Workplace violence in healthcare settings during the COVID-19 pandemic

General 25 january 2022

Causes Of Pandemic-Related Aggressive Incidents In Healthcare Settings Since the onset of the Coronavirus pandemic in early 2020, medical facilities worldwide have come under increasing pressure.


As the virus took hold, an increasing proportion of the population became ill while others spread the contagion asymptomatically. As aresult, healthcare providers and hospital triage nurses found themselves having to deal with escalating COVID-19 admissions. However, in addition to the heavy physical and emotional workload of treating severely unwell patients, medical staff have also faced unwarranted aggression from patients or their relatives. What has caused this ill will? Below, we offer some insights.

Combined causes of healthcare workplace violence during COVID-19 Hospital visits and treatment can be unsettling even at the best of times.

Quite naturally, patients experience a roller-coaster of emotions when their health or that of a loved one is at risk. Then again, the protection measures designed to minimize the spread of COVID-19 have contributed to the situation. Although most adults realize that freedom-restricting protocols are necessary to protect public health, some individuals are less than stoic – and even grudging. It seems logical that the threat of infection with Coronavirus only adds to the pressure on individuals. Unfortunately, the stressful combination of all these factors has led to aggressive behavior in a minority of cases.

Intrinsic and extrinsic factors

In an analysis published by NICE (the UK's National Institute for Health and Care Excellence), most acute hospital assaults occur in emergency departments. These episodes of aggression and violence depend on two aspects. Firstly, intrinsic personality characteristics – particularly when exacerbated by distress and worry. Secondly, extrinsic elements such as the attitude and behavior of surrounding staff and service users tend to influence situations. Amid the COVID-19 pandemic, physical settings and restrictions that limit personal freedom have added to the problem. However, the resulting aggression affects the health and safety of other patients, carers and staff. NICE guidelines recommend intervening before violence occurs but recognize that avoiding it is not always possible. Therefore, the institution recommends graded interventions to prevent minor incidents from escalating.

Misconceptions, uncertainty and impatience

According to a report endorsed by the International Red Cross (IRC), some countries have seen violence result from misconceptions spread on social media. Claims that COVID-19 was a concocted conspiracy circulated widely, erroneously suggesting that patients were being tested and hospitalized unnecessarily. Apart from misinformation, the IRC identified the following circumstances as frequent precursors of workplace violence in healthcare settings during COVID-19:

  • Patient admission and shifting, especially when individuals or families were unaware of where to go or take the unwell person. In overwhelming periods, agitation levels rose on reaching hospital and being refused admission.
  • Patient and attendant behavior. Factors included exasperation, prolonged waiting, overcrowding inside facilities, interference in care and other emotional concerns. In addition, resistance to strict access and infection prevention or control protocols in hospitals was a significant issue.
  • Care provision and outcomes. Conflict arose due to delays, mistakes and limited resources such as the availability of beds, some medicines and oxygen supplies.
  • Poor communication between healthcare workers (HCWs) and family representatives also caused problems at times, particularly a lack of test reports and periodic updates on patients' conditions.

Similarly, accusations of premature discharge arose. In some cases, families demanded extended hospital stays for the hospitalized patient for fear of infecting others at home. These pleas, of course, left them at loggerheads with ward managers who were trying to free up beds to deal with high patient admissions. Other issues arose from:

  • Shifting clinical priorities and changes to treatment protocols.
  • The reluctance of HCWs to spend time with COVID-19 patients for fear of infection.
  • Emotional reactions to the sudden collapse of patients.
  • Demands from families for the immediate release of bodies and not record COVID-19 as the cause of death.


According to information published in the BMJ*, hospital managers in the US are reporting more threats to and assaults on staff and medics than ever. They have singled out the pandemic for generating friction. One Missouri hospital reported a dramatic increase in such incidents, which tripled from 40 in 2019 to 123 during 2020. As a result, staff injuries more than quadrupled year-on-year, up from 17 to 78. Consequently, the Cox Medical Center in Branson outlined plans to issue panic buttons to medics, nurses and receptionists.

Further information

Finally, Frenzs is aware of current events. Its experts lead the field in reducing aggression. If you direct or manage healthcare provision and would like to discover more, we invite you to browse Roger Almvik's authoritative publications about aggression in the workplace. 



*BMJ 2021;375:n2776 Additional research sources


Nice Guidance 


General 25 january 2022
We use cookies.

To learn more, view our Cookie Policy.