“I’ve seen nurses get shoved, pushed, scratched. The biggest one is bitten,” said Dhooghe, who works at in Grand Blanc, Michigan.

The in healthcare has in states such as , , , , and , where Dhooghe and many of her co-workers have been on the picket line since Labor Day last year.

“People will question me and be like, ‘Why are you still working in a place if you’re treated like this?’” said Dhooghe, who gets by on strike benefits and working extra shifts at another hospital. The problem, she said, is that other hospitals aren’t any better. “It’s the same everywhere I go.”

In a statement, spokesperson Dana Jay acknowledged violence against healthcare workers is a “national epidemic” and said the health system’s efforts to address the problem include metal detectors, armed security officers trained to make “misdemeanor arrests,” and de-escalation training.

“We have zero tolerance for violence of any kind,” said Jay, asserting the strike is not about safety but is instead “simply an economic strike.”

Nationwide, hospital workers are seven times as likely to be injured on the job due to violent acts as members of the general working population, according to the available from the Bureau of Labor Statistics. The outcry over workplace violence in healthcare is pitting workers’ demands for better compensation and staffing against hospital operators pressured to cut costs.

‘A Powder Keg’

Violent outbursts are so common that they’ve been dramatized on the popular medical TV series . “Emergency rooms right now are like a powder keg,” said Rachel Odes, an assistant professor at the University of Wisconsin-Madison School of Nursing.

In hospitals, a combative or violent patient is known as a “.” Outbursts can be spontaneous and unpredictable, making some almost impossible to prevent. But research shows the increases when hospitals are understaffed or employees are insufficiently trained or experienced.

Mental health worker Andrew Kimball-Mirzaie said he got hurt in February 2024 at Butler Hospital in Providence, Rhode Island.

He’d been working at the private psychiatric hospital for about six weeks and said he hadn’t yet worked in the ER. He said he was sent there to “monitor” a man in his 20s who was waiting for an inpatient bed.

The patient was alone in a back room watching a Knicks basketball game on TV, he recalled. Kimball-Mirzaie said he got the patient a drink and a snack. They were watching the game when, suddenly, he said, the patient stood up and punched him in the face. He said the assault left him with a concussion and broken nose. His injuries were documented in the hospital’s.

“I understand that there is an inherent danger with the job,” Kimball-Mirzaie said. He doesn’t blame the patient, who was very ill at the time. “We should have had at least another staff member with us,” he said, “and I should have been adequately trained on the unit.”

The attack emboldened Kimball-Mirzaie to join some 700 other unionized Butler workers last spring and summer in a months-long strike, which forced the hospital to close . Service Employees International Union 1199 New England declared the strike a win.

Employees received wage increases that union leaders said would enable the hospital to attract and retain more staff. The hospital also agreed to provide financial support for workers violently injured on the job. And the hospital and union agreed to jointly fund a “time bank” to supplement workers’ compensation for injured workers who need more time to recover.

But five months later, a nurse supervisor at Butler had to call 911 because an unarmed patient in the hospital’s ER was assaulting staff. According to the police report, by the time police arrested the patient, he’d injured two nurses, a security guard, and a police officer.

“Butler recognizes the importance of being proactive in protecting those who provide care,” Mary Marran, Butler’s president and chief operating officer, said in a statement. She added that hospital leadership meets regularly with staff to review safety measures and “identify opportunities to strengthen protection for everyone.”

The patient was charged with four counts of , including against the two nurses.

The American Hospital Association has said punishment is key to preventing violence. It has been to make assaulting healthcare workers a that would carry in prison. At least , including and , have enacted similar laws. But workplace safety experts say there is no evidence that such laws have reduced the incidence of violence against healthcare workers.

Calls for ‘Safe Staffing’

Striking healthcare workers around the country often have demanded “safe staffing” instead of stronger punishments for patients who cause injuries.

The against healthcare workers has caught the attention of the , the accreditation organization for more than 80% of U.S. hospitals and health systems. The commission released national performance goals that and require hospitals to be and that staff be trained “to provide safe, quality care.”

But no federal law limits the number of patients in a nurse’s care across healthcare settings, despite the nation’s largest nurses union, National Nurses United, having pressed for a national standard . Hospitals must “safely staff all units” to enable nurses to “provide the care that patients need before they get agitated or disoriented,” said , lead industrial hygienist for .

Some states have passed their own staffing laws. Only has enacted broad mandatory nurse staffing ratios, which were associated with lower mortality rates and likely higher retention. Oregon enacted a staffing law, . Legislators in and have introduced similar bills, but they have failed to advance to floor votes.

The American Hospital Association opposes mandatory minimum nurse staffing ratios in hospitals, saying they would “remove real-time clinical judgment and flexibility,” , and potentially force some hospitals to turn away patients or delay care, spokesperson Colleen Kincaid said. And she pointed to California, whose for psychiatric hospitals reportedly in at least four counties.

