Sep 12, 2025
The Emergency Department exists to save lives. But for frontline clinicians, working in the ED often puts their own lives at risk.
Workplace violence in the ED is as disturbing as it is common. Although the phenomenon is nothing new, the scale and scope of violence against healthcare workers have increased dramatically in recent years.
Across the country, Emergency Department personnel are punched, kicked, grabbed, and worse while caring for and saving the lives of their own assailants. Verbal abuse, racial or sexual slurs, and intimidation are common occurrences, and the vast majority of these crimes go unreported.
Although verbal and physical assault of healthcare workers may be commonplace, this is not part of the job. It is not normal, and it is not acceptable.
The Unspoken Epidemic
Emergency medicine healthcare workers are uniquely vulnerable to abuse. Patients are often in distress, under the influence of drugs and alcohol, or suffering a mental health crisis. Other times, patients frustrated with the healthcare system direct their anger at staff, and family members, overwhelmed by fear and helplessness, lash out at ED personnel.
The numbers are staggering:
Violent incidents in the workplace are four times more likely to occur when that workplace is a healthcare setting. The Emergency Department is at particularly high risk, according to the International Association for Healthcare Security and Safety (IAHSS)
Data from the Emergency Nurses Association revealed that more than 70% of ED nurses report being physically assaulted at work in the past year.
A study by National Nurses United showed similarly dire numbers: Four out of five nurses experienced workplace violence of some kind in the last year. Nearly half were physically assaulted.
A 2022 ACEP survey found that 85% of emergency physicians had experienced violence in the past year — 45% said the incidents occurred at least once a month.
According to the Bureau of Labor Statistics (BLS), healthcare workers are 5 times more likely to experience workplace violence than workers in other industries.
BLS statistics, while striking, may underrepresent the scope of the problem, as ANA data shows that up to 80% of incidents of workplace violence against nurses go unreported.
As Emergency Physicians, we are expected to provide compassionate, patient-centered care, even as we sustain escalating threats, abuse, and physical harm. The wounds to Emergency Department staff are more than skin deep. There is also an incalculable moral injury associated with working in these conditions.
We have long known that there is tremendous self-sacrifice associated with committing to a career in medicine. Long hours, emotionally and physically taxing labor, and the manifold challenges of practicing in a complex and fractured healthcare system are all things that we faced when we signed up.
However, physicians do not sign up to put themselves in the type of physical danger that has become a hallmark of Emergency Medicine.
In careers where professionals put their personal safety at risk, it is often an unfortunate but recognized aspect of the job, and workplace protections are designed to prevent and mitigate harm. Soldiers do not go into battle without their armor and specialized training. Police officers and firefighters are similarly protected. Even a helicopter pilot has a parachute.
Emergency physicians are engaged in a daily fight for survival, and we find ourselves unprotected, unsupported, and often, without a parachute. It is likely impossible to know the full impact of this ongoing trauma on physician burnout, mental health, resignations, and patient care.
What Workplace Violence Looks Like
Workplace violence in the ED includes physical and non-physical forms of assault.
Verbal abuse, including racial, ethnic, and gender-based slurs: “You’re too stupid to help me,” “You people are useless!”
Threats, harassment, and stalking: “I’ll find you after your shift,” “You’ll be sorry,”
Physical violence: Punching, biting, spitting, throwing objects, or slamming doors.
Sexual harassment: Inappropriate comments, gestures, or physical contact.
Over time, as with physical violence, constant exposure to hostility and verbal abuse takes a massive toll on the victim.
Staff may develop compassion fatigue and emotionally detach. Some physicians may develop substance-abuse disorders or other maladaptive coping mechanisms. Others may live in a near-constant state of hypervigilance, akin to the posttraumatic stress disorder well-characterized in veterans of war.
Even in the most resilient practitioners, repeated experiences of workplace violence steadily erode our sense of safety at work and impact our ability to care for patients. Everyone suffers.
Burnout: The Emotional Cost
Burnout from workplace violence is like a deeper cut in an already festering wound. There is something ironic and tragic about being dehumanized while doing deeply human work.
Showing up in scrubs and going home in tears.
As with the rising rates of violence, trends in physician burnout are staggering:
2022 ACEP Emergency Department Violence Poll:
A comprehensive ACEP report of data gathered from practicing emergency physicians revealed that:
87% reported loss of productivity.
85% reported emotional trauma or increased anxiety due to violence.
In a survey of 814 ED staff across 18 Midwestern centers in late 2020:
21.3% reported symptoms of PTSD.
21.9% said violence affected their ability to perform their job.
18.5% considered leaving their position due to the incident.
A recent study found that emergency department workers exposed to workplace violence reported symptoms of PTSD, depression, and burnout.
