention guidance. Disease control and public health authorities have echoed the figure for years.
4. The hospital incidence rate hit 12.8 per 10,000 full-time workers in 2018.
That compares to an all-industry rate of just 2.1 per 10,000. By 2020, the broader healthcare and social assistance industry rate jumped to 15.2 per 10,000.
5. Workplace violence rose 30% across all healthcare facility types from 2011 to 2021/2022.
A peer-reviewed analysis of BLS data confirmed the long-term trend. Intentional injury from violence rose 63% between 2011 and 2018 alone.
6. The 2020 spike: 175% increase in hospitals, 95% in psychiatric facilities, 63% in home health.
Year-over-year jumps from BLS data exposed how fast workplace violence escalated during the pandemic.
7. Healthcare practitioners faced 7.8 events per 10,000 in 2021–2022.
Healthcare support occupations faced 13.6 — nearly double the practitioner rate.
8. 740 of 5,283 fatal occupational injuries in 2023 were violent acts.
Of those fatal injuries, 458 were homicides — making violence the third leading cause of fatal occupational injuries in U.S. workplaces, per BLS Census of Fatal Occupational Injuries data.
Who Commits Violence against Healthcare Workers?
Most violence against healthcare workers comes from patients and visitors. The Occupational Safety and Health Administration categorizes workplace violence into four types based on the perpetrator’s relationship to the workplace.
| Type | Perpetrator | Common Healthcare Examples |
|---|---|---|
| Type 1 | Criminal intent (no relationship) | Active shooter, robbery, hostage incidents |
| Type 2 | Customer/patient/visitor | Most healthcare violence — patients, family, visitors |
| Type 3 | Coworker, supervisor, or former employee | Bullying, lateral violence, retaliation |
| Type 4 | Personal relationship (domestic) | Abusive partner targeting employee at work |
9. Patient companions are the #1 source of nurse-targeted violence in surgical wards.
A 2024 study found 68% of incidents originated with patient companions.
10. Patients themselves are the second-most common source at 40%.
Combined, patients and visitors account for the overwhelming majority of incidents.
11. Coworkers are the third source at 28%.
Type 3 violence — including bullying, lateral aggression, and incivility — often goes unreported. Hospital workers, including nurses and social workers, frequently cite coworker hostility as a barrier to reporting other forms of violence.
12. Lack of punitive consequences is the top contributing factor in EDs.
ACEP’s 2022 survey of emergency physicians ranked it #1 with a mean score of 2.66.
13. Behavioral health patient volume is the second-highest contributing factor.
ED physicians ranked it 2.87 out of 3 in 2022, up from 2.62 in 2018.
14. Non-compliance with hospital procedures triggers 49.6% of incidents.
Triage of disputes and enforcement of visitor policy are common flashpoints, per a 2022 hospital study. Communication breakdown accounted for 27.4% of incidents, and dissatisfaction accounted for 23.1%.
Which Healthcare Workers Face the Most Violence?
Nurses bear the brunt, but no role is immune. Below are the data points that show which healthcare workers face the highest risk.
15. 81.6% of nurses experience workplace violence in a single year.
National Nurses United’s annual survey of nearly 1,000 registered nurses across 48 states is the most-cited industry benchmark.
16. 91% of emergency physicians were attacked or threatened in 2024.
ACEP’s January 2024 poll captured 800+ firsthand accounts. 71% characterized violence as worse than the prior year.
17. Two nurses are physically assaulted every hour in the U.S.
Press Ganey’s analysis, cited by the AHA, translates to roughly 57 physical assaults per day.
18. 16,975 assaults against nurses occurred in 2023 — a 5% YoY increase.
The AACN cited Press Ganey’s tracking data in its position statement.
19. 66% of New York ED residents experienced physical violence in a single shift cycle.
Among the same group, 97% experienced verbal abuse, 78% verbal threats, and 52% sexual harassment.
20. Healthcare support workers face 13.6 events per 10,000 — nearly double that of practitioners.
CNAs, techs, and patient aides face the highest exposure within healthcare roles. The AHA’s 2025 report flagged certified nursing assistants as facing the highest rates of incivility at community hospitals.
21. 61% of home health workers report some form of violence on the job.
Home health environments have less infrastructure to prevent violence. 16% of nursing home aides face daily assaults, per industry data.
22. Gen Z healthcare workers report assault at 3x the rate of Boomers.
Younger workers also face higher rates of verbal abuse, per Verkada/Harris polling. Female workers and trainees face elevated sexual harassment exposure across the board.
23. Surgeons are an increasingly targeted group.
A 2024 American College of Surgeons report documented rising threats against surgical specialists.
Where in Healthcare Facilities Does Violence Happen Most?
