In 2024 in the United States, there were 2.5 million recorded nonfatal workplace injuries and illnesses, with 5,070 workers losing their lives.
That means someone in the U.S. died at work every 104 minutes. And a relatively small but highly significant part of the workplace injury equation involves workplace assaults. Between 2023 and 2024, workplace assaults caused 77,780 serious nonfatal injuries, with 54,230 incidents so serious that they led to time off work for the victims.
In this study, we’ll consider workplace assaults: the difference between various types (verbal as well as physical) and the shocking rate of fatal workplace violence. We’ll also look at the industries most affected, the injuries accrued by assault victims, the gender differential, and what workplace violence mechanisms are in place (or are clearly needed) to help deal with the issue.
Let’s start by asking: What is workplace violence?
Workplace Violence
Recent data (covering a 12-month period) tells us that workplace assaults accounted for 3% of all work absentee injury cases, the highest share on record. And yet workplace violence, and what defines an assault, might not be so obvious.
Workplace violence encompasses not only definitive acts of physical harm: it also includes threats of violence, harassment, and intimidation directed at workers, clients, customers, or visitors within a work environment.
It ranges from verbal abuse and threatening behavior to physical assault and even a fatal attack (470 people died due to a workplace assault between 2023 and 2024), and all industries are susceptible.
In the U.S., acts of violence are one of the leading causes of fatal workplace injuries. And it’s a crisis that federal regulators have spent decades failing to resolve.
Additionally, occupational health researchers estimate that a true measure of workplace violence would put cases at a 50-70% higher rate than self-reported employer figures suggest. Realistically, the problem is far more severe than official figures indicate.
And it’s a problem that afflicts some key American industries far more than it does others.
The Industry Workers Most Affected By Workplace Violence
Workplace violence is unevenly distributed across American industries. And for those training to enter an industry subject to disproportionate worker vulnerability, knowing what to expect could preemptively prepare new starters against what might otherwise be a shocking career induction.
While workplace violence touches nearly every sector of the U.S. economy, the data tells us that some workers must deal with alarmingly high levels of danger.
Healthcare and social assistance staff face by far the highest level of assault threat. The industry recorded a shocking 55,980 serious violent workplace assaults between 2023 and 2024 at a rate of 17.1 per 10,000 full–time equivalent workers.
That’s more than double the rate suffered by second-placed educational service workers: in this case, there were 5,530 cases at a rate of 8.4 per 10,000 over the same period.
Leisure and hospitality staff were involved in 2,850 cases, retail trade 4,660, and professional and business services 4,410 (though in all three cases at much lower rates than the two top-ranking industries).
Clearly, healthcare and social assistance workers confront extremely violent working conditions compared to almost all other industries.
A Turn-Off For The Next Generation?
For the nursing students, medical assistants, certified nursing assistant candidates, and patient care technicians currently preparing for their future careers, the numbers make for grim reading.
Many healthcare roles are clearly fraught with difficulties. Nurses may work a double shift in an understaffed psychiatric unit; a home health assistant may struggle to cope with a patient afflicted by behavioral conditions; emergency room technicians may have to manage patient intake in facilities with limited or non-existent security protocols; certified nursing assistants may be expected to provide custodial care in long-term facilities where physically aggressive patients have become a routine job hazard. These are often gruelling roles.
And they often lead to serious physical consequences. Instances of healthcare assault resulted in 16,440 cases involving sprains and strains, 12,070 cases involving bruises and contusions, 3,750 involving cuts and lacerations, and 1,350 fractures.
Nearly 80% of all serious workplace assault cases occur in medical and custodial care settings. Despite this, healthcare remains one of the few hazardous U.S. occupations without any mandatory federal violence prevention standards.
“Behind every workplace violence case is a real person: a nursing assistant struck by a patient, a retail worker threatened by an irate customer, a teacher corralling a volatile classroom. These workers are asking for no more than to go to work and come home safely.” — A DeMayo Law spokesperson
The OSHA guidelines meant to protect healthcare workers are (and have been since 1996) entirely voluntary. During that period, the healthcare assault rate has soared, the number of cases has skyrocketed, and the number of healthcare workers has continued to grow without any protections in place.
Healthcare training programs prepare students for clinical emergencies, serious illnesses, and the emotional consequences of caring for sick and dying patients. But there is rarely any preparation against the daily threat of physical workplace violence.
And for female trainees and students, there is a particular reason to worry about the start of their healthcare career.
Workplace Violence: The Gender Gap
As of 2023-2024 figures, women make up 47% of the private-industry workforce, yet they account for a disproportionate share (67%) of the workplace violence burden. Sadly, that’s the predictable outcome of a labor market that has historically featured disproportionate numbers of women in the industries, roles, and environments that carry the highest threat of occupational violence.
Healthcare and social assistance are the perfect example. It’s the most dangerous sector in the country when it comes to workplace violence (17.1 cases per 10,000 full–time workers). And it employs a workforce that’s around 78% female. Educational services, the second most dangerous sector, features a workforce that’s 69% female.
