In harm's way: Who is most vulnerable to violence against HCPs?

By Carol Nathan | Medically reviewed by Kristen Fuller, MD
Published April 27, 2023

Key Takeaways

  • Physicians are at increasing risk of being targeted for violence.

  • The level of risk for an individual doctor or nurse depends on several factors, including gender, race, healthcare specialty, and work environment.

  • Healthcare workers may want to become familiar with guidelines and recommendations issued by healthcare organizations and the US government for support in reducing workplace violence.

All healthcare workers, including doctors and nurses, are increasingly at risk of becoming a target of violence in the workplace, but this risk is not equal across occupations and settings. It can be helpful to understand which environments and individual healthcare workers carry higher risk, and why.

This article complements MDLinx's exclusive special report, Unsafe haven: The rise of violence against physicians in the workplace. Read the report here.

Studies have identified specific factors related to the risk of workplace violence. These include personal characteristics, such as gender, age, race, and other factors. In addition, the type of healthcare a person provides and in what setting greatly influences individual risk. Reports and proposals issued by healthcare organizations and the US government aim to educate and protect healthcare workers from violent incidents in an attempt to mitigate this public health concern. 

Male vs female: More risk for females

An analysis of violence against healthcare workers published in the BMJ focused on how pervasively it affects women.[] Healthcare worker surveys show that “female health workers are greatly affected by violence,” according to the authors. 

They cite a US survey of 1,066 academic medical staff in which 30% of women reported experiencing sexual violence in the workplace, compared with 4% of men.[] This difference was attributed to “gender power relations and their intersectionality with other factors, such as age, ethnicity, and income.” The survey researchers note female healthcare workers tend not to report the violence due to potential economic repercussions. For women, “the gender pay gap in the health sector is larger than the average of all labor sectors combined,” the authors wrote.

Racism at the root 

The AMA explains racism is often the source of the workplace violence.[] Racially and ethnically motivated violence against healthcare workers increased during the COVID-19 pandemic, targeting Black and Asian-American healthcare workers in particular. 

A physician commentary published in Academic Medicine observed that racially motivated attacks are not always acknowledged as such.[] 

Too often, the authors said, violence against healthcare workers is “decontextualized” and classified as “disruptive,” rather than race being named as a factor.

The global scope

The World Health Organization (WHO) has documented that healthcare workers all around the world are at high risk of violence.[] According to their statistics, 8%–38% of healthcare workers had been the target of physical violence at some point in their career. Even more are threatened with verbal aggression. The categories of health workers most at risk of violence include those in disaster or conflict situations, followed by nurses and other staff directly caring for patients, emergency room staff, and paramedics. 

Identical findings emerged from a systematic literature review of violence against physicians and nurses, published in Germany’s Journal of Public Health.[] 

One distinction noted was that physicians were the ones more likely to be targets of physical violence, whereas nurses were more likely to be targets of sexual harassment.

In both cases, the most common perpetrators were patients, their family, or the patients’ friends. 

US government initiatives to protect HCPs

The Occupational Safety and Health Administration (OSHA) has issued specific guidelines intended to prevent violence against health workers.[] OSHA describes specific healthcare environments in which workers are at highest risk for violence. Some of these include:

  • Working directly with patients who have a history of violence, have drug or alcohol abuse problems, or are gang members, plus relatives of patients with these attributes

  • Transporting patients 

  • Working alone in a healthcare facility or in patients’ homes

  • Working at healthcare facilities with poorly lit corridors, rooms, parking lots, and similar areas

  • Providing healthcare in neighborhoods with high crime rates

The US Department of Justice (DOJ) established a task force on Violence Against Health Care Providers, whose jurisdictions extend to reproductive healthcare, including abortion-related violence.[] The purpose of the task force is to serve as a clearinghouse for information on abortion violence and to track trends. Their database is used in prosecutions, a list of which is linked to the DOJ’s statement about the task force.

Overall risk factors

Researchers publishing in the Journal of Postgraduate Medicine provided a comprehensive review of workplace violence in healthcare.[] They identified patient, doctor, organizational, and societal risk factors for violence. 

  • Patient: Types of patients who commit violence against doctors are more likely to be male, have mental health disorders, be under the influence of drugs or alcohol, express dissatisfaction with health services, react to unexpected high cost of health services, have legal issues, or be reacting to a patient's death.

  • Doctor: Female doctors are more likely than males to have violence committed against them, as are shift workers or workers who have less experience in the job. 

  • Organizational: Departments where the most violence occurs are psychiatry and emergency departments; violence can also erupt in overcrowded patient areas with long waiting times and delays in service.

  • Societal: Language and cultural barriers can result in violence against healthcare workers; lack of respect for authority is also a factor. 

Healthcare equipment as weapons

The COVID-19 pandemic provoked an increase in violence against workers in healthcare, further drawing attention to the problem. An article in JAMA described the pandemic-era conditions that intensified the risks for violence, while also addressing the use of medical equipment as weapons.[] The authors offered the following suggested safeguards:

  • Replace IV poles with poles that are attached to the beds.

  • Store small items that can be used as weapons out of reach of patients and their visitors, including oxygen tanks, scissors, scalpels, and IV needles.

  • Consider safer furniture arrangement; eg, position beds to reduce the potential for staff to be trapped inside the patient’s room.

  • Do not wear scrubs outside the hospital environment, as it allows perpetrators to identify healthcare workers and incite violence.

What this means for you 

Although no healthcare worker is immune to workplace violence, knowing the hierarchy of risk can help healthcare workers take precautions to prevent incidents. Research shows that female healthcare workers are more at risk than males for being targets of violence. Racial indicators, like skin color, also play a role in risk level. Healthcare workers who provide reproductive, psychiatric, and emergency services are at higher risk. It can be unwise to wear scrubs outside the healthcare environment, because it can mark workers as a target for someone with a grudge against healthcare personnel. Healthcare workers across settings may want to take the time to become familiar with guidelines and recommendations issued by government and medical establishments for support in reducing workplace violence. 

Share with emailShare to FacebookShare to LinkedInShare to Twitter