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A six-foot-tall intoxicated patient strikes and kicks his medical-surgical nurse. A disgruntled family member tries to choke a doctor. A group of pain clinic nurses dodge bullets from a past patient. The facts about workplace violence are startling: 75% of nearly 25,000 workplace assaults occurred in health care and social services settings; 25% of nurses reported being physical assaulted by a patient or family member; only 30% of nurses report incidents of violence.

Workplace violence against nurses is a challenging issue. It has been described as the silent epidemic that leads to serious consequences. Aggression toward nurses poses a physical threat as well as decreased productivity and quality of care. Referred to as the “care paradox,” benevolent health care workers are plagued by the struggle of wanting to provide compassionate care while needing to apply protection from violent and aggressive patients.

We must consider not only the high cost of services or goods used in treating the results of violent acts, but also the legal cost, the cost of high staff turnover, and, finally, the ongoing turmoil and negative effects on the individual.

At risk are nurses working in organizations that lack staff training for recognizing and managing escalating hostile and violent behavior from patients. The development of a zero-tolerance approach regarding violence is fundamental. Workplace prevention and control policies, security, employee training, proper staffing, and confidential reporting of incidents with follow-up resources are essential to implementing effective programs.

Sarah E. Sidwell • Ballwin