"Emergency rooms right now are like a powder keg. We’re seven times more likely to be injured on the job due to violent acts than the general working population."
The alarming reality faced by healthcare professionals is starkly illuminated by the words of Nurse Crystal Dhooghe, who, accustomed to the rigors of emergency care, finds herself increasingly exposed to violence directed at her colleagues. This pervasive issue has ignited strikes across multiple states, highlighting a critical struggle between healthcare workers demanding better safety and compensation and hospital administrators grappling with financial pressures. The fight for a secure work environment is escalating, forcing a national conversation about the systemic factors contributing to this crisis and the potential solutions needed to protect those on the front lines of patient care.
Nurse Crystal Dhooghe, an emergency room professional at Henry Ford Genesys Hospital in Grand Blanc, Michigan, has witnessed firsthand the disturbing escalation of violence against her peers. Her daily experience, typically involving the management of severe injuries, has been overshadowed by acts of aggression such as shoving, pushing, scratching, and even biting directed at her colleagues. This disturbing trend is not isolated to her institution; it reflects a national epidemic of workplace violence within the healthcare sector. The growing prevalence of such incidents has been a significant catalyst for widespread strikes among healthcare workers in states including Louisiana, New York, Pennsylvania, Rhode Island, and Michigan. Dhooghe herself, along with many of her colleagues, has been on the picket line since Labor Day of the previous year, a testament to the urgency of their concerns.
"People will question me and be like, ‘Why are you still working in a place if you’re treated like this?’" Dhooghe shared, explaining that her resilience is fueled by strike benefits and the necessity of working extra shifts at other facilities. However, her experiences reveal a disheartening truth: the problem is systemic. "It’s the same everywhere I go," she stated, underscoring the widespread nature of the issue.
In response to the escalating concerns, Dana Jay, a spokesperson for Henry Ford Health, acknowledged that violence against healthcare workers is a "national epidemic." The health system has implemented measures such as metal detectors, armed security officers authorized to make misdemeanor arrests, and de-escalation training. "We have zero tolerance for violence of any kind," Jay asserted, while simultaneously characterizing the ongoing strike as "simply an economic strike" rather than one primarily focused on safety. This perspective, however, is challenged by the experiences of frontline workers who report a direct correlation between safety concerns and their demands.
The statistical evidence paints a grim picture of the risks faced by healthcare professionals. According to the most recent data from the Bureau of Labor Statistics, hospital workers are seven times more likely to sustain injuries from violent acts on the job compared to the general working population. This alarming disparity fuels the outcry over workplace violence, pitting the demands of workers for improved compensation and adequate staffing against the financial pressures faced by hospital operators seeking to control costs.
The pervasiveness of violent incidents in healthcare settings has even found its way into popular culture, with the medical TV series "The Pitt" dramatizing these occurrences. Rachel Odes, an assistant professor at the University of Wisconsin-Madison School of Nursing, described emergency rooms as "a powder keg" in the current climate. The term "code gray" is used within hospitals to signify a combative or violent patient, with outbursts often being spontaneous and unpredictable, making prevention a significant challenge. Research, however, indicates a clear correlation between understaffing and insufficient employee training or experience, and an increased risk of workplace violence.
Andrew Kimball-Mirzaie, a mental health worker, recounted a harrowing experience at Butler Hospital in Providence, Rhode Island, in February 2024. Having been at the private psychiatric hospital for only six weeks and not yet assigned to the ER, he was sent to monitor a young adult patient awaiting an inpatient bed. While the patient was alone in a back room watching television, Kimball-Mirzaie provided him with a drink and a snack. During the course of their interaction, the patient abruptly stood up and punched Kimball-Mirzaie in the face, resulting in a concussion and a broken nose. His injuries were officially documented in the hospital’s incident log.
"I understand that there is an inherent danger with the job," Kimball-Mirzaie stated, emphasizing that he did not blame the patient, who was severely ill at the time. His primary concern was the lack of adequate support. "We should have had at least another staff member with us," he explained, "and I should have been adequately trained on the unit." This assault galvanized Kimball-Mirzaie to join approximately 700 other unionized Butler workers in a prolonged strike during the spring and summer of 2025. The strike was so impactful that it forced the hospital to close nearly half of its beds. Service Employees International Union 1199 New England declared the strike a victory, securing wage increases intended to improve staff recruitment and retention. Furthermore, the hospital committed to providing financial support for workers injured on the job and agreed to jointly fund a "time bank" to supplement compensation for injured employees requiring extended recovery periods.
Despite these agreements, the safety concerns persisted. Merely five months later, a nurse supervisor at Butler Hospital had to call 911 following an assault by an unarmed patient in the hospital’s ER. According to the police report, by the time law enforcement arrived and apprehended the individual, he had injured two nurses, a security guard, and a police officer. Mary Marran, Butler’s president and chief operating officer, issued a statement affirming the hospital’s commitment to being proactive in protecting its caregivers. She indicated that hospital leadership engages in regular meetings with staff to review safety protocols and "identify opportunities to strengthen protection for everyone." The patient in question faced charges for felony assault, including against the two nurses involved.
The American Hospital Association (AHA) has advocated for punitive measures as a means to deter violence, actively lobbying Congress to establish assaulting healthcare workers as a federal crime, punishable by up to 10 years in prison. This push aligns with existing legislation in at least 45 states, including Michigan and Rhode Island, which have enacted similar laws stiffening penalties for such offenses. However, workplace safety experts express skepticism regarding the effectiveness of these punitive measures in reducing the incidence of violence against healthcare workers.
In response to the persistent calls for enhanced safety, striking healthcare workers across the nation have increasingly prioritized demands for "safe staffing" over stricter punishments for perpetrators. The escalating violence has captured the attention of The Joint Commission, the accrediting body for a significant majority of U.S. hospitals and health systems. In January, The Joint Commission implemented national performance goals requiring hospitals to maintain adequate staffing levels and ensure staff are trained to provide safe, quality care.
Despite these initiatives, a significant gap remains at the federal level. No federal law currently limits the number of patients a nurse can care for across different healthcare settings. This is in contrast to the persistent advocacy by National Nurses United, the nation’s largest nurses union, which has been pushing for a national nurse-to-patient staffing standard since 2018. Jane Thomason, lead industrial hygienist for National Nurses United, emphasizes that hospitals must "safely staff all units" to enable nurses to "provide the care that patients need before they get agitated or disoriented."
A limited number of states have taken legislative action to address staffing. California stands out as the only state with broad mandatory nurse staffing ratios, which research suggests are associated with lower mortality rates and potentially higher staff retention. Oregon has also enacted a staffing law, albeit with certain exceptions. In Massachusetts and New Jersey, similar legislative proposals have been introduced but have yet to advance to floor votes.
The American Hospital Association opposes mandatory minimum nurse staffing ratios, arguing that such regulations would undermine "real-time clinical judgment and flexibility," exacerbate existing staffing shortages, and potentially compel hospitals to decline patients or postpone care. Colleen Kincaid, an AHA spokesperson, pointed to California’s recent implementation of emergency nurse staffing ratios for psychiatric hospitals, which reportedly led to bed closures in at least four counties, forcing individuals in mental health crises into overcrowded emergency departments.
Jordan Barab, former deputy assistant secretary of labor for the Occupational Safety and Health Administration (OSHA) during the Obama administration, argues that alternative strategies can effectively combat workplace violence. He suggests that hospitals can implement de-escalation training, install metal detectors, and deploy specially trained security guards on-site to mitigate the need for immediate police intervention during incidents.
Debbie Berkowitz, a worker safety and health policy expert at Georgetown University, expressed concern that proposed federal budget cuts could negatively impact hospitals’ financial stability, potentially leading to a reduction in worker protection measures. "When funding dries up," she stated, "protecting workers is going to be the first thing that gets cut." This concern highlights the ongoing tension between financial constraints and the critical need to ensure the safety and well-being of healthcare professionals.
This article is part of a collaboration involving NPR and KFF Health News.