“There are a lot of other things you can do to prevent workplace violence than just increasing staffing levels,” said , who was a deputy assistant secretary of labor for the Occupational Safety and Health Administration during the Obama administration and helped develop OSHA’s for healthcare and social service workers.

Barab said hospitals can, for example, train employees in de-escalation, install metal detectors, or have specially trained security guards on-site so staff don’t have to wait for police to arrive when an incident happens.

, a worker safety and health policy expert at Georgetown University, said the in congressional Republicans’ One Big Beautiful Bill Act will in the next few years.

When funding dries up, she said, “protecting workers is going to be the first thing that gets cut.”

This article is from a partnership that includes and ³Ô¹Ï²»´òìÈ.

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

“If we didn’t have health issues, I’d just go back to where I was in my 40s and not have health insurance,” she said, “but we’re not in that position now.”

Freeman and her husband, , are freelancers who work in storytelling and podcasting.

In October, Lawrence, 52, got very sick, very fast.

“I knew I was in trouble,” he said. “I went into the emergency room, and I walked over to the desk, and I said, ‘Hi, I’ve gained 25 pounds in five days and I’m having trouble breathing and my chest hurts.’ And they stopped blinking.”

Doctors diagnosed him with kidney disease, and he was hospitalized for four days.

Now Lawrence has to take medication with an without insurance of $760 a month.

In January, the cost of the couple’s current “silver” plan rose nearly 75%, to $801 a month.

To bring in extra cash, Freeman has picked up a part-time bartending gig.

Millions of who have ACA health plans are facing soaring premium payments in 2026, without help from the enhanced subsidies that Congress failed to renew. Some are contemplating big life changes to deal with new rates that kicked in on Jan. 1.

It often falls to women to figure out a family’s insurance puzzle.

Women generally than men, in part because of their need for reproductive services, according to , a professor at Brown University’s School of Public Health.

Women also tend to be the for the family, she said, especially for the children.

“There’s a disproportionate role that women play in families around what we think of as the mental load,” said Tobin-Tyler, and that includes “making decisions around health insurance.”

Before the holidays, a few forms of relief for the premium hikes, but nothing has materialized, and significant deadlines have already passed.

Going Uninsured?

As the clock ticked down on 2025, B. agonized over her family’s insurance options. She was looking for a full-time job with benefits, because the premium prices she was seeing for 2026 ACA plans were alarming.

In the meantime, she decided, she and her husband would drop coverage and insure only the kids. But it would be risky.

“My husband works with major tools all day,” she said, “so it feels like rolling the dice.”

NPR and ³Ô¹Ï²»´òìÈ are identifying B. by her middle initial because she believes her insurance needs could affect her ongoing search for a job with health benefits.

The family lives in Providence, Rhode Island. Her husband is a self-employed woodworker, and she worked full-time as a nonprofit manager before she lost her job last spring.

After she lost her job, she turned to the ACA marketplace. The family’s cost them nearly $2,000 a month in premiums.

It was a lot, and they dug into retirement savings to pay for it while B. kept looking for a new position.

Because Congress failed to extend enhanced subsidies for ACA plans, despite ongoing political battles and a lengthy government shutdown over the issue, B.’s family plan would have cost even more in 2026 — almost $3,000 a month.

“I don’t have an additional $900 lying around in my family budget to pay for this,” she said.

B. had already pulled $12,000 out of retirement funds to pay her family’s 2025 rates.

Unless she finds a new job soon, the family’s projected income for 2026 will be less than . That means the children qualify for free coverage through Medicaid.

So B. decided to buy a plan on the ACA marketplace for herself and her husband, paying premiums of $1,200 a month.

“The bottom line is none of this is affordable,” she said, “so we’re going to be dipping into savings to pay for this.”

Postponing a Wedding

The prospect of soaring insurance premiums put a pause on Nicole Benisch’s plans to get married.

Benisch, 45, owns a holistic wellness business in Providence. She paid $108 a month for a zero-deductible “silver” plan on Rhode Island’s insurance exchange.

But the cost in 2026 more than doubled, to $220 a month.

She and her fiance had planned to marry on Dec. 19, her late mother’s birthday. “And then,” she said, “we realized how drastically that was going to change the cost of my premium.”

As a married couple, their combined income would exceed 400% of the federal poverty level and make Benisch ineligible for financial help. Her current plan’s monthly premium payments would triple, costing her more than $700 a month.

Benisch considered a less expensive “bronze” plan, but it wouldn’t cover vocal therapy, which she needs to treat , a condition that can make her voice strain or give out.

If they get married, there’s another option: Switch to her fiance’s health plan in Massachusetts. But that would mean losing all her Rhode Island doctors, who would be out-of-network.

“We have some tough decisions to make,” she said, “and none of the options are really great for us.”

This article is from a partnership with .

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .