Nurses face verbal abuse, threats and physical violence at work in every country, particularly in emergency departments, mental health units, and busy wards with long waits. Workplace violence should never be accepted as “part of the job”, and employers are responsible for safe systems. But individual skills also matter: well-practised de-escalation can stop many situations before anyone gets hurt.
Why people become aggressive
- Fear, pain, and feeling unheard: very common drivers in hospitals.
- Long waits and unclear information.
- Medical causes: hypoxia, hypoglycaemia, head injury, sepsis, delirium, dementia, alcohol withdrawal, intoxication.
- Mental health conditions, such as psychosis or mania.
- Grief and shock in families receiving bad news.
Always consider a medical cause, especially for sudden confusion or aggression in someone who was previously calm. Check blood glucose and oxygen saturation.
Warning signs of escalation
- Raised voice, swearing, rapid speech.
- Pacing, clenched fists, staring, invading personal space.
- Flushed face, sweating, rapid breathing.
- Verbal threats.
- Throwing or hitting objects.
Keep yourself safe first
- Keep an exit route: don’t let the person stand between you and the door.
- Keep at least a leg’s length or more of distance; stand at an angle, not face-on.
- Remove potential weapons (scissors, lanyards, pens) where you can.
- Alert colleagues early and know how to call security or use alarms.
- Never try to manage a dangerous situation alone; if weapons are involved or violence is imminent, withdraw and call for help.
Verbal de-escalation techniques
- One person speaks. Multiple staff talking at once increases agitation.
- Introduce yourself and use the person’s name.
- Calm, low, slow voice. Short sentences.
- Listen and acknowledge feelings: “You’ve been waiting five hours and you’re in pain. I’d be frustrated too.”
- Find something to agree with.
- Offer choices: “Would you like to sit here or in the quiet room?” This restores a sense of control.
- Set clear, respectful limits: “I want to help you, and I can’t do that while you’re shouting. Can we talk calmly?”
- Don’t argue, threaten, or take insults personally.
- Be honest about what you can and can’t do.
Non-verbal communication
- Open, relaxed posture; hands visible, not on hips or crossed.
- Appropriate eye contact (not staring).
- Don’t touch without consent.
- Sit down if the person sits.
When de-escalation isn’t enough
If there is immediate risk to the patient or others, restrictive interventions (physical restraint, rapid tranquillisation or seclusion) may be used only as a last resort, by trained staff, in line with law and policy, for the shortest time possible. Patients receiving rapid tranquillisation need close monitoring of vital signs and airway. Every restrictive intervention should be documented and reviewed.
Prevention
- Keep patients and families informed about waits and plans.
- Treat pain promptly.
- Identify patients at risk of agitation (e.g. delirium, withdrawal) early.
- Calm, uncluttered environments.
- Training in de-escalation for all staff.
After an incident
- Check for injuries and get treatment.
- Report every incident, including verbal abuse; reporting drives change.
- Debrief with the team. See our guide on supporting nurses after a traumatic event.
- You have the right to report assault to the police.
- Speak to your union or professional body if you feel unsupported.
Related: Workplace violence against nurses · Dementia care communication
Based on NICE NG10 (Violence and aggression: short-term management in mental health, health and community settings) and WHO/ILO/ICN framework guidelines on workplace violence in the health sector. Educational content: follow local policy and training.