Category: English

Source: The Conversation – USA (2) – By Roxana Shafiee, Environmental Fellow, Center for the Environment, Harvard University; Harvard Kennedy School

Heat pumps can reduce carbon emissions associated with heating buildings, and many states have set aggressive targets to increase their use in the coming decades. But while heat pumps are often cheaper choices for new buildings, getting homeowners to install them in existing homes isn’t so easy.

Current energy prices, including the rising cost of electricity, mean that homeowners may experience higher heating bills by replacing their current heating systems with heat pumps – at least in some regions of the country.

Heat pumps, which use electricity to move heat from the outside in, are used in only 14% of U.S. households. They are common primarily in warm southern states such as Florida where winter heating needs are relatively low. In the Northeast, where winters are colder and longer, only about 5% of households use a heat pump.

In our new study, my co-author Dan Schrag and I examined how heat pump adoption would change annual heating bills for the average-size household in each county across the U.S. We wanted to understand where heat pumps may already be cost-effective and where other factors may be preventing households from making the switch.

Wide variation in home heating

Across the U.S., people heat their homes with a range of fuels, mainly because of differences in climate, pricing and infrastructure. In colder regions – northern states and states across the Rocky Mountains – most people use natural gas or propane to provide reliable winter heating. In California, most households also use natural gas for heating.

In warmer, southern states, including Florida and Texas, where electricity prices are cheaper, most households use electricity for heating – either in electric furnaces, baseboard resistance heating or to run heat pumps. In the Pacific northwest, where electricity prices are low due to abundant hydropower, electricity is also a dominant heating fuel.

The type of community also affects homes’ fuel choices. Homes in cities are more likely to use natural gas relative to rural areas, where natural gas distribution networks are not as well developed. In rural areas, homes are more likely to use heating oil and propane, which can be stored on property in tanks. Oil is also more commonly used in the Northeast, where properties are older – particularly in New England, where a third of households still rely on oil for heating.

Why heat pumps?

Instead of generating heat by burning fuels such as natural gas that directly emit carbon, heat pumps use electricity to move heat from one place to another. Air-source heat pumps extract the heat of outside air, and ground-source heat pumps, sometimes called geothermal heat pumps, extract heat stored in the ground.

Heat pump efficiency depends on the local climate: A heat pump operated in Florida will provide more heat per unit of electricity used than one in colder northern states such as Minnesota or Massachusetts.

But they are highly efficient: An air-source heat pump can reduce household heating energy use by roughly 30% to 50% relative to existing fossil-based systems and up to 75% relative to inefficient electric systems such as baseboard heaters.

Heat pumps can also reduce emissions of greenhouse gases, although that depends on how their electricity is generated – whether from fossil fuels or cleaner energy, such as wind and solar.

Heat pumps can lower heating bills

We found that for households currently using oil, propane or non-heat pump forms of electric heating – such as electric furnaces or baseboard resistive heaters – installing a heat pump would reduce heating bills across all parts of the country.

The amount a household can save on energy costs with a heat pump depends on region and heating type, averaging between $200 and $500 a year for the average-size household currently using propane or oil.

However, savings can be significantly greater: We found the greatest opportunity for savings in households using inefficient forms of electric heating in northern regions. High electricity prices in the Northeast, for example, mean that heat pumps can save consumers up to $3,000 a year over what they would pay to heat with an electric furnace or to use baseboard heating.

A challenge in converting homes using natural gas

Unfortunately for the households that use natural gas in colder, northern regions – making up around half of the country’s annual heating needs – installing a heat pump could raise their annual heating bills. Our analysis shows that bills could increase by as much as $1,200 per year in northern regions, where electricity costs are as much as five times greater than natural gas per kilowatt-hour.

Even households that install ground-source heat pumps, the most efficient type of heat pump, would still see bill increases in regions with the highest electricity prices relative to natural gas.

Installation costs

In parts of the country where households would see their energy costs drop after installing a heat pump, the savings would eventually offset the upfront costs. But those costs can be significant and discourage people from buying.

On average, it costs $17,000 to install an air-source heat pump and typically at least $30,000 to install a ground-source heat pump.

Some homes may also need upgrades to their electrical systems, which can increase the total installation price even more, by tens of thousands of dollars in some cases, if costly service upgrades are required.

In places where air conditioning is typical, homes may be able to offset some costs by using heat pumps to replace their air conditioning units as well as their heating systems. For instance, a new program in California aims to encourage homeowners who are installing central air conditioning or replacing broken AC systems to get energy-efficient heat pumps that provide both heating and cooling.

Rising costs of electricity

A main finding of our analysis was that the cost of electricity is key to encouraging people to install heat pumps.

