To help mitigate the problem, the 2025 RAND report found strong support for two strategies: enforcing anti-violence policies in hospitals and enacting state or federal laws that increase the legal consequences for violence directed at health care workers. Those and other potential strategies, emergency physicians and nurses said, have been undermined by a lack of resources to institute deterrents such as metal detectors and security guards, as well as poor enforcement of existing policies and inconsistent guidance from regulatory agencies.

Better Reporting, Harsher Penalties

As chair of the New York ENA Government Affairs Committee, Nover played a key role for ENA, in a joint effort with NY ACEP, to pass a state law called the Workplace Violence Prevention for Health Care and Social Services Workers Act.

The act, signed into law in December 2025, and scheduled to take effect in September 2026, mandates programs to include annual workplace safety assessments that adhere to regulatory requirements established by CMS and security presence in EDs. The Act also requires hospitals to create workplace safety committees, develop violence safety plans, and share data. For EDs in catchments of more than one million people, the law requires an off-duty police officer or trained security guard to be onsite at all times, while smaller hospitals must at least have security officers in the hospital who are available to respond to ED incidents.

“This is a tremendous gain,” Nover said.

The law is the latest in a series of victories that ACEP and ACEP chapters have spearheaded to confront the crisis of workplace violence in EDs. In 2025, Ohio ACEP advocated for the passage of HB 452, aimed at preventing hospital violence, enhancing training, improving incident tracking and reporting, and strengthening security plans for emergency department staff. The law was passed by Ohio Governor Mike DeWine in April 2025.

New York ACEP, Dr. Rabrich said, would eventually like to see mandated weapon screening and restricted access at all facilities, as well as a permanent security presence in EDs, regardless of size. Although the association recognizes the costs involved, he said, the goal is to have uniform safety standards — perhaps facilitated through state or federal grants.

In North Carolina, the Hospital Violence Prevention Act, which went into effect on October 1, 2024, requires all hospital EDs to have at least one armed law enforcement officer onsite or to apply for an exemption. Some of the pushback suggested that violence was a bigger issue in larger facilities, said Rep. Reeder, the law’s sponsor. “What I argued was that those big institutions, the trauma centers, they actually have more staff and are more equipped to do this,” he said. “What I’m worried about is the 10-bed critical access hospital where there is no security.”