Until the industries and regulatory frameworks that govern these workplaces better appreciate the gendered nature of occupational violence, women will continue to face unnecessarily disproportionate danger. And when physical assaults at work take place, the measurable results are there to see.
Workplace Injuries Sustained During Assaults
Of the 77,780 workplace violence incidents recorded in 2023-2024, sprains and strains (18,750 cases or 24%), bruises and contusions (16,230 cases or 21%), and cuts and lacerations (5,070 cases, or 6.5%) are the most frequently recorded injuries.
While fractures (2,860 cases) represent a relatively low 3.7% of all workplace violence injuries, a fracture involves significant recovery time, often leading to significant income loss, especially for low-income workers.
Soreness and swelling accounted for 6,130 cases (7.9%). Such injuries are often dismissed as minor but can suggest more serious musculoskeletal damage that may worsen over time.
The overwhelming majority of workplace assault injuries (73,490 cases, roughly 94%) were a result of hitting, kicking, or beating by another person, with the single largest subset occurring while workers were providing medical or custodial care (61,760 cases, 79%).
Severe, low-frequency injuries were also recorded (stabbings and cuttings (500 cases), shootings (210 cases), and strangulation (170 cases). In each case, such an assault can change or end a life.
Clearly, those vulnerable to workplace violence face a variety of assault types and injuries. And those facing the highest level of threat are also often among those least compensated among the country’s workers.
The High-Danger, Low-Pay Conundrum
To a high degree, the industries with the highest rates of workplace violence are also those that pay their workers the least. That adds another layer of disadvantage for millions of Americans: not only do they face the highest level of workplace physical risk, but they’re also some of the country’s least compensated workers.
In 2024, healthcare and social assistance staff suffered the highest number of assaults in the workplace by a significant margin, yet they were also paid a median annual wage of just $37,180, well below the national average of $49,500.
Educational service roles were ranked second on the danger scale (8.4 cases per 10,000 FTE workers; 5,530 total violent assault cases). And teachers and support staff must navigate an increasingly volatile environment while earning an average annual wage of around $43,000, again below the national average.
Retail trade (4,660 violent assault cases; 1.4 per 10,000 FTE workers) employees must routinely endure violent assaults during robberies, thefts, and fraught confrontations with dangerous individuals. Yet retail workers earned an average $31,350 in 2024, less than two-thirds the national average wage.
Leisure and hospitality (2,850 violent act cases; 1.6 per 10,000 FTE workers) staff endured regularly violent confrontations with often impaired customers in bars, restaurants, hotels, and entertainment venues while earning an average annual wage of approximately $33,800. Accommodation and food services workers, the subset most directly exposed to volatile public-facing environments, earned even less ($30,700 a year).
To compare, professional and business services workers, who suffer the lowest workplace violence rate in this analysis (just 0.4 cases per 10,000 FTE workers), earn an average annual wage of around $83,600, more than double the earnings of high-violence industry staff.
That workers who suffer the highest levels of workplace violence are also paid the lowest wages represents one of the most underreported inequities in American working life. Without a federal prevention standard, the workers at the bottom of the wage scale will continue to bear a disproportionate share of both physical and financial punishment.
Employee Protection Standards
Despite workplace violence leading to 77,780 DART cases and 470 workplace homicides between 2023 and 2024, the federal framework meant to prevent such cases remains largely ineffective. There’s no specific federal OSHA standard that mandates workplace violence prevention in any industry.
Instead, employers across most industries, including healthcare and education, are subject to the Occupational Safety and Health Act’s General Duty Clause, which loosely requires workplaces to be free from recognized endangering hazards.
This means that most workers are protected solely by a 54-year-old catch-all statute with no industry-specific stipulations or binding regulations, no obligatory prevention plans, no training requirements, and no binding workplace violence risk assessments.
Overall, there’s a widening gap between the scale of workplace violence and regulatory guardrails. Healthcare and social assistance, with 55,980 instances of workplace violence in 2024 (nearly 5.5 times the private industry average), still operates without a mandatory prevention standard. OSHA spent years working on healthcare regulations, with their application due for late 2024. Yet these were later reclassified and removed, leaving the nation’s highest-risk industry subject to largely meaningless guidelines.
Educational services (with 5,530 workplace violence cases in 2024), retail trade (4,660 cases), and leisure and hospitality (2,850) suffer from similar issues, and are as ill-protected as low-risk office workplaces.
As things stand, maximum penalties for serious violations are capped at $16,131 per incident. Repeat violations can lead to a maximum penalty of $161,323, a figure that often falls far below the eventual costs involved with a violent workplace assault and prolonged repercussions.
And enforcement potential is low: as of 2023, just 1,875 federal and state OSHA inspectors scrutinised around 11.5 million workplaces. That’s enough to check every U.S. workplace once every 186 years, with an average budget of $3.93 per worker.
