Last Updated on October 21, 2026 by Nurseslab.in Editorial Team
Most nurses have been assaulted at work. Most of those assaults were never reported.
That second sentence is the one the new generation of workplace violence laws is built to change — and it’s why the legislation passing in 2026 matters differently than what came before. Earlier laws told hospitals to have a plan. The newer ones tell hospitals to collect incident data, investigate what caused it, analyze the trends, and report upward — which means the whole legal structure now rests on something it cannot generate by itself.
The federal picture: stalled, and that matters
For years the expectation was that OSHA would issue a national workplace violence standard for healthcare. The groundwork was laid: a request for information in 2016, granted union petitions in 2017, and a Small Business Advocacy Review panel convened in 2023.
Then it stopped. OSHA moved the Prevention of Workplace Violence in Health Care and Social Assistance rule to its Long-Term Actions list in the Spring 2025 regulatory agenda published in September 2025 — a change industry observers described as unexpected. The previous agenda had the rule at the proposed stage with Federal Register publication planned for mid-2025. The Notice of Proposed Rulemaking date is now listed as “to be determined,” with no regulatory action expected for at least a year.
Had it proceeded, the rule would have required a written prevention program, regular hazard assessments, hazard controls, staff training, a dedicated workplace violence recordkeeping log, incident investigation procedures, and notice to employees of their rights.
What this means practically: there is no national standard, and your protections depend almost entirely on which state you work in.
One important caveat. No standard does not mean no enforcement. OSHA’s long-standing position is that the General Duty Clause requires employers to take reasonable steps to abate recognized violence hazards, and in 2019 the Occupational Safety and Health Review Commission ruled for the first time that the clause extends to protecting employees from workplace violence. OSHA has cited employers on that basis — including a 2024 case proposing $101,397 in penalties against a psychiatric and rehabilitation facility operator after a worker was hospitalized, where OSHA found insufficient controls to prevent escalating aggression.
The Joint Commission’s workplace violence prevention standards remain in force as well, requiring accredited hospitals to run prevention programs with data collection, analysis, and follow-up.
What states built in the gap
Twenty states now require at least some healthcare employers to adopt workplace violence prevention plans: Arizona, California, Colorado, Connecticut, Illinois, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New York, North Carolina, Ohio, Oregon, Rhode Island, Texas, Vermont, and Washington.
Separately, most states have criminal penalty enhancements for assaulting a healthcare worker. Missouri, for example, classifies first-degree assault as a class A felony when the victim is a “special victim” such as hospital or emergency personnel, and treats interference with a healthcare facility as a separate offense.
Penalty enhancements are politically easy and get the headlines. They also do very little on their own — a patient in florid delirium or psychosis is not deterred by a felony statute, and those patients account for a substantial share of assaults. The laws that change conditions are the ones that touch systems.
The real shift in 2026: from plans to data
This is the development nurses should understand, because it changes what your incident report does.
Washington — the most consequential for frontline nurses
Changes to Washington’s workplace violence prevention law under RCW 49.19 took effect January 1, 2026, and they are unusually substantive:
- Every incident must be promptly investigated — and the investigation must examine systemic causes, staffing levels, and other contributing factors.
- Quarterly reporting to the safety or workplace violence prevention committee, including de-identified incident data, investigation findings, trend analysis, and recommendations for improving the plan.
- Annual review and update of the prevention plan, rather than every three years, drawing on incident reports, investigation findings, staffing patterns, and unit-level risks.
Read that first bullet again. Staffing is now a named factor in violence investigations. For years nurses have argued that short staffing, long waits, and delayed care drive patient and family aggression, and been told that violence is a security matter rather than a staffing one. Washington’s law writes the connection into the investigative requirement.
The Washington State Nurses Association’s guidance to its members is blunt about why reporting matters now: the law relies on complete and accurate data to identify trends and justify safety improvements. Incomplete data produces a prevention plan built on a fiction.
Utah
A law effective May 6, 2026 requires hospitals to establish comprehensive workplace violence reporting systems by November 1. Hospitals must record all reported incidents, protect workers from retaliation for reporting, track incident details, analyze the data and retain records for at least two years, and report data to the state health department — with internal reporting to the chief medical officer and chief nursing officer.
That last element is quietly important. Data that reaches the CNO is data that can change a staffing or security decision.
New York
Governor Hochul signed legislation in December requiring hospitals to establish workplace violence prevention programs including security staffing in emergency departments. General hospitals in cities or counties of at least one million people must maintain at least one off-duty law enforcement officer or trained security officer in the ED at all times. The law takes effect September 18.
Virginia
Virginia already requires hospitals to establish a workplace violence incident reporting system under Va. Code § 32.1-127, following 2025 legislation, with ED-based hospitals additionally required to maintain a risk-based security plan and training. Multiple 2026 bills amending that section passed both houses, including one expanding reporting of threats or violence against healthcare providers. Separately, bills signed in June prohibit firearms and other dangerous weapons in medical facilities providing mental health and developmental services, including emergency departments, making possession a Class 1 misdemeanor.
