The Hospital Safety Crisis: Protecting Patients Means Protecting the People Who Care for Them

A patient entering a hospital places extraordinary trust in the institution. A family expects its loved one to receive care in an environment designed for healing. A nurse beginning a shift accepts responsibility for protecting lives, often under demanding and unpredictable circumstances.

That trust carries an obligation extending beyond medical expertise.

Hospitals must provide not only competent clinical care but also environments in which patients, healthcare professionals, and visitors are reasonably protected from foreseeable harm.

Yet violence against healthcare workers, weapons entering emergency departments, and persistent weaknesses in prevention and reporting systems reveal a significant challenge for American healthcare.

The consequences are not confined to security departments. They affect workforce stability, clinical operations, patient confidence, institutional finances, and the reliability of care.

The evidence does not establish that every American hospital is unsafe, nor does it suggest that every violent incident can be prevented. Risks vary substantially across institutions, clinical settings, and communities.

What it does establish is that violence and physical security risks warrant sustained attention from healthcare leadership.

Having a hospital security program is not the same as having a hospital that is demonstrably safe.

That distinction should guide the next phase of hospital safety policy, investment, and institutional accountability.

An $18.27 Billion Warning to American Healthcare

In June 2025, the American Hospital Association published The Burden of Violence to U.S. Hospitals, a research report prepared by the Harborview Injury Prevention and Research Center at the University of Washington School of Medicine.

The report estimated that community and workplace violence imposed an annual financial burden of $18.27 billion on U.S. hospitals in 2023.

The estimate included approximately $3.62 billion in prevention and preparedness expenditures and $14.65 billion in costs arising after violent incidents.

The largest component, approximately $13.17 billion, represented healthcare costs associated with treating victims of violence.

These distinctions are essential.

The $18.27 billion figure does not represent financial losses caused exclusively by security failures inside hospitals. Much of the estimated burden reflects the treatment of individuals injured by violence in the broader community.

Similarly, prevention expenditures include activities such as staff training, violence prevention programs, security personnel, infrastructure modifications, and monitoring technology. They are not necessarily evidence of institutional failure.

The report therefore should not be interpreted as suggesting that improved hospital security could eliminate the entire financial burden.

Its significance lies elsewhere.

Violence creates substantial demands on healthcare resources, affecting both the institutions responding to incidents within their facilities and those treating the consequences of violence occurring beyond their walls.

The financial burden also raises questions that cannot be answered through accounting alone.

How much clinical capacity is diverted when an emergency department experiences a serious security incident? What are the consequences when an experienced nurse leaves a high-risk workplace? How do repeated threats affect employee confidence, organizational culture, and the continuity of care?

These effects are difficult to quantify consistently, but they belong within any serious assessment of hospital performance.

Hospital leaders should understand violence not merely as a security expense but as a broader operational and public health challenge.

Healthcare Workers on the Front Line

The human consequences of workplace violence become particularly evident in the experiences reported by healthcare professionals.

A National Nurses United survey conducted between July 2025 and May 2026 collected responses from 1,267 registered nurses across 28 states and Washington, D.C.

Among respondents:

• 84.8% reported experiencing at least one form of workplace violence during the preceding year.
• 70.3% reported being verbally threatened.
• 23.4% reported physical injuries or symptoms associated with violence.
• 25.5% reported considering leaving nursing because of workplace violence.

The survey also found that 42.5% of respondents reported that their employers had not changed practices to reduce violence risks, while 22.8% reported that employers ignored reports of violence.

These findings require careful interpretation.

The survey reflects the experiences of participating nurses and should not be treated as a nationally representative estimate of violence among all American nurses. Its recruitment methodology and respondent characteristics limit the extent to which its percentages can be generalized.

Nevertheless, the findings identify serious concerns regarding workplace protection, reporting practices, and organizational responsiveness.

They are also consistent with the broader recognition of healthcare workplace violence as an occupational safety problem.

The Occupational Safety and Health Administration has long identified healthcare and social assistance as sectors facing elevated workplace violence risks. The Joint Commission likewise recognizes workplace violence as a threat to employee safety, workforce stability, and patient care.

The implications extend beyond the individuals directly harmed.

