The general assumption tends to be that violence in hospitals is on the rise. But is it? And, if so, how are hospitals responding to this trend?

Over the past year, 23 percent of hospitals reported an overall increase in attacks and assaults, compared with 10 percent reporting a decrease; 34 percent reported a rise in patient and family violence against emergency department staff versus 7 percent reporting a drop; and 29 percent reported an uptick in patient and family violence against other staff, compared with 7 percent reporting a decline.

These are some of the findings from a survey by Trustee sister publication Health Facilities Management and the American Society for Healthcare Engineering.

Despite the tough financial environment facing hospitals, nearly half the respondents said their security department's budget increased in 2011, while more than a third said there was no change. Almost 70 percent said their hospital's security strategic plan had been updated within the past 12 months. In addition, a large majority said their facilities had adopted workplace-violence and active-shooter policies to prepare staff for handling such emergencies.

The heightened focus on security comes as hospitals have experienced several violent incidents and threats in recent years. Government statistics back this up: a Bureau of Labor Statistics report examining workplace safety from 2003 to 2007 found that nearly 60 percent of all nonfatal assaults and violent acts in U.S. workplace settings occurred in the health care and social assistance industry.

Additionally, while homicides and shootings in health care settings are rare, there were 73 murders in health care settings, including 20 in hospitals from 1997 through 2009, according to government figures. The Joint Commission's June 2010 Sentinel Event Alert noted that the actual number of assaults, rapes and homicides in health care settings is probably significantly higher due to substantial under-reporting by health care institutions.

Nursing staff in emergency departments, intensive care units and psychiatric units are at a particularly high risk of being victims of violence. More than 1 in 10 ED nurses surveyed last year said they had been attacked in the previous week, according to the Emergency Nurses Association.

Many observers attribute the perceived increase in violence in hospitals to heightened stress faced by patients, family members and staff as increasing numbers of unemployed, uninsured, drug-using and mentally ill people seek care they can't access elsewhere.

For more survey results, go to