Nursing staff in A&E departments in England report being punched, spat at and even threatened with acid, an investigation by the Royal College of Nursing (RCN) has revealed, with violence against emergency department staff almost doubling since 2019.
The nursing union said that without decisive action to end the “utterly abhorrent” rise in violence, including by reducing lengthy waits in A&E, ending corridor care and tackling chronic understaffing, violence and aggression will continue to rise.
It comes as new RCN analysis of NHS data shows that waits of more than 12 hours in A&E increased by over 20 times between 2019 and 2024. For the first time, the RCN is warning ministers that failing to reduce violence in healthcare settings will see the government’s plans to turn round the health service in England “fail completely”.
Across the 89 Trusts that answered the RCN’s FOI request, there were 2,093 incidences of physical violence against staff recorded in 2019 compared to 4,054 in 2024. The rise has been so pronounced that it means during a typical working day in England, A&E staff are now being attacked every hour.
At Southmead Hospital in Bristol, which houses one of the largest A&Es in the South West, incidents of violence against A&E staff almost doubled between 2019-2024 (83 attacks to 152). At Manchester Royal Infirmary, incidents rose from 39 in 2019 to 79 in 2024. While at Maidstone Hospital in Kent, incidents rose by over 500% from 13 in 2019 to 89 in 2024.
One senior A&E nurse based in east London said her hospital was a “tinder box” for violence. She has seen colleagues punched, kicked, had a gun pointed at them and has herself been spat at by a patient and threatened with an acid attack.
She developed depression and anxiety and has taken a secondment in research as a break from the profession. “The violence I saw made me become more fearful outside of work. I saw how volatile people can be,” she said.
A senior charge nurse from the East Midlands, Rachelle McCarthy, said that things have got so bad in her hospital “even patients you would expect to be placid are becoming irate because of just how long they have to wait”.
“You can only imagine the behaviour of those who are already prone to violence,” she said. In one incident, McCarthy herself was punched “square in the face” by a “drunk, six foot two bloke”.
Another senior A&E nurse in the South West of England told of multiple occasions where she had witnessed violence in her ward including seeing a patient “pinning a nurse up against a wall” and another punching a member of staff “in the groin and stomach”.
Expressing her concern violence was having on staff morale, she said: “It’s not going to help with our retention and recruitment if you think you’re going to be clobbered every shift.”
Sarah Tappy, a senior sister in an A&E in East London, was in a waiting room when a patient punched her in the head knocking her unconscious. She later developed anxiety and PTSD as a result of the incident.
“The violence is awful,” she said. “And it’s just constant. Nurses, doctors, receptionists – none of us feel safe.”
In April, the health secretary Wes Streeting pledged to “keep NHS staff safe” by implementing mandatory hospital-level reporting of violence against staff, saying that “protecting staff from violence is not an optional extra”. However, the RCN says, “the government needs to do more than just record the shocking levels of violence” and ensure violent incidents begin to fall. Taking action on corridor care, understaffing and lengthy waits should be central to any plan, the College says.
“The stark reality is that unless the government does something about terribly long waits, understaffed nursing teams and dangerous corridor care, more nursing staff will become victims to this utterly abhorrent behaviour,” Nicola Ranger said.
Evidence of rising violence follows a landmark RCN report released at the start of the year which revealed an epidemic of corridor care in hospitals, as 5,000 nurses gave shocking testimony detailing overwhelming pressures on wards and severe overcrowding.
RCN General Secretary and Chief Executive Professor Nicola Ranger said: “Behind these shocking figures lies an ugly truth. Dedicated and hard-working nursing staff face rising violent attacks because of systemic failures that are no fault of their own. Every incident is unacceptable, but we need ministers and trust leaders to acknowledge some of the key underlying causes.
“Nursing staff not only go to work underpaid and undervalued but now face a rising tide of violence. It leads to both physical and mental scarring, lengthy time off and sometimes staff never returning. It is unarguably true that you can’t fix the health service when vital staff are too scared to even go into work.
"The government needs to do more than record the shocking levels of violence – it needs to reduce it. Measures to keep staff safe day-to-day are crucial, but the stark reality is that unless the government does something about lengthy waits, corridor care and understaffed nursing teams, more nursing staff will become victims of this utterly abhorrent behaviour. Left unaddressed, this could see plans to reform the NHS fail completely.”
