Patient experience matters. Patients deserve compassionate care, dignity, clear communication, and an active voice in decisions about their health. Their feedback can help healthcare organizations identify opportunities to improve care.
But patient-centered care and patient satisfaction are not always the same thing.
Nurses routinely make clinical decisions that patients may dislike. We hold medications when administration would be unsafe. We enforce fall precautions when patients insist on getting up independently. We prioritize a deteriorating patient while another waits. We establish boundaries when behavior becomes inappropriate.
These decisions may not always result in a satisfied patient, but they may represent exactly what safe nursing practice requires.
That distinction becomes especially important when the pursuit of patient satisfaction begins to overshadow the safety and dignity of the nurse.
“Was the Patient Confused?”
A nurse is kicked, punched, spat on, scratched, threatened, grabbed, or groped.
Too often, one of the first questions that follows is:
“Was the patient confused?”
It is an important clinical question. Delirium, dementia, withdrawal, intoxication, hypoxia, neurological conditions, medications, and other illnesses can contribute to aggressive or unpredictable behavior. Nurses understand this. Determining what caused a sudden behavioral change is part of our clinical responsibility.
But when we focus exclusively on explaining the patient’s behavior, we risk minimizing what happened to the nurse.
Where is the other question?
“Are you okay?”
The patient may have been confused, but the nurse was still kicked. The patient may have been experiencing delirium, but the nurse was still spat on. The patient may have lacked the capacity to understand their actions, but the nurse may still be left injured, humiliated, shaken, or afraid.
Two distinct realities can exist at the same time.
We can have compassion for a cognitively impaired patient while also acknowledging the impact of that patient’s behavior on the human being providing their care.
This is not an isolated concern. NIOSH reports that healthcare workers accounted for nearly half of nonfatal workplace-violence injuries requiring days away from work in 2021–2022, despite representing only about 10% of the U.S. workforce. Workplace violence in healthcare is not simply “part of the job.” It is an occupational safety problem.
Understanding Behavior Is Not an Agreement to Absorb Harm
Nurses are trained to look beyond behavior and search for its cause. We know agitation may signal pain, hypoxia, withdrawal, delirium, fear, or another acute change. We assess, de-escalate, redirect, and advocate.
That clinical empathy is one of nursing’s greatest strengths.
But understanding why someone causes harm should never mean that violence becomes an accepted occupational hazard.
The American Nurses Association has taken the position that nurses should practice in environments free from workplace violence. That responsibility cannot rest solely on the individual nurse’s ability to de-escalate a difficult situation. Organizations also have a responsibility to prevent violence, respond appropriately when it occurs, and support the people affected by it.
After an incident, the response must extend beyond assessing the patient.
Was the nurse injured? Do they need medical attention? Do they feel safe returning to the room? Does the care plan need to change? Are additional staff, security measures, closer observation, or environmental interventions necessary?
And perhaps most simply:
Is the nurse okay?
These questions do not diminish our duty to the patient. They acknowledge an equally important truth: Healthcare workers deserve protection too.
Being Groped Is Not a Job Requirement
Sexual harassment and violations of physical boundaries are another uncomfortable reality in healthcare.
A patient’s medical or cognitive condition may affect judgment, inhibition, and behavior. That clinical context should guide how we respond, but it should never determine whether the nurse deserves protection.
Being grabbed, sexually touched, or subjected to sexually explicit or degrading comments should not simply be dismissed as an unavoidable part of bedside nursing.
When patients have the capacity to understand boundaries, those boundaries should be clearly reinforced. When they lack that capacity, different interventions may be necessary—additional staffing, closer observation, environmental modifications, behavioral strategies, or changes to the plan of care.
The clinical response may differ.
The responsibility to protect staff does not.
The Joint Commission also recognizes workplace violence as more than physical assault; its framework encompasses threatening, intimidating, harassing, and other disruptive behaviors. Preventing and responding to these events is an organizational safety responsibility, not simply something individual nurses should learn to tolerate.
The Illusion of the Unaffected Nurse
Perhaps one reason these experiences become normalized is that nurses almost always keep working.
The medications are still due. Another patient’s call light is flashing. An admission is waiting. A neighboring patient is deteriorating.
The nurse, who was just assaulted, steps away, collects herself, documents what happened, and walks into the next room.
But continuing to function is not evidence of being unaffected.
We must stop mistaking professional resilience for an unlimited capacity to absorb harm.
Repeated exposure to verbal abuse, physical aggression, threats, and sexual harassment can take a toll. When incidents are repeatedly minimized, nurses may eventually stop reporting because they lose confidence that reporting will lead to meaningful change.
That silence should concern healthcare leaders.
When nurses stop reporting, organizations also lose important information. Patterns remain hidden. Opportunities for prevention are missed. Risks that might have prompted changes in security, staffing, observation, or the plan of care may continue.
Reporting creates data. Data reveal patterns. Patterns should drive prevention.
Patient-Centered Cannot Mean Nurse-Expendable
Patients deserve compassion, even when illness changes their cognition or behavior.
But compassion cannot flow in only one direction.
Setting a therapeutic boundary is not poor customer service.
Reporting an assault is not a lack of empathy.
Requesting security or additional support is not an unwillingness to provide care.
And asking for appropriate protection before returning to an unsafe situation should not be viewed as abandoning the patient.
These are safety concerns.
Healthcare organizations must be capable of holding two responsibilities at the same time: providing compassionate, appropriate care to the patient and protecting the healthcare professional delivering that care.
Neither requires sacrificing the other.
Patient satisfaction is a metric.
Patient safety is essential.
Nurse safety must be non-negotiable.
So when a nurse is kicked, punched, spat on, threatened, grabbed, or groped, ask the clinical questions.
Was the patient confused? What contributed to the behavior? Does the treatment plan need to change? What interventions can prevent another incident?
But do not stop there.
Turn to the nurse and ask:
“Are you okay?”
Because the professional standing at that bedside is not an expendable resource expected to absorb the violence of the shift.
The nurse is a person too.
References
American Nurses Association. (2025). Workplace Violence: ANA Position Statement.
ANA Workplace Violence Position Statement
This is especially strong for your article because ANA states that nurses and employers share responsibility for creating a culture of safety free from workplace violence. Nursing World
National Institute for Occupational Safety and Health. (2024). Prioritizing Our Healthcare Workers: The Importance of Addressing the Intersection of Workplace Violence and Mental Health and Wellbeing.
CDC/NIOSH Workplace Violence and Healthcare Workers
This supports your statistic that healthcare workers represented about 10% of the workforce but experienced 48% of nonfatal workplace-violence injuries in the cited 2021–2022 data. CDC
The Joint Commission. National Performance Goal #2a: Preventing Workplace Violence.
The Joint Commission – Preventing Workplace Violence
This supports the organizational-responsibility portion of your article, including reporting systems, data analysis, leadership oversight, post-incident response, training, and prevention. Joint
