Many Americans seeking a career have streamed into nursing in recent years, drawn by the ample employment opportunities, good pay and sense of purpose the profession offers. Less evident is a darker side of the job — a level of workplace violence that has many nurses fearing for their own safety.
"The reality is if you ask emergency nurses, they will tell you every single shift they work there is some case of workplace violence," said Patti Kunz Howard, president of the Emergency Nurses Association. "It's a very real challenge in the workplace setting, and it's no longer OK."
Nurses on the front lines, particularly those who work in emergency rooms, say it's a tough — even dangerous — environment rife with verbal and physical abuse. Burnout, especially among younger caregivers, is common.
No more silence on violence
It's worth noting that most nurses say they are satisfied with health care as a career, according to a recent survey staffing company AMN Healthcare. But far fewer are happy with the quality of the job itself.
In the era of the #MeToo movement against sexual harassment and assault, meanwhile, nurses are demanding reforms in how employers handle workplace violence, bullying and incivility.
"For many years it's been accepted as part of the job, but in today's world we recognize no one should be scared at work. We can't be effective if we are worried about being endangered by other patients and family members," Howard said.
Emergency room nurse Randee Litten said she was recently punched in the face by a patient as she attempted to draw their blood at St. Joseph Hospital in Eureka, California.
"I was trying to medically clear them so they could go to a mental health facility, and I got punched in the face by her and got a black eye," Litten told CBS News.
Litten's experience is not unusual. This unfortunate reality is borne out in the AMN Healthcare survey, which shows that 41% of nurses say they have been victims of bullying, incivility or other forms of workplace violence. Twenty-seven percent of those who were surveyed said they had witnessed workplace violence and 63% of those surveyed said their organization did not address the situation in a way that was satisfactory to them.
And these figures are conservative, because many in the profession have become inured to verbal and physical harassment, experts say.
"I think that statistic is actually low, because most nurses who are assaulted don't come forward with their stories. We have just kind of accepted it as part of our job, but now we are at the point where violence is becoming more and more aggressive, so we are trying to band together and report it more now," Litten said.
Hospitals reflect societal trends
Litten attributes the uptick in violent incidents to a lack of mental health resources in the area.
"The ER has become the holding spot for mental health patients, so if a patient is a danger to us or others, they end up being housed in our emergency department for up to seven days," she said. "Mental health hasn't been invested in for years, and now we have a huge [increase] in the mental health population in California. There are no resources for them, so they come to us."
Anna Dermenchyan, a veteran nurse who sits on the board of the American Association of Critical Care Nurses, described nursing as a "dangerous" profession.
Violence "is happening very frequently in the acute and critical care populations where you think patients are too sick. Most incidents involve patients and their families, but it can also come from coworkers, other nurses and physicians," Dermenchyan said.
Nurses are most vulnerable because they provide the most direct care to patients. But they're not always prepared to defend themselves.
"They don't teach it in nursing school or medical school. A lot of time is spent on clinical content, but when you get out there in the workplace, this is one of the dangers, and it sometimes takes until someone experiences something to learn how to deal with," she said.
More reporting in #MeToo era
None of the health care professionals to whom CBS MoneyWatch spoke were surprised by the high percentage of nurses who said they'd either experienced or witnessed workplace violence. In fact, they suspect that even the latest statistic is conservative.
One reason for the prevalence of abuse could be that the medical field remains a largely male-dominated profession, Dermenchyan said
"Incidents might have taken place, but they felt they had to stay quiet. But #MeToo has given rise to more reporting and people being open and honest on Twitter, and saying 'this is not okay,'" she said. "It has been around for a long time, but I think the #MeToo movement has brought more awareness and power to people to speak up against injustices."
As for why they stay, many nurses are deeply committed to the profession, despite negative experiences on the job, according to Dr. Cole Edmonson.
But burnout is real — and deleterious to the profession.
"Up to 21% of nurses leave the profession because of bullying and incivility," Edmonson said. "This to me is an unacceptable loss to the profession and society — that any nurse should leave because of the behavior of a colleague or patient."
Better leadership and harm-reduction efforts are essential to reversing nurses' departure from the trade, industry vets say.
They include teaching de-escalation techniques in nursing and medical school, equipping hospital rooms with panic buttons to summon help, and encouraging victims to report incidents of workplace violence or bullying.