Assaults on Nursing Assistants

Posted on by SangWoo Tak, ScD, MPH

nurse aids patient trying to stand from a seated positionNursing assistants are a critical part of the dedicated staff who work day and night in nursing homes to keep residents safe, secure, cared-for, and comfortable. Yet the very workers ensuring the safety of our seniors are themselves at risk for workplace violence and assaults.

Recent NIOSH research based on the first large, nationally representative sample of nursing assistants reported that that nursing assistants in nursing homes have a high rate of work-related physical injuries from assault.1 Overall, 35% of nursing assistants reported physical injuries resulting from aggression by residents, and 12% reported experiencing a human bite during the year before the interview. Nursing assistants employed at nursing homes with special units for Alzheimer patients had a significantly elevated risk for assault injuries and human bites (37% reported injuries from assaults and 13% reported human bites).

Additional finding include:

  • nursing assistants reporting mandatory overtime and not having enough time for assisting residents with activities of daily living reported more assault injuries and human bites
  • Non-Hispanic Black nursing assistants were significantly less likely to report physical injuries from assaults and human bites
  • older nursing assistants (aged 55 years or older) were least likely to report an injury from a resident’s assault
  • those with job tenure of less than 12 months were significantly more likely to report physical assaults.

So how can we keep nursing assistants safe? Improving staffing levels may reduce the risk of assault by reducing workload demands and allowing staff more time to spend with each resident and avoiding the need to rush care. Additionally, nursing homes with specialized wings or wards for Alzheimer disease could benefit from more focused workplace violence prevention efforts.

Keeping nursing assistants safe is an important factor for retaining trained, motivated, and capable nursing assistants in long-term care. As the U.S. population ages, the need for nursing assistants will increase. It has been shown that nursing personnel who were subjected to work-related violence on at least a monthly basis reported higher intent both to leave the nursing profession and to change institutions. Research such as this is another step to understanding and improving the work environment for nursing assistants. We welcome input from readers on strategies that have worked to reduce violence against nursing assistants.

Dr. Tak is an epidemiologist in the NIOSH Division of Surveillance, Hazard Evaluations, and Field Studies


  1. Tak S, Sweeney MH, Alterman T, Baron S, Calvert GM, Workplace Assaults to Nursing Assistants in US Nursing Homes: A Multilevel Analysis, American Journal of Public Health 2010 100(10): 1938-1945
Posted on by SangWoo Tak, ScD, MPHTags

11 comments on “Assaults on Nursing Assistants”

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    Exactly as stated above, the only way to decrease injuries to nursing assistants, and to nurses, is to improve caregiver to resident ratios. But given the industry’s current practices, staffing is always low, to keep their profit margins, and when someone calls in sick, it creates a staffing crisis, and managers cannot always replace the staff—this also greatly increases risks of falls and other injuries to the residents also.

    This has been known for years, Pres. Bill Clinton even mentioned it years ago, but nothing has been done, the CEO”s of these nursing home corporations will not change unless there is a government mandate, which they will lobby against—there are many areas of “health care reform” that still need to be addressed.This major safety issue is an area where both the residents and caregivers are being “ripped off”. They are put at risk daily by the money crunchers, who have ruled healthcare ever since DRG’s, ICD-9 Cocdes, and other Reagan-era “reforms” were put into place in the 1980’s. Things just kept kept getting “leaner and meaner” in healthcare ever since. Beware when government wants to “reform” healthcare, things just end up more complex and expensive and less efficient.

    I do not know yet whether to return to school to study to be a nurse practitioner, or to go into science-related, health-related field that is NOT direct-care nursing. I’ve been a nurse for 32 years, and have to continue to work , with past-work related injuries and pain, until I can retire–like many others, I’m thinking “it’s not worth it” , I still want to have my body left, to be able to enjoy my retirement. Many times nurses say, ” I went to college for THIS?” Many young people who work as nursing assistants are “trying on” the idea of going into nursing, then decide, “it’s not worth it”, and this jeopardizes the future of nursing and perpetuates the shortage.

    For many years nurses have been saying this, but we have no power, it seems.

    Thank you for doing the above research—but what will become of it? It reinforces what has been said for years.

    Do any congress people read your research, or the president? What is the chance of this information being acted upon? Thank you for addressing it.

    Thank you for your comment. One challenge with research is the practical application. Our goal is to provide those working in the field, policy makers, worker representatives, industry, and other researchers with the best data available to make informed decisions. We hope that this study, which involves the first large, nationally representative sample of nursing assistants, will add to the body of research documenting the challenges facing nurses and the health care industry.

    I can not speak for all nursing homes, but, we do try to keep a higher ratio of Certified Nurse Assistants to residents at our facility. However, the stability of today’s workforce is very tenuous.

    We offer all types of incentives to employees, but, their stayability is very poor. They want immediate gratification, no, matter what the staffing level may be. You see “help wanted” on store front billboards now, that use to be where they advertized their products. Where our parents had 4 to 10 children, we had 0 -3 off spring. So, the off spring now needs to take care of the larger group of baby boomers. This by itself is causing concerns for all employers trying to hire the same people for their business.

    The situation will get worse, not, better, whether it be in health care or any type of business.

    Dr. Tak,
    I find this study extremely interesting and relevant to an extremely significant workers’ compensation issue. Would it be possible to obtain a copy of this article?

    Thanks for such pertinent research on an issue that needs greater national attention.

    i am an R.N. currently taking my masters degree i just want to also obtain a full copy of this article. i would like to present this study in my class report in research.
    thank you very much..

    This is a good article. There are news out there about employees harming residents. Sometimes we forget the other way around that employees are also at risk of violence from residents.

    This is unfortunate, but can be prevented by increasing the ratios of required caregivers to patients. Some states do not have any minimum requirements, which leaves the door entirely open to inviting negative occurrences. State nurse aide requirements can be obtained here []

    In [hospital name removed] assaults againts hospital workers is increase, violence in the streets by drug dealers is the high risk and Every day wounds people arrive to ER and Trauma Center.

    We have a very close friend and client that was punched in the face by a male patient and she is still not back to work. She has vision problems and is also some what scared to go back. This is one side of the industry that most people don’t think of.

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Page last reviewed: December 7, 2016
Page last updated: December 7, 2016