Threats against healthcare workers are rising — How hospitals can respond

A nurse in an emergency department is threatened by a patient’s relative. A social worker receives a verbal tirade during a routine visit. A psychiatrist is physically attacked while conducting an assessment. These are not exceptional scenarios. For many healthcare professionals across Europe, they are Tuesday.

The World Health Organization puts it starkly: between 8% and 38% of health workers suffer physical violence at some point in their careers. Many more are threatened or exposed to verbal aggression. And the trend is not improving — it’s accelerating.

If you’re responsible for safety, training, or workforce strategy in a healthcare organisation, this article lays out what the evidence says, where European regulation is heading, and what practical steps actually reduce incidents.

How big is the problem, really?

The short answer: bigger than most organisations acknowledge, and far bigger than what shows up in incident reports.

Global data

The ILO/Lloyd’s Register Foundation/Gallup survey (2022) — the first of its kind — found that nearly 23% of workers globally have experienced violence or harassment at work. That translates to roughly 750 million people. Healthcare workers are disproportionately affected: according to multiple sources, around 25% of all workplace violence victims worldwide are health workers, even though they make up a far smaller share of the global workforce.

A 2019 meta-analysis of 47 observational studies found that the overall prevalence of workplace violence against healthcare professionals was 62.4%, with verbal abuse the most common form (61.2%), followed by threats (39.5%) and physical violence (13.7%).

European data

Eurofound’s European Working Conditions Telephone Survey (EWCTS 2021), covering over 70,000 workers in 36 countries, found that 12.5% of EU workers experienced adverse social behaviour at work in 2021. But the numbers are sharply higher for frontline health professionals.

  • Healthcare workers reported unwanted sexual attention at three times the EU average (5.7% vs. 1.7%)
  • Healthcare and protective services workers reported bullying, harassment and violence at two to three times the EU average
  • Verbal abuse or threats is the most common form of adverse social behaviour directed at frontline workers
  • Workers who deal with customers and patients are twice as likely to experience adverse social behaviour as those who do not

A 2023 European Parliament question highlighted that in Italy alone, more than 4,800 cases of violence against healthcare workers were recorded between 2019 and 2021 — averaging around 1,600 cases per year. Women represented 71% of those targeted.

European estimates from the Scandinavian Journal of Work, Environment & Health (2025) indicate that 2–5% of the general workforce is directly affected by work-related violence, but rates climb to 5–30% in high-risk sectors such as healthcare, social services, education and public administration.

The underreporting problem

Perhaps the most concerning finding in the ILO/Gallup survey: roughly half of all victims never report what happened to them. The most common reason? They believed it would be a waste of time.

In healthcare specifically, the pattern is even more pronounced. Many healthcare workers still treat violence as an occupational inevitability — something that comes with the job. Research consistently shows that reporting rates in healthcare are low, with studies suggesting the vast majority of incidents go undocumented. When workers do report, many feel their concerns are not acted upon.

This creates a dangerous feedback loop: incidents go unrecorded, so the problem appears smaller than it is, so resources for prevention are not allocated, so incidents continue — and staff become even less likely to report. Breaking that cycle requires more than a policy change. It requires a cultural shift, starting with training that helps staff recognise what constitutes a reportable incident and understand why documentation matters.

What happens when violence goes unaddressed?

The consequences extend far beyond the individual incident.

Health impacts.
Research consistently links workplace violence to depression, anxiety and PTSD. Eurofound data shows that workers who experience adverse social behaviour are roughly three times more likely to suffer physical and emotional burnout (32% vs. 10%) and emotional exhaustion (40% vs. 14%), and nearly twice as likely to experience anxiety (53% vs. 27%) or be at risk of depression (38% vs. 20%). Emerging evidence also points to increased cardiovascular risk among those repeatedly exposed.

