KANSAS CITY, Mo. -- According to the American Nurses Association, one in four nurses nationwide is either verbally or physically assaulted in their career.
Nurses in the metro and across the country now say violence in the workplace from patients and their families is happening every day.
A U.S. General Accounting Office Survey reveals more than 70% of workplace assaults between 2011 and 2013 happened in healthcare and social service settings.
And a study by the occupational health safety network found nurses and nurse assistants were the most likely to be injured in assaults in the workplace.
“I've been punched. I've been swung at many, many, many times,” said “Cindy,” a nurse for more than 20 years. “I've been verbally assaulted in a way that I can never forget.”
"Monica," another metro nurse who also wants to remain anonymous, can`t forget the recent attack by a patient that endangered the life of her unborn baby.
“I was about 24 weeks pregnant, and a patient came into the ER that was most likely intoxicated and she punched me in the stomach,” said “Monica,” a nurse for more than six years.
“When I told her that I was pregnant, she instantly knew that- you could see on her face that it wasn`t right, but then proceeded to say some really nasty stuff about the outcome of my baby.'
She said patients have threatened her life more often than she can count.
“I've physically been told like when I leave here, I`m going to find out who you are, where you live, and I`m going to come kill you. And you just become numb to it all,” said “Monica.”
Violence against nurses is a serious growing problem. according to the Missouri Nurses Association.
“I would say it's an epidemic. It's a massive problem not just in the state but also nationally,” said Heid Lucas, the director for the Missouri Nurses Association.
What's causing this growing violence?
During our investigation, nurses repeatedly pointed to the opioid crisis, behavioral health issues, staff shortages, and what many consider a lack of respect for healthcare staff. A Kansas Hospital Association study backs that up.
Some nurses also blame the relatively new patient satisfaction surveys called HCAHPS that are tied to federal funding. It's a survey that patients fill out. Funding and jobs can be affected by these surveys.
The centers for Medicare and Medicaid require the surveys, and hospitals with lower scores, get less in government funding.
“Hospitals are paid based on satisfaction surveys that are given to patients - a few of the questions are was your room clean? Was your pain under control?” said “Cindy.”
“I would say a majority of people in healthcare want to make the patient happy, and that`s the outcome they want, but sometimes it`s not always what`s best for them is what they want,” said “Monica.”
And nurses said the fear of a bad HCAHPS survey may make them less likely to report violence assaults to superiors.
“There is definitely that fear that if they report it, outside, particularly if it goes to police and gets prosecuted there is concern that that will hurt their reputation going forward,” said “Cindy.”
Cindy Samuelson, vice president of the Kansas Hospital Association said the under-reporting is partially due to the empathy nurses feel for their patients.
“Caregivers are under-reporting it because they often times don`t think of verbal abuse as workplace violence,” Samuelson said.
“If that patient has dementia or is under a lot of stress, they may say they really didn't mean to do it. But we still want folks to report it so we can address it and prevent it from ever happening again.”
Patients are the most likely to assault nurses. According to the workplace violence survey by the KHA, nearly 73% of nurses and other hospital workers polled in the Sunflower State said patients initiated the violence.
Nearly 13% said patients' family members started the violence. About 46% said violence happens one to three times yearly.
Depending on the facility, though, acts of violence can happen daily.
“We saw in the survey that 30% of the individuals felt there was more workplace violence than a year ago,” Samuelson said.
At the Level One Trauma Center where she works, “Monica” said violence toward nurses happens nearly every day.
“It's pretty frequently -- at some point it's verbal or physical daily," said "Monica." “It's nothing for a physical assault to happen on a daily basis.”
Nurses and their advocates say it's time for a change.
“I get very angry. We're just trying to do our jobs. We`re just trying to come to work, do our jobs, do it well and come home to be with our family,” said “Monica.”
To address this increasing violence, some states, including Missouri, have tougher laws and heightened penalties for those who assault nurses and other healthcare workers.
Other states require hospitals to have mandatory workplace violence prevention plans. Many hospitals have beefed up security teams, and some nursing schools warn students about workplace violence and offer de-escalation training.
“Monica,” however, said the training she got in school was unrealistic.
“For example, if someone is like choking you, you`re supposed to ask someone to stop. And it's not really realistic. If someone is already to the point where they have their hands on you, asking someone to stop is not really going to help the case,” she explained.
It's a tricky balance because while defending themselves, nurses must be careful to not injure the patient they're caring for.
“It's an issue. Somebody could lose their job because somebody attacked them and they tried to keep from getting hurt,” Heidi Lucas said.
Even with the threat of violence, nurses we talked to said they still love their job. But if they could do it all over again, would they choose nursing?
“I would definitely be looking at other careers,” said “Cindy.”
“I don`t know if I would do it again,” said “Monica.”
Missouri State Sen. Wayne Wallingford introduced a bill last session that would require hospitals to have workplace violence prevention plans. The measure didn`t gain traction.
Wallingford`s office, however, told FOX4 the senator will re-introduce that bill in December.
One final note, “Monica” filed a police report against the woman who assaulted her and her unborn child. That case is pending.
Federal lawmakers are also taking action to address this issue. Late last week, the House approved a bill that requires the Department of Labor to develop workplace violence prevention plans for hospital employees. That bill now moves on to the Senate.
Interested in more resources on violence against nurses? You can find them here.