When we think about dialysis units, we often picture a place of healing — where patients with kidney failure receive life-sustaining treatment several times a week. But behind the scenes, these environments can sometimes be tense, emotionally charged, and even unsafe. Abuse and violence, whether directed at staff or patients, are serious and growing concerns in dialysis care.

The Hidden Reality in Dialysis Clinics

Dialysis is a demanding treatment, both physically and emotionally. Patients often undergo three to four-hour sessions, three times a week — a schedule that leaves little room for a normal life. Add to this the burden of chronic illness, strict dietary rules, and the psychological toll of dependency, and it’s no surprise that tensions can run high.

Unfortunately, this high-stress environment can lead to conflict. Studies have shown that healthcare workers are up to four times more likely to experience workplace violence than workers in other industries (OSHA, 2015). In dialysis units specifically, verbal abuse and threats from patients or family members are not uncommon, and in some cases, even physical violence has been reported (Pompeii et al., 2013).

When Patients Turn Violent

Some dialysis patients may experience mental health challenges like depression, anxiety, or even cognitive impairment — often exacerbated by uremia or fluctuating blood pressure. These conditions can sometimes result in aggressive behavior.

In fact, up to 25% of dialysis nurses have reported being physically assaulted at work, while many more experience frequent verbal attacks (Stagg & Sheridan, 2010). It’s a difficult situation for the  staff: they are caught between  providing  compassionate care, but  also needing to protect themselves and their colleagues.

Abuse Can Go Both Ways

While much attention is (rightly) paid to protecting healthcare workers, it’s important to remember that patients can also be victims of abuse — especially in understaffed or poorly managed dialysis centers. This can include verbal mistreatment, emotional neglect, or even rushed and careless clinical procedures.

Healthcare burnout is a major contributing factor. A 2020 study found that nearly 40% of dialysis nurses report feeling emotionally exhausted (Flythe et al., 2020). Burned-out staff may struggle to remain empathetic, increasing the risk of inappropriate behavior or neglect toward patients.

Systemic Issues at Play

It’s not just about individual behavior — the system itself can contribute to the problem. Many dialysis units operate with tight budgets and lean staffing, especially in private or for-profit settings. This means nurses and technicians often care for too many patients with too few resources, leaving everyone vulnerable to mistakes and emotional breakdowns.

The physical setup of dialysis units doesn’t help either. Patients are often seated close together in open spaces, with minimal privacy and limited access to mental health support. These factors create an environment where conflict can quickly escalate if not carefully managed.

The Cost of Ignoring the Problem

When abuse or violence occurs in a dialysis unit, the impact is deep and lasting. Staff may suffer trauma, burnout, and even leave the profession altogether. Patients, on the other hand, may become fearful, avoid care, or stop adhering to their treatment plans — all of which can be life-threatening.

Beyond the personal toll, there’s also a broader ethical concern. Abuse in healthcare settings violates core principles of dignity, respect, and care. It compromises everything the healthcare system is meant to stand for.

What Can Be Done?

Thankfully, there are proven strategies that can help make dialysis units safer and more compassionate:

• Training staff in de-escalation techniques and trauma-informed care
• Offering mental health support for both patients and staff
• Establishing clear policies for reporting and addressing abuse
• Improving staffing levels and work conditions
• Fostering a culture of empathy, safety, and accountability

In some units, the introduction of behavioral health teams has made a big difference. Providing support for patients who are struggling emotionally can prevent violent episodes and improve overall care quality.

Final Thoughts

Dialysis units should be sanctuaries of healing, not battlegrounds of stress and conflict. By acknowledging the problem of violence and abuse — and actively working to prevent it — we can create safer, more supportive environments for both patients and staff.

After all, everyone deserves to feel safe, respected, and cared for, especially in a place where life itself hangs in the balance.

References:

• OSHA. (2015). Workplace Violence in Healthcare: Understanding the Challenge.
• Stagg, S. J., & Sheridan, D. (2010). Effectiveness of Workplace Violence Prevention Programs. Journal of Nursing Scholarship.
• Flythe, J. E., et al. (2020). Burnout in Nephrology Nurses. Nephrology Nursing Journal.
• Pompeii, L. A., et al. (2013). Perpetrator and Workplace Characteristics Associated with Violence in Hospitals.Work.