Violence can contribute to psychological distress, absenteeism, turnover, and diminished workplace confidence. When healthcare professionals work in environments where threats are inadequately addressed, the consequences may affect team functioning and the reliability of clinical operations.

Protecting healthcare workers is therefore not separate from protecting patients.

It is one of the conditions necessary for dependable healthcare delivery.

Weapons at the Emergency Department Door

A peer-reviewed study published in the American Journal of Emergency Medicine in 2025 provides a revealing example of the security challenges facing hospitals.

Researchers examined the introduction of passive weapons screening technology at a large academic Level I trauma center in the Midwestern United States.

Between November 2022 and October 2023, approximately 230,646 patients and visitors passed through the screening system.

During that period, the system detected or deterred 1,741 weapons, including:

• 1,390 knives
• 69 firearms
• 282 other or improvised weapons

Before implementation, the emergency department had detected an average of no more than one weapon per month.

The findings demonstrate a substantial increase in documented weapons identification following the introduction of structured screening.

They do not, however, establish that 1,741 violent attacks were intended or prevented.

Weapons detection is an intermediate security outcome. It is not equivalent to demonstrating reductions in assaults, injuries, or patient harm.

The study also reflects the experience of one institution. Its findings cannot automatically be generalized to hospitals with different patient populations, security arrangements, entrances, or operational requirements.

A separate systematic review and meta-analysis, published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes, examined 14 observational studies conducted in U.S. healthcare settings.

The researchers reported a pooled weapons prevalence of 4.0% among screened populations, with a 95% confidence interval of 2.0% to 7.8%.

However, prevalence varied widely across studies, ranging from 0.4% to 26.3%. Differences in screening methods, patient populations, clinical environments, and study design contributed to substantial heterogeneity.

The pooled estimate should therefore not be interpreted as a universal weapons prevalence rate for American hospitals.

Together, these studies support an important conclusion: weapons may enter healthcare environments, and systematic screening can identify risks that less structured practices may fail to detect.

What remains less certain is the extent to which particular screening interventions consistently reduce violence, improve patient outcomes, or deliver favorable results across different healthcare settings.

For hospital leaders, that distinction is critical.

Security investments should be informed by documented local risks, operational feasibility, patient access requirements, and evidence of effectiveness.

The objective is not simply to detect more threats.

It is to reduce preventable harm while preserving timely, dignified access to medical care.

Where Policies Fail to Become Protection

Hospitals operate within established federal requirements, accreditation standards, and occupational safety frameworks.

Under the Centers for Medicare & Medicaid Services Conditions of Participation, hospital patients have the right to receive care in a safe setting.

The Joint Commission's National Performance Goals, effective January 1, 2026, provide additional organizational guidance relevant to workplace violence and physical security.

Two goals are particularly important.

National Performance Goal 2a: Preventing Workplace Violence addresses multidisciplinary prevention programs, staff education, reporting processes, incident analysis, support for affected individuals, worksite assessments, and leadership oversight.

National Performance Goal 11: Creating a Secure and Safe Physical Environment addresses security risk management, access to sensitive areas, security incident procedures, and systems for monitoring, reporting, and investigating safety and security events.

These goals reflect established expectations reorganized within the 2026 accreditation framework rather than an entirely new set of obligations.

Their importance lies in the recognition that hospital safety requires organizational systems, not isolated protective measures.

Yet the existence of a policy does not establish its effectiveness.

A hospital may provide workplace violence training without ensuring that employees can report incidents easily. It may operate surveillance systems without consistently reviewing relevant events. It may maintain emergency response procedures without regularly testing coordination among clinical, security, and administrative personnel.

The National Nurses United survey illustrates this potential gap.

Although 74.8% of respondents reported receiving workplace violence prevention training, only 38.4% reported having a clear way to report incidents. Just 35.5% reported that staff were always available to respond to violence, and 18.2% reported employee involvement in violence risk assessments.

These percentages describe survey respondents rather than the national hospital system. Nevertheless, they highlight an important question for institutional governance.

Are hospitals measuring whether safety policies exist, or whether those policies are understood, implemented, and effective?

A meaningful safety program requires more than documentation.

