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profit, instead of as a basic human need and right. Most hospitals and clinics in developed countries could significantly beef up RN staffing, an investment that pays off in staff retention as well as safer conditions for patients and nurses. Emergency departments around the world would be less crowded and have shorter wait times if health systems focused on preventive care and then actually provided the staff and resources needed to run a safe, efficient, and effective ER. Hospitals could be physically designed and outfitted to be safe if protecting work- ers and patients took priority over maximizing profits per square foot. Instead, healthcare institutions consciously gamble with their work- ers' and patients' lives by weighing monetary costs and risks. Do the right thing or do what will make the most money? Who absorbs the risk if conditions are not safe? Sadly, under our current globally lax regula- tory environment, employers financially benefit by simply shifting the risk of their failure to provide safe workplaces onto nurses and patients. In the face of for-profit healthcare, then, what nurses must do is fight collectively on multiple fronts for safe workplaces for themselves and their patients: at the contract bargaining level; at the political, legislative, and regulatory level; and, most of all, by taking direct action and protest. While the dilemma of violence against healthcare workers, especially nurses, persists, nursing and healthcare unions around the globe are winning victories and pushing the boundaries in combatting workplace violence. "Hospitals know what to do. They just don't want to do it," said Castillo. "We know that we cannot depend or rely on our employers, or our legislators or public officials, to protect nurses in the workplace. We have to make them act by showing up and speaking out to protect both nurses and our patients." * * * * * I nternational bodies such as the World Health Organization and International Labor Organization define workplace violence as "incidents where staff are abused, threatened, or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being, or health." The form can be physical or psychological. Physical examples involve beating, kicking, slapping, stabbing, shooting, pushing, biting, and pinching, but also includes spitting and throwing things—even bodily fluids or biomedical waste—at workers. Psychological includes verbal abuse, harassment (of which there are many forms), and threats. Sources of violence are predominantly patients, the vast majority of whom don't intend to hurt anyone but may suffer from confusion or delusion as a result of mental health issues, their medical condition, or medication state, or may just be lashing out under an abnormally high level of stress and fear. Other sources of violence include patients' domestic partners, family members, friends, enemies of the patient, and management. While data varies, different sources point to the conclusion that healthcare workers, and particularly registered nurses who provide the bulk of hands-on care to patients and their families, suffer the highest rates of workplace violence among all occupations. According to groups such as the WHO and ILO, violence in the health sector may constitute almost a quarter of all violence at work, and that num- ber is likely much higher due to a great num- ber of unreported incidents. The WHO estimates that up to 38 percent of healthcare workers will experience physical violence at some point in their work lives, and the U.S. Occupational Safety and Health Administration (OSHA) states that over a 12-month period in 2014, 21 percent of RNs and nursing students report being physically assaulted, and more than 50 percent are verbally abused. And by all accounts, workplace violence is on the rise. Every sin- gle nursing union we spoke with said that over the past five years, incidents are more frequent and sometimes more severe. On a micro, local level, nurses are attributing the increased violence to more instances of untreated mental health among patients, greater drug use and alcoholism, more cases of domestic violence, and greater stress due to poorer health as a result of unemployment. On a macro, global level, Global Nurses United posits that international finance capital, which has devastated national economies, is to blame for the high rates of unemployment and poverty that create the stress and suffering that destabilizes people and increases rates of substance abuse. It is likewise guilty of the forced austerity budg- ets imposed on so many countries' citizens that have led to huge cuts in health services, including mental health, and for the underfund- ed, understaffed hospitals receiving all these patients. Staffing healthcare settings with the appropriate number and skill mix of staff based on patient acuity is the number one action employ- ers could take to prevent workplace violence, but it's also the thing they are most loath to do because of costs. "Staffing is at the bottom of this. I have no doubt whatsoever," said Judith Kiejda, assistant general secretary of Australia's New South Wales Nurses and Mid- wives Association (NSWNMA), which won expanded staffing ratios last year. Staffing ratios are the key to both improving patient care and nurses' health and safety. That's why guaranteeing safe staffing ratios is such an important issue to nurses across the world. From this perspective, then, increasing violence against nurses is a logical and predictable result of the current unjust social and eco- nomic system. Anecdotally, nurses' stories show that workplace violence rates are actually much higher than the official data reveals. If you are in a room of hundreds of nurses and ask who has ever experienced physical or 16 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G M AY | J U N E 2 0 1 6 "When the nurse is at risk, the patient is at risk. And when the patient is at risk, the community is at risk." —Bonnie Castillo, RN and director of the Health and Safety Division of NNU ABOVE LEFT: LISA MOYLES