Kentucky and Missouri
Kentucky’s HB 176 (2023) requires safety assessments, safety plans, annual training, recordkeeping, an internal reporting system, and annual compliance audits. A 2026 bill would add posted notices about the consequences of threatening behavior and require notice to workers when policies change.
Missouri’s HB 3401, advanced by two House committees, would require facilities to form prevention committees and adopt plans with annual training, incident investigation, anti-retaliation protections, post-incident services, and patient assignment adjustments — plus signage in ED and labor and delivery waiting rooms stating that assaulting a healthcare professional is a serious crime.
What this means on your shift
1. Your incident report is now a legal input, not a complaint
Under the newer statutes, aggregated incident data drives mandatory investigation, trend analysis, committee review, annual plan revision, and in some states reporting to a state health department. An unreported assault is not a private decision to let something go — it’s a data point removed from the evidence base that determines whether your unit gets a security presence, a redesigned triage area, or additional staff.
This is the single most important shift, and it reverses the old logic. The common reason nurses give for not reporting is that nothing will change. Under these laws, reporting is the only mechanism by which anything can change.
2. Anti-retaliation protections are increasingly explicit
Utah’s law prohibits retaliation against employees who report. Missouri’s pending bill includes anti-retaliation protections. Where these provisions exist, pressure not to report — subtle or otherwise — has a legal consequence attached.
3. “It’s part of the job” is now contradicted by statute
When a state requires systematic investigation of every incident including systemic causes, it has legislatively rejected the premise that violence is an acceptable feature of nursing work. That’s useful language to have behind you.
4. Staffing arguments have a new venue
If your state requires investigations to consider staffing levels, then documenting the staffing context of an incident is not editorializing — it’s responsive to what the investigation must assess.
5. Quarterly committee reporting creates leverage
Where committees must receive quarterly de-identified data, trend analysis, and recommendations, there is a recurring forum where unit-level patterns become visible to people with budget authority. Nurses who serve on these committees are in the room where decisions get made. Volunteer for one.
The under-reporting problem
None of this works if nurses don’t report, and the barriers are well understood:
- Time. Filing takes fifteen minutes you don’t have mid-shift.
- Futility. Previous reports produced nothing visible.
- Normalization. Being grabbed, scratched, or screamed at stops registering as an event.
- Attribution to illness. Nurses routinely decline to report patients with dementia, delirium, psychosis, or intoxication because the patient “didn’t mean it.”
- Fear of blame for de-escalation that didn’t work.
- Concern for the patient, particularly where criminal penalties might attach.
The fourth one deserves direct attention, because it removes the largest category of incidents from the data. Reporting an assault by a confused or psychotic patient is not an accusation against that patient. It is a record that a hazard exists — one that may be addressed through staffing, environmental design, sitter availability, behavioral response teams, or unit layout rather than through any consequence to the individual. Most prevention plans are built to address exactly this category, and they cannot be calibrated to incidents that were never logged.
How to report well
- Report every incident — physical assault, attempted assault, verbal threat, weapon-related event, and sexual harassment. Threats count.
- Use the designated system, not just a verbal mention to your charge nurse. Only formal entries enter the dataset.
- Document objectively and specifically: time, location, what preceded the incident, what was said or done, who witnessed it, and what physical contact occurred. Avoid characterizing the patient; describe the behaviour.
- Record the contextual factors — staffing on the unit, wait times, whether security was available and how long they took, whether a behavioural flag existed in the record.
- If injured, seek medical attention and notify your supervisor first, then complete the report. Your injury documentation and your incident report are separate records and both matter.
- Report to your union as well, where you have one, through its own reporting mechanism.
- Keep your own dated note of what happened. Memory degrades and personnel change.
Questions worth asking your employer
- Does our prevention plan meet the current requirements in this state, and when was it last reviewed?
- Who sits on the workplace violence prevention committee, and how do frontline nurses get on it?
- What happens to a report after I file it — who investigates, and what is the timeline?
- Do we receive the aggregated incident data back, and in what forum?
- What is the policy on behavioural flagging of patients with a documented history of violence?
- What is the actual response time for security on my unit, and is it measured?
- What post-incident support exists — and is it offered automatically or on request?
For nurse leaders
Two things determine whether these laws function on your unit.
The first is closing the loop. Nurses stop reporting when reports disappear. Where quarterly data and trend analysis go to a committee, feed some of it back to the floor — even briefly. A unit that sees its own numbers reports more.
The second is treating investigation findings as operational information rather than compliance paperwork. A statute that requires examining staffing levels as a contributing factor is handing you evidence for a staffing case. Most organizations file it instead.
REFERENCES
- Epstein Becker Green Health Care Workplace Violence Legislation Heats Up in 2026 https://www.ebglaw.com/health-law-advisor/health-care-workplace-violence-legislation-heats-up-in-2026
- J. J. Keller, OSHA Sidelines “Workplace Violence in Health Care and Social Assistance” Proposed Rule — J. J. Keller https://www.wsna.org/news/2026/2026-changes-to-washingtons-workplace-violence-prevention-law-what-rns-need-to-know
- Becker’s Hospital Review, 4 States Tackling Hospital Violence Prevention in 2026, https://www.beckershospitalreview.com/hr/4-states-tackling-hospital-violence-prevention-in-2026/
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