Jamie Brown, one of four national presidents of National Nurses United, and Jane Thomason, a certified industrial hygienist and assistant director of health and safety for the NNU, joined the America's Work Force Union Podcast to discuss the health and safety crisis facing nurses and healthcare workers across the country.
Thomason described healthcare as the most dangerous industry in the United States for workplace violence, with nurses and other healthcare workers experiencing the highest rates of nonfatal workplace violence of any occupation, despite only a fraction of incidents being reported.
Brown and Thomason made the case for the Workplace Violence Prevention for Health Care and Social Service Workers Act, legislation that would mandate safe staffing ratios and workplace violence prevention programs at hospitals that receive Medicare and Medicaid funding. The bill also addresses a range of environmental health hazards in the hospital environment, including drugs meant to control cancer cells, disinfectants and the emerging threat of wildfire smoke drifting into healthcare facilities.
Thomason has spent her career at the intersection of worker health, science and advocacy. She came to nursing health and safety from the environmental health and safety field, having spent years in the nuclear weapons cleanup industry in the 1980s. She described what she found when she arrived as shocking: an industry that tolerates levels of workplace violence that would be considered a crisis in any other setting.
Healthcare workers account for approximately 73 percent of all nonfatal workplace violence injuries in the United States. Nurses and healthcare workers are five times more likely to experience workplace violence than workers in any other industry. Those numbers, Thomason said, represent only what gets reported. Healthcare culture has historically treated being hit, kicked, bitten or verbally abused by patients as an expected part of the job. Other disincentives include reporting systems that are often cumbersome, supervisors who sometimes actively discourage filing a report and workers who worry that filing a report will impact how management views their performance or threaten their job security.
The result is that violence in healthcare settings remains hidden, normalized and unaddressed at a scale that would produce emergency legislative responses in most other industries.
Brown made the case that workplace violence and inadequate staffing are two parts of the same problem. When a nurse is responsible for seven, eight or 10 patients rather than four or five, the margin for the relationship-based work of nursing disappears entirely. Nurses do not have time to sit with a patient who is anxious, in pain or confused. They do not have time to de-escalate a family member who is frightened or frustrated. The interaction that might have prevented an incident does not happen because there is no time for it.
The result is that understaffing drives up the frequency and severity of violent incidents, not just because there are fewer people to respond when something happens, but because the conditions that produce those incidents in the first place go unaddressed. The connection between staffing ratios and workplace safety is one of the most critical things the public does not understand about how hospital violence actually works, Brown said.
She described the nurses’ experience during an incident as traumatic. Different colleagues she has worked with have been hit in the head hard enough to cause a concussion, knocked to the ground and choked. The lack of public outrage about the violence healthcare workers experience reflects how effectively the culture of the industry has normalized it, she said.
The Workplace Violence Prevention for Health Care and Social Service Workers Act has been introduced in the U.S. Congress on multiple occasions under different names. Brown and Thomason both described it as the legislative vehicle that addresses both problems at once. The bill would require hospitals receiving Medicare and Medicaid funding to implement safe nurse-to-patient staffing ratios and workplace violence prevention programs as conditions of receiving the federal funding.
Hospitals that depend on Medicare and Medicaid reimbursement cannot simply walk away from compliance requirements tied to that funding. Making safe staffing and violence prevention programs a condition of participation in those programs creates real accountability rather than voluntary guidelines that facilities can ignore.
California's experience with mandated staffing ratios, in place for over two decades, demonstrates that the policy works, Brown said. California hospitals have lower nurse-to-patient ratios, better patient outcomes and safer working conditions than states without similar mandates. The research is not ambiguous. The model is proven. The question is whether Congress will act.
Thomason used the second half of the conversation to address health hazards that receive far less public attention than workplace violence but represent serious, chronic risks to nurses’ long-term health.
Antineoplastic drugs, the chemotherapy agents used to treat cancer patients, are handled by nurses in many hospital settings. These drugs are absorbed through the skin and represent a significant occupational exposure risk. Thomason noted that nurses who handle these agents face elevated risks of cancer and reproductive harm, including harm to fertility and fetal development. Proper handling protocols and protective equipment are in place, but they are not uniformly followed or enforced, Thomason added.
Disinfectants are a second category of concern. The widespread adoption of more aggressive disinfectant products after COVID created a healthcare environment saturated with chemicals that have known respiratory and skin effects. Thomason said the volume and frequency of disinfectant use in many facilities go well beyond what standard protocols recommended before the pandemic, and that the long-term occupational health consequences of that exposure are not yet fully understood.
The third hazard she raised is becoming more significant as climate change continues: wildfire smoke. In California and across the West, wildfire smoke is increasingly drifting into hospital facilities during fire season. Most hospital filtration systems are designed for biological contaminants, not the fine particulates in wildfire smoke. Those particles pass through standard filtration and enter the air that both patients and healthcare workers breathe. Thomason said the intersection of climate change and hospital environmental health is an emerging area that the nursing and occupational health communities need to address proactively rather than reactively.
Both guests described the NNU's health and safety work as one of the most important, but least visible, parts of what the union does. Having a full-time, certified industrial hygienist at a nurses’ union is unusual in the labor movement, Thomason said, and reflects NNU's commitment to addressing its members' occupational health with the same seriousness as any other heavily exposed workforce. She described the work as a feedback loop where the nurses report what they are experiencing on the job, then researchers and scientists at the union investigate and quantify the exposure and the union advocates for protections through bargaining, legislation and regulatory engagement.
The NNU's health and safety program is one of the things that make membership in the union substantively different from working without a union, Brown said. Research capacity, access to expert guidance and advocacy at the regulatory and legislative levels, are not things individual nurses or hospitals can replicate on their own.
More information on National Nurses United is available at nationalnursesunited.org.
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