The ripple effect is real: staff leave, morale plummets, and trust erodes. Ultimately, patients also suffer when the people caring for them are wounded and demoralized, with increased risks of patient safety events and decreased patient satisfaction.
A Call to Action: What Needs to Change
The burnout crisis in medicine has been recognized, and many institutions and specialty organizations have proposed and implemented programs designed to improve wellness and decrease burnout. To the extent that the problem is recognized and acknowledged, efforts to combat workplace violence are also typically varied and local, and may be hindered by state law and institutional culture. States like California, Oregon, and Washington have led the charge and created some of the most comprehensive workplace violence prevention initiatives.
A common approach to the interrelated crises of burnout and workplace violence is to focus on personal factors. Educating staff about de-escalation strategies is one example. While important, such programs in isolation place all emphasis on how healthcare workers respond to workplace abuse, rather than how this violence may be prevented and how healthcare systems and society can support and protect clinicians at risk.
Similarly, a workplace violence strategy centered on fostering resilience in healthcare workers is as insufficient as it is offensive. Just as we should not address domestic violence by teaching women how to take a punch, neither should we teach physicians how to adapt and endure workplace violence.
As a profession, in hospitals, and across society at large, we must not only address the horrific outcomes of this scourge.
We must refuse to accept that violence against healthcare workers is ever acceptable.
The epidemic of violence against healthcare workers unnecessarily endangers emergency department staff and patients alike, and the urgency to address and prevent this trauma demands comprehensive institutional change and definitive action by hospital leadership and legislators. As a profession and in society, our actions must say definitively that violence and abuse of healthcare workers is unacceptable, and our people deserve protection.
At minimum, we need and deserve:
Zero-tolerance workplace violence policies that are consistently enforced.
Clear reporting pathways for staff — with follow-up and accountability.
De-escalation training and security support that is responsive, not reactive.
Environmental design changes — panic buttons, controlled access, and safe zones. No blind corners in care spaces!
Visible leadership support — rounding, listening, advocating.
Accessible, free, and comprehensive mental health resources for staff impacted by violence — We see you
Public signage and awareness: Patients and families need to know in no uncertain terms that verbal abuse and violence will not be tolerated.
Partnership and support from our local law enforcement agencies and prosecutors.
Progress
The move to recognize and combat workplace violence against healthcare workers is gaining momentum nationally. In 2024, leading organizations like the American Nurses Association (ANA), Emergency Nurses Association (ENA), and American College of Emergency Physicians (ACEP) have sounded the alarm on healthcare workplace violence and have begun to advocate for critical federal legislation.
Bills such as the Workplace Violence Prevention for Health Care and Social Service Workers Act, which would require employers to implement comprehensive violence prevention plans, and the Safety From Violence for Healthcare Employees Act, designed to make assaulting hospital workers a federal crime, are working their way through the legislative process, raising awareness and the hope for better protection and a safer future for emergency department staff.
Other State-Level Legislative Actions Include:
Ohio – House Bill 452 (Effective April 9, 2025) requires hospitals to:
Develop comprehensive security plans based on risk assessments.
Include input from healthcare employees and patients.
Implement de-escalation training for security personnel.
Establish incident reporting systems and protect employees from retaliation.
The law also grants civil immunity to healthcare workers who act in self-defense during violent incidents.
Virginia – House Bill 1919 (Effective January 1, 2027) mandates employers with 100 or more employees to:
Develop and maintain a workplace violence policy.
Implement clear incident reporting mechanisms.
Designate individuals to oversee policy implementation.
Ensure protections against retaliation for reporting incidents.
Provides for a civil penalty of up to $1,000 per violation.
Massachusetts – Multiple bills aimed to enhance workplace safety and support for affected employees are under consideration, including laws that would:
Require healthcare employers to conduct annual risk assessments and create written violence prevention plans.
Mandate paid leave for employees assaulted in the line of duty.
Mandate paid leave for employees assaulted in the line of duty.
Require hospital implementation of workplace safety training programs.
New York – Assembly Bill A203 requires hospitals to:
Establish violence prevention programs.
Ensure at least one off-duty law enforcement officer or trained security personnel is present in emergency departments at all times.
These and other efforts reflect a growing recognition that protecting healthcare workers must be a legal and organizational priority—not just a cultural aspiration.
Reclaiming the ED as a Place of Safety — for Everyone
Daily violence cannot continue to be the norm. The Emergency Department should be a place of healing — not harm. As clinicians, leaders, and healthcare systems, we must stand up for our teams, advocate for change, and make it clear that protecting staff is not optional: It is foundational.
We deserve to feel (and be) safe at work. Compassion can never truly thrive in a climate of fear. We can not effectively care for others if we are constantly under attack.