Staff turnover and sick leave.
Violence is a leading driver of job dissatisfaction in healthcare. International studies estimate that nurse turnover attributable to workplace violence ranges from 15–36% annually in some contexts. In a profession already facing critical shortages across Europe, this is not a marginal issue — it is a workforce crisis accelerator.

Patient safety.
Exhausted, anxious staff make more errors. A 2024 narrative review in eClinicalMedicine found clear links between workplace violence, poor worker health outcomes, reduced patient safety and increased medical errors. The relationship is not theoretical — when staff don’t feel safe, patient care suffers.

Financial costs.
Sick leave, staff replacement, rehabilitation, security measures, legal liability and lost productivity all add up. While comprehensive pan-European cost estimates are still lacking, the pattern across individual studies is consistent: the total financial burden is substantial and largely preventable.

What does European regulation require?

This is not a discretionary area. The EU Framework Directive 89/391/EEC requires employers to assess and mitigate all workplace risks — including psychosocial risks such as threats, violence and harassment. Training is explicitly named as a core employer obligation.

The EU Strategic Framework on Health and Safety at Work 2021–2027 goes further, promoting a “vision zero” approach to work-related harm and naming mental health at work as a priority. EU-OSHA’s upcoming Healthy Workplaces Campaign (2026–2028) will focus specifically on mental health and psychosocial risks, with healthcare as one of the highlighted sectors.

At the national level, Sweden’s updated provisions (AFS 2023:2) on systematic work environment management require employers to identify, assess and address threats and violence as part of ongoing preventive work. Similar requirements exist across Nordic and other EU Member States. The direction across Europe is unmistakable: regulators expect documented, proactive prevention — not just reactive incident management.

Training works — and the evidence is clear

Here is the good news: structured, evidence-based training makes a measurable difference.

A 2025 meta-analysis published in the International Nursing Review found that workplace violence prevention training for healthcare professionals significantly improves participants’ confidence in managing aggressive behaviour. That confidence is not a soft metric — it translates directly into better de-escalation, earlier intervention and fewer escalating incidents.

In a 2023 study published in BMC Health Services Research, a prevention strategy based on situational theory reduced the overall incidence of workplace violence among nurses from 64% to 46% within nine months, while also decreasing the severity of both physical and psychological violence. From a single, well-designed intervention.

Tesus Academy’s own evaluation data tells a consistent story. After completing training:

  • 95% of participants felt equipped to handle conflict situations at work
  • 85% reported reduced stress around threatening or conflict-filled situations
  • 89% reported a clear understanding of their workplace’s routines for threats and violence
  • Participants gave the training an average rating of 4.4 out of 5

As one safety coordinator put it: staff shifted from reacting after incidents to reaching out before — because they could now recognise early warning signs. That shift, from reactive to proactive, is exactly what regulators, researchers and common sense all point to.

So what should hospitals and healthcare organisations do?

The evidence and the regulatory direction converge on a few priorities:

  1. Include threats and violence in your risk assessment. Not as an afterthought or a line in a generic document, but as a structured assessment that covers psychosocial hazards, identifies high-risk roles and settings, and leads to concrete preventive actions.
  2. Train all staff — not just the most exposed. Tesus’s experience across Swedish municipalities, hospitals and care providers shows that training the entire organisation creates a shared language, shared awareness and collective readiness that training only frontline staff cannot achieve. When a receptionist, a manager and a nurse all recognise the same early warning signs, the whole system becomes more resilient.
  3. Build reporting into the culture. Provide clear, simple reporting systems. Follow up visibly on every report. Make it explicit that reporting is not a complaint — it is a professional responsibility that protects colleagues and improves the system.
  4. Document everything. Risk assessments, training records, incident reports, follow-up actions. Your documentation is both your compliance evidence and your improvement tool.

The bottom line

Workplace violence against healthcare workers is not a new problem, but it is a growing one. The data is unambiguous, the regulatory expectations are tightening, and the cost of inaction — in human suffering, staff retention and financial terms — is too high to ignore.