Emergency departments and behavioral health units are the highest-risk locations, but workplace violence happens nearly everywhere in a hospital.
24. Emergency departments are the #1 incident location.
24/7 access, behavioral crises, and police drop-offs concentrate risk. Strategic camera placement and access control in ED waiting rooms support investigations and reduce workplace violence — see our hospital security camera systems for more.
25. Behavioral health and psychiatric units face 62x the all-industry violence rate.
BLS 2018 data revealed the extent of risk concentration in these healthcare settings. Weapons confiscations are most common in psychiatric facilities.
26. Outpatient clinics recorded 34.8% of incidents in one hospital study.
Outpatient settings experience high rates of wait-time and billing-related conflicts.
27. Surgical services accounted for 18.7% of communication-driven incidents.
Stress-driven verbal aggression concentrates on procedural areas.
28. Hospital parking lots, loading docks, and service entrances face exterior assault risk.
Shift-change exposure and poor lighting are documented vulnerabilities at perimeter access points.
29. Labor and delivery is now a named high-risk area.
California’s AB 2975 specifically requires weapons detection at L&D entrances.
30. Geriatric and dementia care units face elevated unintentional violence.
Cognitive impairment drives incidents that often go unreported. Long-term care wings see daily assault rates among the highest in healthcare.
31. ICUs face Type 2 violence from family stress and end-of-life decisions.
Family conflict during high-stakes care drives incidents in critical care units.
32. Main entrance lobbies are the front line for visitor management.
Industry data suggests that up to a 64% reduction in violence is possible with strong front-door controls. Only 4 in 10 hospitals currently verify visitor IDs.
What Does Workplace Violence Cost Hospitals?
The American Hospital Association estimates workplace violence costs U.S. hospitals $18.27 billion in 2023. Below are the cost data points that justify the investment in prevention.
33. Total annual cost: $18.27 billion in 2023.
The AHA’s comprehensive 2025 report quantified the burden for the first time, drawing on research from the University of Washington.
34. Pre-event prevention costs: $3.62 billion.
Includes security personnel, training, policy and procedure development, facility modifications, and technology investments.
35. Post-event response costs: $14.65 billion.
Healthcare treatment for victims, staffing replacement, infrastructure repair, legal costs, and community relations dominate this figure.
36. Staffing-related nonphysical impact: $541 million annually.
Emotional trauma, stress, and burnout drive measurable losses. This breaks down to $139M in absenteeism, $184M in productivity loss, and $218M in turnover.
37. Average bedside RN turnover cost: $61,110 per departure.
NSI Nursing Solutions’ 2026 report quantified the per-RN cost.
38. Average hospital loses $4.2M–$6.2M annually from RN turnover.
A meaningful share is directly attributable to workplace safety concerns — and it’s deepening the staffing crisis. Each percentage point reduction in RN turnover saves roughly $289,000 per hospital annually.
39. OSHA estimates nurse replacement cost ranges from $27,000 to $103,000.
The range covers separation, recruiting, hiring, orientation, and training.
40. Penn Medicine spent $28 million on workplace violence prevention and security.
The system is rolling out Evolv weapons detection across its facilities.
41. Delnor Hospital paid $7.2 million in one nurse hostage settlement.
Legal settlement costs are largely unquantified but significant. Liability insurance premiums also rise after documented incidents.
42. Cal/OSHA penalties reach $158,727 for willful violations.
State enforcement of Occupational Safety and Health Administration standards is real and growing.
How Does Violence Affect Healthcare Staff Retention and Patient Care?
Workplace violence is one of the leading drivers of the U.S. staffing crisis. It also degrades patient care quality.
43. 6 in 10 nurses considered leaving because of violence.
NNU’s 2024 findings rank workplace violence alongside staffing ratios as a top retention issue. National Nurses United continues to push for federal regulatory standards.
44. 19.2% of nurses changed or left their jobs due to violence.
Another 4.1% left the profession entirely.
45. 138,000 nurses have left the U.S. health care workforce since 2022.
The shortage shows no signs of recovery. Recruitment marketing spend rises in high-violence units.
46. 50% of nurses are likely to leave their jobs in 12 months over safety fears.
The Verkada/Harris Poll captured this leading indicator. 39% of physicians said the same.
47. 80% of emergency physicians said violence is harming patient care.
ACEP’s 2018 findings have not improved. Burnout from repeated exposure correlates with cognitive failures that directly affect patient safety.
48. 26% of healthcare workers considered quitting due to hospital violence.
That figure spans nurses, physicians, support staff, and security personnel. 53% of Hennepin Healthcare survey nurses had seriously considered exiting the profession.