It requires reliable reporting, risk assessment, staff participation, response readiness, incident investigation, corrective action, and ongoing evaluation.

Compliance establishes essential expectations.

Institutional accountability requires evidence that those expectations translate into protection.

Hospital Security Is a Patient Safety Responsibility

Hospital security has traditionally been associated with access control, surveillance, guarding facilities, and responding to disturbances.

These functions remain necessary, but their significance extends beyond protecting property.

Security incidents can interrupt treatment, threaten healthcare professionals, compromise restricted clinical areas, and interfere with hospital operations.

An emergency department responding to a violent disturbance may face competing demands on personnel and space. An unauthorized individual entering a sensitive area may create risks for vulnerable patients. A serious threat against clinical staff may disrupt the delivery of care.

The Joint Commission explicitly recognizes that security incidents can delay medical treatment and cause patient harm.

This connection places hospital security within the broader responsibilities of patient safety, emergency preparedness, clinical governance, and enterprise risk management.

However, effective protection requires more than increasing security presence.

Hospitals care for people experiencing medical emergencies, cognitive impairment, behavioral health crises, severe pain, trauma, and emotional distress.

These conditions may sometimes involve agitation or behavior that presents safety challenges. They must not automatically be interpreted as criminal intent.

A patient experiencing delirium, for example, may require urgent medical evaluation, compassionate de-escalation, and coordinated clinical support.

An individual making a credible threat of intentional violence may require a different response.

Security personnel and clinical professionals have distinct responsibilities. Neither can substitute for the other.

Effective systems must enable them to work together while respecting patient rights, clinical judgment, privacy, and the obligation to provide appropriate care.

Security measures should also be evaluated for unintended consequences, including unnecessary treatment delays, discriminatory screening practices, inappropriate escalation, or barriers affecting vulnerable patients.

The objective is not to turn hospitals into restrictive environments.

It is to make necessary healthcare access compatible with reasonable, proportionate protection.

Five Questions Every Hospital Board Should Ask

The responsibility for hospital safety cannot rest exclusively with security directors or frontline employees.

Hospital boards and executive leaders establish institutional priorities, allocate resources, oversee risk, and determine how performance is evaluated.

A credible governance approach should begin with five questions.

1. Do we know where our greatest security risks exist?

Risk assessments should reflect the institution's actual clinical environment, patient population, physical infrastructure, and history of incidents.

Emergency departments, behavioral health units, entrances, parking facilities, pediatric areas, and other sensitive locations may require different safeguards.

Hospitals should identify foreseeable risks through documented assessments rather than assuming that a uniform security model is appropriate for every department.

2. Are incidents consistently reported, investigated, and addressed?

Reporting systems should be accessible, credible, and designed to encourage participation.

Leadership should examine not only the number of reported incidents but also the possibility of underreporting.

An apparent decline in reported violence does not necessarily demonstrate improved safety if employees have lost confidence in the reporting process.

Institutions should evaluate the timeliness of investigations, the quality of corrective actions, and whether recurring risks are being addressed.

3. Are clinical and security teams prepared to respond together?

Hospitals should establish clear responsibilities for responding to threatening behavior, medical emergencies involving agitation, unauthorized access, and other security events.

Training should reflect the different roles of nurses, physicians, security personnel, behavioral health professionals, and emergency responders.

Preparedness should be tested through appropriate exercises, communication reviews, and post-incident learning.

4. Can we demonstrate that our safeguards are effective?

Security performance should be evaluated through meaningful indicators rather than equipment counts or staffing levels alone.

Depending on institutional circumstances, measures may include employee injuries, reported threats, response performance, treatment interruptions, completion of corrective actions, training readiness, and staff perceptions of safety.

These indicators require careful interpretation.

For example, increased incident reporting may initially reflect improved reporting culture rather than worsening conditions.

Likewise, more weapons detected may reflect improved identification rather than an increase in weapons entering the facility.

Leadership must distinguish changes in detection and reporting from changes in underlying risk.

5. Who is accountable for results?

Hospital safety should have clear executive ownership and appropriate board oversight.

Clinical leaders, security directors, facilities teams, human resources, emergency management, and technology leaders should participate in coordinated risk management.

