Prevention plans, de-escalation education, and more employer support could help reduce violence against Texas healthcare workers


Maddie McCarthy


According to a recent American Hospital Association survey, around half of nurses have experienced a verbal or physical assault from a patient or a patient’s family member in the last two years. More than a quarter of those nurses said they will likely leave their position because of the violence they have experienced. 

Texas is not immune to the issue, and stakeholders discussed violence prevention efforts at the 2024 Texas State of Reform Health Policy Conference on Feb. 27. 

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While healthcare workplace violence has existed since long before the COVID-19 pandemic, the public health emergency exacerbated the issue, said Cameron Duncan, JD, vice president of advocacy and public policy at the Texas Hospital Association (THA). This was due to two major reasons, he said.

“Our demand increased significantly,” Duncan said. “We had more patients and sicker patients coming into hospitals for a long period of time. [And] the supply of direct care staff started to dwindle really substantially.”

Serena Bumpus, a registered nurse and CEO of the Texas Nurses Association (TNA), said evidence shows that workplace violence increases when staffing is low. 

The Texas Department of State Health Services previously estimated a current shortage of almost 28,000 nurses in the state. It predicted a shortage of around 57,000 nurses in the state by 2032. Bumpus said that number is likely higher because the estimate was made before the pandemic.

Bumpus also noted that the regulations healthcare providers have to follow are more stringent, adding to the complexity of care. She said many doctors and nurses spend more time providing documentation for their patients than they actually spend providing hands-on care for them.

“We have to figure out how to change the system in order to give our clinicians time back to actually [care] for our patients,” Bumpus said. “It is a problem we continue to slap band-aids on instead of drilling down on the actual issue.”

Sen. Donna Campbell, MD, (R-New Braunfels), said the fear experienced by both providers and patients during the pandemic was a major factor in the state’s escalated workplace violence. 

“Nursing and medicine, those professions are held on a pedestal. Most certainly nurses, because nurses have always been the caregivers. They’re the ones that show love at the bedside. And when COVID hit, patients were afraid of dying, nurses [and] doctors were afraid of dying. Family members wanted to see their family and they couldn’t, and they got mad. They got angry.”

— Campbell

Bethany Fijan, a certified medical-surgical registered nurse and assistant clinical professor at Texas Woman’s University, said many medical and nursing students are not aware of the violence healthcare workers experience. 

Fijan said nursing students are often not assigned to patients with any sort of violent or combative history. This is often due to safety concerns, which Fijan supports. But it also causes many students to be unprepared when they become a registered nurse (RN), she said.

“When my nursing student becomes an RN, she is now going to be entering the regular assignment and be exposed to that,” Fijan said. “And so it kind of feels like a bait-and-switch at a used car dealership for nursing students.”

Fijan said that up to half of new nursing graduates leave the profession within two years.

Bumpus highlighted the utilization of virtual reality education, which some nursing schools use to train their students on de-escalation tactics. However, she emphasized that violence prevention starts at home where people talk to their children, friends, and family about what behaviors are acceptable.

Campbell introduced and passed Senate Bill 240 during Texas’ 88th legislative session in an effort to prevent violence against healthcare workers. The bill requires hospital facilities to establish a workplace violence prevention committee consisting of an RN, a physician, security staff (if the hospital has it), and other medical and non-medical hospital employees. 

“[The committee] sits and makes a recommendation on a workplace violence prevention policy and plan, and the board of the hospital has got to consider those recommendations,” Duncan said. “They don’t necessarily have to follow them but they have to consider them … It’s a big step forward. That law goes into effect Sept. 1.”

Duncan said the bill further defines workplace violence, including physical violence and threats of violence, that could cause psychological trauma. 

TNA and THA released a workplace violence prevention toolkit to guide facilities on how to comply with SB 240. 

Duncan said 89 percent of hospitals in Texas currently have some sort of workplace violence prevention efforts in place, but SB 240 will ensure there are standards to follow. The bill requires facilities to offer incident response services for healthcare workers involved in a violent exchange. 

Fijan noted that most employers offer wraparound services for their employees, such as the Employee Assistance Program (EAP), that are often underutilized. Talking about workplace violence allows people to feel like getting help is acceptable. during post-violence debriefings, healthcare workers have the tendency to say they are fine, she said.

“[We need to be] recognizing what happened, recognizing this is not OK and not something [they] just need to take, and getting [them] the appropriate care, whether that’s physical or psychological.”

— Fijan

Bumpus said workplace violence is underreported because many healthcare workers feel violence is just a part of their job.

Duncan said he expects the reported number of incidents to rise, which would mean policies are working as they should.

“If you’re not reporting it, you’re definitely not going to be requesting services to be supported for incidents that happen,” Duncan said.

Campbell said healthcare facilities need to be able to plan for responses to people who are in an altered state of mind. A person who has dementia, for example, may be violent toward a healthcare worker for different reasons than someone who is simply frustrated with their care. Nursing schools should ensure their students are taught proper care for older adults, she added.

Campbell encouraged healthcare workers to form support groups within their organizations in order to assist each other.

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