The evidence is equally clear that well-designed training works. Not as a silver bullet, but as a foundational part of a prevention strategy that includes risk assessment, clear routines, organisational support and a culture where safety is everyone’s responsibility.

Your staff deserve to feel safe at work. And the data shows it’s possible to get there.

Tesus offers E-learning courses developed by leading experts in conflict management, safety and psychology. 

Sources

  1. WHO: 8–38% of health workers suffer physical violence during their career WHO, Preventing Violence Against Health Workers https://www.who.int/activities/preventing-violence-against-health-workers
  2. 23% of workers globally experienced violence/harassment; ~750 million workers ILO / Lloyd's Register Foundation / Gallup, Experiences of Violence and Harassment at Work: A Global First Survey, 2022 https://www.ilo.org/publications/major-publications/experiences-violence-and-harassment-work-global-first-survey
  3. 25% of all workplace violence victims are health workers; >60% have experienced a violent incident WHO / ILO / Equal Times reporting https://www.equaltimes.org/violence-against-healthcare
  4. Meta-analysis: 62.4% overall prevalence of WPV against healthcare professionals Liu et al., Occupational and Environmental Medicine, 2019 https://pmc.ncbi.nlm.nih.gov/articles/PMC9206999/
  5. 12.5% of EU workers: adverse social behaviour at work in 2021 Eurofound, European Working Conditions Telephone Survey (EWCTS), 2021 https://www.eurofound.europa.eu/en/commentary-and-analysis/all-content/violence-workplace-women-and-frontline-workers-face-higher-risks
  6. Healthcare workers: 2–3x EU average for bullying, harassment and violence; 3x for unwanted sexual attention Eurofound EWCTS data analysis https://www.socialeurope.eu/abuse-at-work-who-bears-the-brunt
  7. Italy: 4,800+ cases of violence against healthcare workers, 2019–2021 European Parliament, Parliamentary Question E-001335/2023 https://www.europarl.europa.eu/doceo/document/E-9-2023-001335_EN.html
  8. 2–5% general workforce; 5–30% high-risk sectors (Europe) Scandinavian Journal of Work, Environment & Health, 2025
  9. ~50% of victims never report; most common reason: "waste of time" ILO / Gallup, 2022 (see source #2)
  10. Burnout 3x more likely; anxiety nearly 2x; depression risk nearly 2x among those experiencing adverse social behaviour Eurofound EWCTS analysis, reported via Euronews https://www.euronews.com/next/2023/03/09/young-european-women-nearly-four-times-more-likely-to-face-workplace-sexual-harassment-tha
  11. WPV linked to poor health outcomes, staff turnover, reduced patient safety, medical errors O'Brien et al., eClinicalMedicine (Lancet), 2024 https://pmc.ncbi.nlm.nih.gov/articles/PMC11152903/
  12. Nurse turnover attributable to WPV: 15–36% annually (US-based estimates) PSNet / AHRQ, 2023 Note: European rates tend to be lower.
  13. EU Framework Directive 89/391/EEC: employer obligations EUR-Lex https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex:31989L0391
  14. EU Strategic Framework on Health and Safety at Work 2021–2027 European Commission, COM(2021) 323 https://osha.europa.eu/en/safety-and-health-legislation/eu-strategic-framework-health-and-safety-work-2021-2027
  15. Healthy Workplaces Campaign 2026–2028: mental health and psychosocial risks EU-OSHA https://osha.europa.eu/en/themes/psychosocial-risks-and-mental-health/research
  16. Meta-analysis: training significantly improves confidence in managing aggression Chung et al., International Nursing Review, 2025
  17. Training reduced violence incidence from 64% to 46% in 9 months Cai et al., BMC Health Services Research, 2023
  18. Sweden AFS 2023:2 systematic work environment management Arbetsmiljöverket (Swedish Work Environment Authority) https://www.av.se