The governing body should receive meaningful information about serious incidents, emerging risks, corrective actions, and unresolved vulnerabilities.

These five questions are proposed governance priorities, not a substitute for applicable legal or accreditation requirements.

Their purpose is to move the institutional conversation beyond whether a hospital possesses security policies toward whether its protective systems can withstand scrutiny.

Technology Must Demonstrate Value, Not Merely Capability

Healthcare institutions have access to increasingly sophisticated security technologies.

Weapons screening systems, electronic access controls, advanced video analytics, emergency communications, incident management platforms, and artificial intelligence-supported monitoring may offer useful capabilities.

Their potential should be evaluated seriously.

So should their limitations.

A surveillance camera does not automatically prevent an assault. A detection system does not replace trained personnel. An emergency notification platform cannot ensure an effective response when responsibilities are unclear.

Artificial intelligence may assist with identifying patterns or supporting situational awareness, but its outputs can be affected by data quality, system limitations, false alerts, and implementation conditions.

Hospitals must also consider privacy, cybersecurity, accessibility, operational reliability, and the risk of disproportionate or inappropriate responses.

Procurement decisions should therefore distinguish among three different questions:

Can the technology perform its stated technical function?

Can it operate reliably within the hospital's clinical environment?

Does its implementation produce meaningful improvements in safety outcomes?

A product may perform well on the first measure without sufficient evidence to establish the third.

The weapons detection research illustrates this distinction. Detecting previously unidentified weapons is a measurable capability. Demonstrating that a screening program reduces actual violence or patient harm requires additional evidence.

Healthcare organizations should establish appropriate performance measures before major implementation decisions and evaluate outcomes afterward.

Technology providers, in turn, should be expected to support claims with transparent evidence and clearly identified limitations.

The appropriate standard is not technological sophistication for its own sake.

It is demonstrated value within a responsible, clinically compatible safety strategy.

The Cost of Inaction Extends Beyond Hospital Budgets

Hospital security failures can create consequences that are difficult to capture in conventional financial reporting.

Healthcare professionals who experience repeated threats may suffer psychological distress, lose confidence in their workplace, or consider leaving their positions.

Patients and families who witness violence may experience fear or diminished confidence in the care environment.

Clinical operations may be disrupted even when an incident does not result in physical injury.

These consequences can interact.

Workforce instability may increase pressure on remaining employees. Operational disruption may affect patients who were not directly involved in an incident. Poor reporting practices may prevent institutions from recognizing recurring vulnerabilities.

Not every consequence can be attributed exclusively to security conditions, and not every risk can be eliminated through institutional action.

Nevertheless, foreseeable threats deserve systematic assessment and reasonable preventive measures.

The relevant question is not whether hospitals can guarantee absolute safety.

No complex healthcare institution can do so.

The question is whether leadership can demonstrate that risks are being identified, safeguards are proportionate, incidents are investigated, and lessons are translated into improvement.

That is the difference between treating security as a recurring operational cost and recognizing protection as an essential component of healthcare infrastructure.

A Shared Responsibility for Safer Healthcare

The challenges facing American hospitals cannot be addressed by any single profession, institution, or technology provider.

Healthcare executives establish priorities and accountability. Clinical professionals contribute essential knowledge of patient care and frontline conditions. Security specialists bring expertise in threat assessment, access management, and emergency response.

Researchers help distinguish promising interventions from those supported by stronger evidence.

Technology companies can contribute tools that address clearly defined operational needs.

Public safety agencies, educational institutions, insurers, policymakers, and community organizations also have important roles in prevention, preparedness, and response.

The American Chamber of Health believes that these stakeholders should work through structured, evidence-based collaboration to advance safer healthcare environments.

Three priorities deserve particular attention.

First, strengthen interdisciplinary collaboration. Hospital safety planning should integrate clinical leadership, security expertise, workforce perspectives, emergency preparedness, and institutional governance rather than treating these responsibilities as isolated functions.

Second, improve the evidence supporting prevention and investment. Healthcare institutions should share practical lessons, encourage rigorous evaluation, and distinguish measurable safety improvements from technology adoption or policy compliance alone.

