Prevention is key to safety for health workers

Attacks on Accident and Emergency nurses in England have almost doubled over the last six years. National Health Service (NHS) figures show the number of incidents of violence against nurses in hospital A&E units rose from 2,122 in 2019 to 4,054 in 2024 – a 91 per cent increase. According to the Royal College of Nursing, nurses have been punched, spat at, pinned up against the wall and threatened with having acid thrown at them.^{[Ref 1]}

Workplace violence against health workers is a globally growing problem and notwithstanding decades of research and interventions, violent incidents are still rising in their severity and frequency.^{[Ref 2]} Despite the fact reported rates of violence and aggression differ between regions, the rates of physical violence, verbal abuse and sexual harassment or assault remain unacceptable high.   

In some cases, the abuse is not intentional. It is understood that some patients unintentionally become violent or aggressive due to their medical condition. A patient coming out of a low sugar event or a seizure may well be confused and violent, with a trained health worker aware of this and prepared to protect themselves. It is the unprovoked and unexpected events they are not prepared for – a frustrated family member who thinks it’s acceptable to take a slug at the nurse, that angry patient who insults the person giving them care.

Reactive 

I sympathised with a recent statement from the UK health secretary in response to the appalling statistics related to violence again nurses in his country: “Nurses dedicate their lives to helping others and deserve to go about their jobs free from violence or intimidation,” he said. 

“Anyone who violates this core principle will feel the full force of the law.”^{[Ref 1]} 

But I see this as a purely reactive approach to managing the situation, as we can often see with accident investigations in the workplace. Prosecuting offenders is not preventative. To me, the horse has bolted the stable and we need to be acting to prevent these events happening in the first place. Policy makers need to take proactive steps to stop this sickening violence against nurses and all health workers. It has to be about ensuring the harm doesn’t take place, rather than focusing on punitive action after the event. 

What safety and health professionals can do

These events occur in the line of duty, clearly making them an occupational hazard. It therefore falls to us, as occupational safety and health (OSH) professionals, to proactively address abuse and violence in the workplace. So, what can the OSH professional do? Here are some pointers.

• Recognise violence and abuse as occupational hazards and give them the same focus afforded to other hazards.
• Conduct risk assessments to identify and address the hazards. As psychosocial hazards, abuse and violence are very often poorly risk rated, leaving health workers vulnerable.
• Develop and implement zero-tolerance policies and back these up with workplace specific procedures to follow as needed. Communicate these policies to staff through training, and to the public and patients through posters, for example.
• Conflict may give rise to abuse and violence, so training health workers in how to avoid and manage conflict will aid de-escalation.
• Avoid lone working, especially in areas such as emergency units where tensions may run high. 
• Ensure health workers have a means of raising the alarm, eg provide coded calls or alarm buttons if the potential for escalation is identified. 
• Train staff in how to manage their stress so they can better respond to situations. 
• Organise debriefing sessions to allow workers to verbalise fears and anxieties and talk through their experiences – this supports their mental health.
• Conduct incident investigations for all events, including verbal abuse cases. Identify why events occur to help manage the root cause  
• Research needs to be funded to better understand what techniques are effective at preventing episodes of violence and aggression.  

The current statistics clearly demonstrate that we are not doing enough to protect our nurses and our NHS staff. Actions speak louder than words and the NHS trusts need to consider how delayed appointments, people’s inability to make appointments and long waiting times, for example, are contributing factors in escalating the risk of violence.

They would do well to reflect that, sadly, it’s the front-line workers – nurses, doctors and paramedics, for example - who fall victim to abuse stemming from frustration. The consequences of this include burnout, physical injuries, adverse mental health outcomes, and the overall attrition of staff.  We need to see concerted action to proactively address the root causes as is expected in any incident/accident investigation.  

Many health workers see their role as a calling rather than a job and often go above and beyond the call of duty to put their patients’ needs above their own. Yet, of course, it is no less distressing to hear of the escalation in violence and abuse these workers are facing. 

While I understand and appreciate the need for stab vests and other drastic means of protection, this can’t be a panacea. You never know when you are going to need a health worker – a sudden heart attack, an allergic reaction to a bee sting or just for some good old-fashioned advice. Whenever it is, it’ll be when you most need help. As OSH professionals, if we’re not there for them and don’t do more to protect their health, safety and wellbeing, they may not be there when we need them.

References

1. Campbell D. ‘None of us feel safe’: attacks on A&E nurses double in six years as waits rise. The Guardian [Internet]. 2025 12 Aug 2025]. Available from: https://www.theguardian.com/society/2025/aug/12/ae-nurses-attacks-rise. 
2. O'Brien CJ, van Zundert AA, Barach PR. The growing burden of workplace violence against healthcare workers: trends in prevalence, risk factors, consequences, and prevention–a narrative review. EClinicalMedicine. 2024;72.