“People are often stunned when they hear about the frequency of workplace violence in nursing,” said Wolf, director of the Institute for Emergency Nursing Research at the . “Other patients and staff are often not aware that it’s happening because these incidents occur behind curtains or closed doors.”

According to a survey of more than 7,000 emergency nurses nationwide, more than 54% of participants reported experiences of physical violence or verbal abuse within the past seven days. The leading forms of physical violence were being grabbed/pulled, hit, spit on and pushed/shoved/thrown, while the most common types of verbal abuse were being yelled at, sworn at, called names or threated with legal action. The full study was published in 2011 by the ENA.

For Wolf, one of the disturbing discoveries was that 33% of nurses in the study said they considered leaving the profession due to the violence. “This is a huge problem because this could be a significant loss of expertise and experience, which would have implications for patient care,” Wolf said.

Findings from a different study of 5,000 nurses at Inova Health System in Virginia suggest that violence is also prevalent in other hospital units. Forty-four percent of nurses in inpatient units reported incidents of workplace violence within a year — higher than the EDs or psychiatric units at Inova, according to the 2014 study in the Journal of Emergency Nursing. Also, male nurses experienced fewer incidents of violence, but they were more likely to formally report these incidents.

The also has developed online toolkits to help nurses enhance skills that decrease the chances of workplace violence, such as patient engagement techniques. Establishing a human connection with the patient is perhaps one of the most important skills nurses can acquire to keep themselves safe, said Diane Allen, MN, RN-BC, NEA-BC, chair of the Council of Safe Environments for APNA.

“Sometimes this may seem counterintuitive when we are feeling afraid of a patient, but it’s critical to make that connection and explain to a patient that I’m on his or her side,” said Allen, who is acting director of nursing at New Hampshire Hospital in Concord, an acute, inpatient psychiatric hospital.

The majority of the patients at her hospital have been admitted involuntarily because they have been deemed dangerous due to mental illness, and many of them do not recognize that they have an illness. She’s treated patients who tell her they need to leave, and rather than becoming controlling, Allen offers to help them understand why they were admitted and what they can do to get discharged.

“When I focus my attention on trying to understand their biggest concerns, whether it be getting a glass of water or making a phone call, I have built an alliance that can carry over as I continue working with the patient,” she said.

Although organizations like the APNA are promoting practices that increase safety for nurses, research suggests that nurses need even more support. According to a study published in Research in Nursing & Health, assault rates in psychiatric units have not changed significantly over time. In the study, researchers collected data from 345 hospitals nationwide between 2007 and 2013, and they found that nursing staff members were the most severely injured victims in assaults in 65% of cases during those six years. When nurses are assaulted, it’s important for organizations to provide support, such as employee assistance programs and assaulted staff action programs, Allen said.

“Nurses shouldn’t expect violence to be a part of providing care,” she said. “As demand for services continues to increase with the aging baby boomers and more nurses retiring, it’s more important than ever for nurses to take steps to protect themselves and their units.”