Healthcare providers are increasingly victim to aggression of patients and their loved ones. ‘I no longer dared to take care of the patient’

« They said, we will remember you, girl, » says nurse Reni. She has been working in the Rijnstate Hospital for over four years and was confronted with a patient’s threatening family a few months ago. The incident did not fall from the sky. For days the visitors had been addressed at the breaking of the rules: they came with too much at the same time and outside of the visiting times. Reni (« Rather not a last name »): « When I added the security guards after the umpteenth violation, some family members started pushing, hitting and scratching. »

In 2024, Rijnstate received 430 internal reports of aggressive behavior by patients or visitors. That was a hundred more than a year earlier. In addition to Reni’s experience, the hospital heard about incidents with spitting, swearing and throwing chairs. A door at the Emergency Department (SEH) was also destroyed. « In 1995 we had four security guards walking around here. In the meantime there are 34, » says Geraline Leusink, chairman of the board in her office.

What happens in Rijnstate is in line with what other large hospitals also report: healthcare providers are increasingly confronted with severe forms of verbal or physical aggression of patients or their loved ones. The Leiden University Medical Center (LUMC) sends an overview of reports by e -mail that the security considered serious enough to register. In 2021 there were 378, in 2022 442, 2023 682 reports, and in 2024 630 reports were received (some reports were lost due to a system adjustment).

The LUMC says via the phone that the number of reports has not only increased, but that the aggression also takes other forms. For example, employees receive intimidating messages via Facebook or Instagram from patients who did not get their way or think they should wait too long.

Nature of the aggression

National figures about the increase are missing. Umbrella organization Dutch Association of Hospitals (NVZ) says it does not have a complete picture of the aggression problems: internal reports and declarations are not passed on to the umbrella organization. Rijnstate in Arnhem is striking because it was one of the few institutions to bring the increase in incidents and its impact to the attention, for example in lobstery De Gelderlander.

Care is already struggling with staff shortages. This kind of stories does not help recruitment

According to Mike Wijngaarden, who gives training in hospitals throughout the country – also in Rijnstate – in dealing with aggression, that reluctance often comes from fear of deterring potential employees. « Care is already struggling with staff shortages. This kind of stories does not help recruitment. » He states that the problem in some hospitals is much greater than in Rijnstate. « I know university hospitals where the number of reports up to almost two thousand a year. »

To understand how the incidents arise, Rijnstate first looks at the nature of the aggression. Luc Beije, business safety manager of the hospital, explains that there are roughly three forms that he regularly sees. The first comes from a disease, such as dementia or psychological disruption. The second arises for fear or incomprehension. And the third, most problematic form, is the targeted aggression. Behavior intended to intimidate, threaten or force something. Like a patient who thinks he is entitled to priority, or family members who demand that the staff run faster.

Healthcare providers learn to recognize the first two categories and to deal with them. Anyone who recognizes and responds signals on time can often prevent escalation. In short or grumpy behavior, for example, can be an expression of panic. « Many caregivers take a distance, but then you have to seek rapprochement, » says Rijnstates head of psychiatry Willemijn Schepens. In her department she regularly sees patients who are hostile because they feel unheard of or misunderstood.

« You grow an elephant’s skin, » says SEH doctor Maik Berendsen. He regularly gets shouting or abuse of patients or family members who are in panic by what they experience as a serious injury. He has already established that there is no direct danger and first treats an urgent patient. « By quietly explaining that we monitor everything, even when we are not in the room, things usually calm down again. »

According to Beije and Wijngaarden, the actual problem is in the targeted aggression. Upon calculated threat, the learned techniques for de-escalation often fall short.

Emotional damage

Healthcare providers are advised to engage security for the first signals of this behavior. Nowadays, emergency buttons nowadays hang in many departments. And the staff can omit the last name on the nameplate. They are measures that limit the damage and increase the sense of security, but they do not tackle the source of targeted aggression, Wijngaarden emphasizes. « Security guards can sometimes prevent aggression by simply showing their faces. But the anger remains difficult to nip in the bud. »

There is no clear cause of the increased aggression. Those involved call a range of statements: a paved society, the decreasing trust in doctors through online self -diagnoses and the aftermath of Corona. People are also long waiting times. « Bol.com is faster than the emergency department, » Seh-Arts Berendsen was once heard.

Only when the patient left the hospital, did I feel safe in the department again

If threats are not damaged in time, care providers often remain with emotional damage. « The day after the incident I had service again, » says nurse Reni. « I no longer dared to take care of the patient, because I could meet his family again. I thought: should I do my hair differently so that they don’t recognize me? » Eventually she handed over the care to colleagues. « That went against my principles. I took a nurse oath. I want to take care of all patients. »

Reni touches the core of the problem: everyone is entitled to care, but if employees are intimidated or physically hindered, they cannot always provide that care. Healthcare providers sometimes have to keep taking care of the same patient for weeks and repeatedly face his family.

Reni: « Only when the patient left the hospital did I feel safe in the department again. » Not everyone knows how to stand in this, she sees. Colleagues are spanning at home for months or does less decisive after an incident. « You are getting wary to stand on your stripes. »

It would help enormously if hospitals were allowed to warn each other

Warnings

« The reports that come in are just the tip of the iceberg, » says Wijngaarden. For more insight, care providers organization NU’91 held a national poll at the beginning of this year among more than twelve hundred healthcare professionals. At the request of NRC The organization filtered the hospital staff that had responded to the questionnaire – those were 266 respondents. This shows that 43 percent indicated that they had had to deal with aggression in 2024, both verbally and physically. Almost half of them indicated that the aggression followed out of disagreement about the treatment plan and a third party that it was an (alleged) waiting time.

Targeted aggression is difficult to prevent. But punishing measures can prevent someone from going over again in the future. Since 2001, hospitals have been taking measures independently against aggressive visitors, without the intervention of the police. With a red card they can temporarily deny someone access, as long as the person does not need emergency care. In Rijnstate, such a denial applies for a year.

When Beije started at the hospital in 2017, six red cards went out. Last year there were 24. Beije: « Before the suspension ends, I will contact them. I usually hear that they will not do something like that again. And that is true: I have never experienced that someone went over again after a denial. »

This limit works within the walls of your own institution, but it sometimes means that the misconduct moves to elsewhere. Due to privacy legislation, hospitals are not allowed to inform each other about incidents. « The place where someone comes in after he has been sent away from us has no idea who they are confronted with, » says Beije. It is one of the reasons that Rijnstate chooses to come forward in the media about aggression, he says. « We want this problem to be on the political agenda. It would help enormously if hospitals were allowed to warn each other. »

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