California remains the sole national outlier after introducing a broad mandatory workplace violence prevention law for general industry employers. Senate Bill 553, effective from July 1, 2024, means most employers must apply written Workplace Violence Prevention Plans, keep incident logs, and provide employee training.
For the tens of millions of comparatively endangered workers in healthcare, retail, education, accommodation and food services, and leisure and hospitality, employers are not obliged to observe recommended safety protocols.
And the financial consequences of workplace violence issues as they arise rarely reflects the financial, physical, or emotional gravity of workplace violence incidents. Such a lack of involved oversight often compounds worker burnout.
Workplace Violence And Worker Burnout
The consequences of continual workplace violence are far-reaching. Repeated exposure to assault, threats, and harassment can mean psychological injury and may even lead to burnout. That then means time off work, leading to significant costs for both workers and employers: often far more than any costs involved to impose adequate prevention strategies.
According to NIOSH, workers who experience workplace violence may report disproportionately high levels of depression, anxiety, PTSD, burnout, disrupted sleep patterns, and diminished job satisfaction.
In healthcare and social assistance, 60% of workers reported depression, 81% reported burnout, and nearly 2 in 5 reported they’d considered leaving their positions due to workplace violence. In educational services, 60% of K-12 educators reported burnout, with 20% absent from their roles in 2023 due to burnout. For some (7%), it was bad enough that they resigned from their roles during the 2023-2024 school year.
In leisure and hospitality, 47% of managers suffered burnout in 2024; 64% of their staff left for the same reason, citing customer volatility. In retail trade, 35% of workers said they felt unsafe at work (up from 27% a year earlier), with one in four considering leaving their job due to personal safety worries, and the industry as a whole is disproportionately likely to feature depressed workers.
The financial consequences are significant. Absenteeism due to workplace violence increases by an estimated 20% among staff in vulnerable roles, turnover rates rise by 15% in workplaces that feature frequent violent incidents, and companies lose 10% of workforce productivity after a violent workplace attack.
For workers already earning comparatively low wages, burnout may well be the end result in a role that’s stressful, potentially dangerous, and which lacks a meaningful federal prevention mandate and adequate institutional support.
For a combined workplace risk metric, it’s worth considering how all high-risk roles fare when we consider the Workplace Violence Worker Risk Index.
The Workplace Violence Scorecard
The Workplace Violence Worker Risk Index combines all the data we’ve examined in this study to provide an at-a-glance comparative representation of all the roles at significant risk of workplace violence.
Healthcare and social assistance solely occupies the Critical tier with a composite score of 9.5 out of 10, driven by the nation’s highest workplace violence rate at 17.1 cases per 10,000 FTE workers, an 81% burnout rate among violence-exposed workers, and a workforce where nearly two in five employees have considered leaving specifically because of violence exposure, despite a median annual wage of only $37,180.
The remaining four industries are all considered ‘High’ risk, though they often differ in terms of categorical scores. Educational services ranks second overall, fueled by high workplace violence and burnout rates, though lower-ranked industries often score higher for wage inequality and turnover.
As a group, the five indexed industries employ tens of millions of Americans, all operating without violence prevention regulations, all comparatively underpaid, overexposed, and extremely vulnerable to burnout. The data does not represent a workforce in decline: it describes one suffering a real crisis.
Workplace Violence: Too Prevalent, Too Unchecked
Workplace violence is a serious issue. Workplace assaults account for 3% of all workplace absences, following tens of thousands of attacks and injuries. At worst, workplace assaults result in fatalities. The workplace should be a safe space, but so often isn’t.
Workplace violence is also one of the most underreported, under-regulated, and underestimated occupational hazards in the U.S., with little preparation in place for trainees getting ready to start careers in healthcare, the role subject to by far the highest rate of workplace violence.
Healthcare and social assistance staff suffered the highest number of assaults in the workplace by a significant margin, yet they were also paid a median annual wage of just $37,180, well below the national average $49,500
Additionally, workers facing high levels of workplace violence are often among the lowest-paid workers in the country, and are on wages that cannot cover disproportionate levels of absenteeism, illness, and injury.
With limited or nonexistent workplace violence prevention measures in place, plus a lack of meaningful, mandatory employer regulatory requirements covering any of the dangerous roles under consideration, many workers are exposed to worrying conditions with little recourse for resolution.
With all these issues in mind, it’s easy to see why roles subject to high levels of workplace violence and minimal protection lead to high levels of burnout and turnover.
Overall, the American workplace violence crisis clearly requires significant attention. Without notable improvements across multiple factors, American workplaces (some far more than others) will continue to be potentially highly dangerous environments for those who should by rights feel at least relatively safe while they fulfil their responsibilities.
You should be able to complete your job safely. When you get hurt at work, your employer and their insurance company should pay you fair compensation. At DeMayo Law Offices, our Charlotte workers’ compensation lawyer can help you demand it.