49. 50% of operating room nurses report intent-to-quit due to violence.
A peer-reviewed study found that internationally, 60% of new nurses quit within six months in high-violence units.
How Underreported Is Workplace Violence in Healthcare?
An estimated 88% of workplace violence incidents in healthcare go unreported, per a 2015 Arnetz study cited by the American Nurses Association.
50. Only 12% of workplace violence incidents are formally reported.
The 2015 study established the most-cited figure for underreporting. Half of verbal and physical assaults by patients are never reported in writing.
51. One study found 76% of nurses experienced violence, but only 2.1% reported to employee health
Speroni et al. captured the gap between exposure and formal reporting. ANA data shows up to 80% of nurse violence cases go unreported.
How Often Do Active Shooter Incidents Happen in Hospitals?
Active shooters and Type 1 incidents in hospitals are rare but rising, and they drive disproportionate change in security strategy.
52. UPMC Memorial Hospital shooting (Feb 2025) killed a police officer
A gunman entered the ICU, took hostages, and injured five others.
53. UnitedHealthcare CEO Brian Thompson was shot in December 2024
UnitedHealth subsequently spent $1.7 million on executive security.
54. Violent crime in hospitals hit an 8-year high in 2021
Homicide, rape, robbery, and aggravated assault rose from 1.4 per 100 beds in 2019 to 2.5 per 100 beds in 2021, per the IAHSSF Healthcare Crime Survey. Disorderly conduct hit 52.2 per 100 beds, and assault hit 22 per 100 beds.
55. Most hospital shootings occur in or near emergency departments
EDs are the most common locations for Type 1 incidents. Hospital pharmacies face elevated Type 1 robbery risk from drug-seeking offenders.
56. Run-Hide-Fight protocols are now standard healthcare training
Active assailant drills are Joint Commission-recommended. DHS and FBI guidance has been adopted across healthcare institutions.
How Does Workplace Violence Affect Mental Health?
Violence carries lasting psychological consequences for healthcare workers — and many never receive adequate support.
57. 60% of nurses report anxiety, fear, or hypervigilance from violence
NNU 2024 captured the widespread impact on mental health. 33.4% of nurses also report physical symptoms — headaches, stomachaches, sleep disruption.
58. 49.4% of ED nurses report mental health prejudice from violence
Yet only 14% sought mental health support—58.5% experience psychosomatic symptoms, including throbbing, nervousness, and aches.
59. 44% of ED nurses experience nightmares from violent incidents
Symptoms of post-traumatic stress disorder persist long after physical injuries heal. 56% experience avoidance behaviors, and 48% experience flashbacks.
What Is Being Done about Workplace Violence in Healthcare?
Federal, state, and accrediting bodies have moved to require workplace violence prevention plans (WVPPs). Below is the current 2026 regulatory and policy landscape.
60. Joint Commission standards took effect January 1, 2022
R3 Report Issue 30 implemented new requirements after a comprehensive review of input from key stakeholders, including practicing clinicians and licensed practitioners across the healthcare and social assistance industry. The standards require leadership oversight, a multidisciplinary team, policies and procedures, reporting systems, data collection, post-incident strategies, and training.
61. The Joint Commission has issued 100+ requirements for improvement since 2022
Survey activity has driven measurable hospital response. Behavioral health Joint Commission standards followed in July 2024.
62. CMS Conditions of Participation now embed workplace violence prevention
Medicare participation depends on prevention compliance. CMS now treats reporting as a condition of Medicare participation.
63. California AB 2975 mandates weapons detection by March 2027
Automated systems are required at the main entrances, ED entrances, and L&D entrances.
64. North Carolina Hospital Violence Prevention Act (2024) requires armed LE in EDs
Hospitals can apply for an exemption, but must meet alternate criteria. Vermont H.259 (2025), Colorado SB-166, Oregon HB 4002, New Jersey A-3199, Illinois, and Washington State all have prescriptive frameworks.
65. The Workplace Violence Prevention for Health Care Act is pending in Congress
H.R. 2663/S. 1176 would mandate a federal standard for the health care workforce. The Save Healthcare Workers Act (H.R. 3178/S. 1600) would establish federal criminal penalties for assaulting hospital workers.
66. AHA, ACEP, and ANA actively lobby for federal action
The AHA’s Hospitals Against Violence (#HAVhope) campaign and ACEP/ENA’s “No Silence on ED Violence” initiative continue to inform federal policy.
How Can Hospitals Reduce Workplace Violence?
Effective prevention combines engineering controls, administrative controls, training, and reporting infrastructure. Below are the documented strategies that work.
