Violence and abuse against nurses are among the most common workplace hazards in health care. Many hospitals display “zero tolerance” posters, but nurses often say nothing happens when they report abuse.
The question: Should patients who are violent or abusive be refused non-emergency care?
The case for
- Nurses have the same right to safety as any worker.
- Clear consequences may deter abuse.
- Other patients are put at risk by violent behaviour.
- Without real action, “zero tolerance” is just a poster.
The case against
- Abuse is often caused by illness: delirium, dementia, head injury, mental illness, intoxication or pain.
- Refusing care may breach legal and ethical duties.
- Withdrawing care can harm vulnerable people and make things worse.
- It may be applied unfairly to some groups more than others.
What the evidence says
The World Health Organization and International Council of Nurses report that a large proportion of health workers experience violence at some point in their careers, and that much of it goes unreported. Many countries now have policies allowing warnings, behaviour agreements and, in some cases, withdrawal of non-emergency treatment for people who are abusive with capacity, while never withholding emergency care.
The bottom line
Most policies separate abuse caused by illness, which needs clinical care and protection for staff, from deliberate abuse by people with capacity, which can have consequences. What nurses want most is to be believed and backed up when they report.
Related: De-escalation phrases for angry relatives
Where do you stand? Tell us in the comments. We read every one, and the best answers may feature in a follow-up article.
Sources: World Health Organization and International Council of Nurses, workplace violence in the health sector framework; NHS England violence prevention and reduction standard.
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