Third, prioritize community impact. Progress should ultimately be assessed through better protection for healthcare professionals, reduced preventable harm, stronger operational readiness, and safer access to essential healthcare services.

As an independent healthcare collaboration platform, the American Chamber of Health supports constructive engagement among private healthcare organizations, public institutions, researchers, technology providers, and community stakeholders.

Its institutional perspective is that lasting improvements require shared responsibility, measurable outcomes, and sustained commitment.

No hospital operates in isolation from the community it serves.

Safer healthcare environments are therefore both an institutional obligation and a broader public interest.

Protection Is Part of Healing

American hospitals have made extraordinary advances in medical technology, clinical treatment, and the management of complex diseases.

The environments in which those advances are delivered deserve equally serious attention.

The available evidence identifies substantial financial consequences associated with violence, troubling experiences among surveyed healthcare professionals, and documented weapons risks in healthcare settings.

It also reveals important limitations in what is currently known about the effectiveness of specific interventions.

Those limitations should encourage better research and more rigorous evaluation, not institutional complacency.

Hospital leaders should be able to explain where their greatest risks exist, how employees report threats, how clinical and security teams respond, and whether protective measures are producing meaningful results.

The central question is no longer whether hospital security matters.

It is whether healthcare institutions can demonstrate that the people entrusted to their care, and the professionals providing it, are protected by systems that work.

Policies must become practices. Investments must be evaluated against outcomes. Leadership must accept accountability for both prevention and response.

A hospital cannot fulfill its mission of healing if the people inside it are not adequately protected.

Hospital safety is not simply a security concern.

It is a healthcare responsibility.

And it deserves the sustained attention of every institution and stakeholder entrusted with the future of American healthcare.

Editorial Sources and References

The following references support the principal research findings, regulatory requirements, and institutional standards discussed in this editorial.

1. American Hospital Association. The Burden of Violence to U.S. Hospitals. June 2025. Research prepared by the Harborview Injury Prevention and Research Center, University of Washington School of Medicine. https://www.aha.org/costsofviolence

2. National Nurses United. The State of Workplace Violence in Health Care in 2025–2026. Survey of registered nurses, July 2025 to May 2026. National Nurses United, published survey report.

3. McGuire SS, Gazley BF, Mullan AF, Clements CM. One year of passive weapons detection and deterrence at an academic emergency department: A mixed-methods study. American Journal of Emergency Medicine. 2025;89:57–60. https://doi.org/10.1016/j.ajem.2024.12.021

4. McGuire SS, Clements CM, Gerberi DJ, Murad MH. Prevalence of weapons in the health care setting: A systematic review and meta-analysis. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2025;9(1):100587. https://doi.org/10.1016/j.mayocpiqo.2024.11.004

5. The Joint Commission. National Performance Goal 2a: Preventing Workplace Violence. Hospital accreditation framework effective January 1, 2026. https://www.jointcommission.org/en-us/standards/national-performance-goals/preventing-workplace-violence

6. The Joint Commission. National Performance Goal 11: Creating a Secure and Safe Physical Environment. Hospital accreditation framework effective January 1, 2026. https://www.jointcommission.org/en-us/standards/national-performance-goals/creating-a-secure-and-safe-physical-environment

7. Occupational Safety and Health Administration. Hospitals: Workplace Violence. U.S. Department of Labor. Federal occupational safety guidance. https://www.osha.gov/hospitals/workplace-violence

8. Centers for Medicare & Medicaid Services. 42 CFR §482.13: Condition of Participation, Patient's Rights. Federal hospital participation requirements. https://www.ecfr.gov/current/title-42/section-482.13

Editorial Note

This article represents the institutional editorial perspective of the American Chamber of Health. It draws on published research, professional surveys, accreditation standards, and federal guidance.

Financial estimates are attributed to their original reporting periods. The economic burden of community and workplace violence is distinguished from costs directly attributable to security incidents within hospitals.

Survey findings are reported as the experiences of respondents and are not presented as nationally representative prevalence estimates. Observational weapons detection findings are distinguished from evidence of prevented attacks or reductions in violence.

Recommendations concerning governance, performance measurement, and collaboration represent editorial analysis and should not be interpreted as additional regulatory requirements or as evidence that any particular intervention guarantees safety.