67. Deploy automated weapons detection at high-risk entrances
California AB 2975 mandates this for hospitals by March 2027. Penn Medicine uses AI-driven systems system-wide. Walk-through metal detectors are statistically associated with weapons confiscation in psychiatric intake areas.
68. Deploy wearable duress buttons with room-level RTLS
Bassett Healthcare deployed them to every employee in 2021. BeWell in Philadelphia reported a 39% drop in violent incidents over one year, enabling them to respond effectively to staff in distress. Stationary panic buttons supplement wearables in patient rooms.
69. Deploy strategic video surveillance across high-risk zones
Strategic camera placement reduces incidents and supports investigations. Patient-Engaged Video Surveillance (PEVS) studies across 73 hospitals demonstrated measurable risk identification. Body-worn cameras for security officers have documented de-escalation effects.
70. Implement integrated access control with credentialed entry
Behavioral health, pediatrics, L&D, pharmacy, and ICU should require credentials. Integrating an access control system with video creates automated incident verification.
71. Deploy intercom entry systems at staff and visitor doors
Audio-video verification through a hospital intercom system adds a layer of pre-entry control. Industry data suggests that up to 64% of violence can be reduced with strong front-door management.
72. Establish unit-specific written workplace violence prevention programs
California requires this; effective programs use it regardless. OSHA’s 5-element framework for a workplace violence prevention program starts with a worksite hazard analysis to identify risk factors, implement appropriate precautions, and prevent violence before it occurs.
73. Use triage flagging tools to identify high-risk patients early
STAMP, Broset Violence Checklist, VRSDSiT, and the Alert System support early identification. Behavioral Emergency Response Teams (BERT) and EmPath units offer alternatives to law enforcement for behavioral crises.
74. Choose NDAA-compliant technology for SLED healthcare facilities
State, county, and university medical centers must comply with Section 889. Approved procurement vehicles such as CMAS, PEPPM, and BuyBoard streamline procurement for state mental hospitals and public hospitals.
Where We Fit In
We’re a commercial security integrator with 19+ years of experience and 20,000+ locations protected, including healthcare facilities navigating Cal/OSHA §3342 and Joint Commission accreditation. As a Verkada Platinum Partner, we design integrated video surveillance, access control, and panic infrastructure systems for hospitals and SLED healthcare facilities. For state, county, and university medical centers procuring through CMAS, PEPPM, or other cooperative purchasing vehicles, we’re approved on 15+ government procurement contracts. To discuss your facility’s security posture in relation to Joint Commission, Cal/OSHA, or CMS requirements, reach out for a free consultation.
FAQs
What states have laws protecting healthcare workers from assault?
Most U.S. states now have laws that increase penalties for assaulting healthcare workers, but enforcement and scope vary widely. California, North Carolina, Vermont, Colorado, Oregon, New Jersey, Illinois, and Washington have the most prescriptive workplace violence prevention laws for hospitals as of 2026. California’s framework — SB 1299, SB 553, and AB 2975 — is the most comprehensive in the nation.
Federal protections are still pending. The Save Healthcare Workers Act would create federal criminal penalties similar to those protecting airline workers, but it has not yet passed Congress.
What is the most common type of workplace violence in healthcare?
Type 2 violence — patient-on-worker assault — is by far the most common. It accounts for the overwhelming majority of incidents reported in BLS, NNU, ACEP, and AHA data. Within Type 2, verbal threats and abuse are most frequent, followed by physical threats, then physical contact (pinching, scratching, slapping). Severe assaults involving weapons are rarer but have risen sharply since 2019.
Conclusion
Healthcare workplace violence is measurable, escalating, and expensive. 81.6% of nurses experience violence in a year, hospitals lose $18.27 billion annually, and an estimated 88% of incidents never get reported. State mandates — California’s AB 2975 leading the way — are reshaping what hospital security must look like by 2027. Facilities that build layered prevention programs now will incur lower costs, retain more staff, and meet new accreditation standards without scrambling. To assess your facility against Joint Commission, Cal/OSHA, or CMS requirements, contact us.
Sources
- Workplace Violence in Healthcare, 2018 — U.S. Bureau of Labor Statistics
- Workplace Violence 2021–2022 — Bureau of Labor Statistics
- The Burden of Violence to U.S. Hospitals — American Hospital Association
- High and Rising Rates of Workplace Violence — National Nurses United
- Violence in the ER — American College of Emergency Physicians
- Workplace Violence in the ED: In Search of Lasting Solutions — ACEP Now
- Trends in workplace violence for health care occupations and facilities — NCBI
- The growing burden of workplace violence against healthcare workers — NCBI
- Risk factors for workplace encounters with weapons by hospital employees — NCBI
- Impact of Patient-Engaged Video Surveillance on Nursing Workforce Safety — NCBI