Electricity prices have risen sharply across the U.S. in recent years, driven by factors such as extreme weather, aging infrastructure and increasing demand for electric power. New data center demand has added further pressure and raised questions about who bears these costs.

Heat pump installations will also increase electricity demand on the grid: The full electrification of home heating across the country would increase peak electricity demand by about 70%. But heat pumps – when used in concert with other technologies such as hot-water storage – can provide opportunities for grid balancing and be paired with discounted or time-of-use rate structures to reduce overall operating costs. In some states, regulators have ordered utilities to discount electricity costs for homes that use heat pumps.

But ultimately, encouraging households to embrace heat pumps and broader economy-wide electrification, including electric vehicles, will require more than just technological fixes and a lot more electricity – it will require lower power prices.

Roxana Shafiee does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Americans want heat pumps – but high electricity prices may get in the way – https://theconversation.com/americans-want-heat-pumps-but-high-electricity-prices-may-get-in-the-way-273981

Source: The Conversation – USA (2) – By Heidi Reynolds-Stenson, Associate Professor of Sociology, Criminology and Anthropology, Colorado State University Pueblo

There’s been a rise of know-your-rights training sessions in response to the Trump administration’s aggressive immigration enforcement tactics. This has included local public officials and organizations sharing online information over the past few months about what to do if Immigration and Customs Enforcement or other federal agents knock on your door, among other scenarios that involve immigration law enforcement.

Knowledge is power, the adage goes. But learning the letter of the law has its limits, legal rights experts have noted, if law enforcement officers do not follow the law. The Associated Press reported on Jan. 21, 2026, that ICE distributed an internal memo authorizing ICE officers to forcibly enter someone’s private home with only an administrative warrant – not one signed by a judge, as the Fourth Amendment requires.

Amy Lieberman, education editor for The Conversation U.S., spoke with Heidi Reynolds-Stenson, a scholar of social movements and protest policing, to understand the role education can play in Minnesota’s ongoing anti-ICE protests and how legal training’s limits are becoming clear.

What role is education playing in fueling Minnesota’s anti-ICE protests?

I think it is a really unique moment. There is discussion in the news nationwide about legal observing and know-your-rights training sessions. This kind of legal support and education has been part of social movements for a long time, but have never, perhaps, been in the spotlight on the level that they are right now after the January killings of ICE observers Renee Nicole Good and Alex Pretti.

A coordinated way of offering legal support to protesters grew out of 1960s and ‘70s civil rights protests. Legal support for protesters became even more organized during the student-led anti-Vietnam War movement around this same time. The first time there was an organized, mass legal defense of protesters was for the Stop the Draft Week in 1967, when a group of lawyers and law students began working in coordination with activists.

Since then, community organizers, lawyers, law students and others have developed strategies for offering legal support to protesters. That includes legal observers. Legal observers can be lawyers, law students or others trained not to protest, but to independently observe, take notes on and photograph or video incidents at protests, like law enforcement arresting or assaulting someone.

We see, over time, that the way people organize and offer legal support to protesters has become more and more sophisticated. More and more people have knowledge about their civic and legal rights. Other forms of legal support, such as jail and court solidarity, in which individual people who are arrested make collective decisions to support one another, have become more common.

Now, people are also learning about more than their First Amendment rights – they are learning about the rights of immigrants and of anyone who is interacting with ICE and Border Patrol officers. That intensifies the complexity of what people need to know.

Altogether, there is a complex system of legal support in place that has been shown to be very effective at preventing activists from disengaging after experiences of state repression.

What does your own research show regarding how education can shape protests?

In my own research, when activists had experiences of repression – when they were arrested at protests, as has happened in Minneapolis, or experienced police violence, like being sprayed with chemical irritants – legal education was a major determining factor on whether they continued to be involved in the protest movement.

Another deciding issue was whether or not protesters were being helped by pro bono lawyers or there were legal observers present to make protesters feel more confident going into a certain situation.

As people become more educated about their rights and more prepared for the potential risks of protesting, that can make them more confident about going to a protest in the first place and more likely to continue in that work.

We know that, in reality, the rights people learn about are not always respected, at protests or in other situations. So, it is one thing to say that you have a right to do something, like to protest, or not let ICE or Border Patrol agents into your home without a judicial warrant.

It is another thing in practice, especially in the current moment that we are in, in which immigration enforcement officers have increasingly shown disregard for people’s rights. But it is still important for people to be aware that those rights exist.

What role do legal observers play in influencing protest movements?

Legal observers can play a critical role in collecting independent, neutral information about law enforcement actions at protests that can be used if there is a civil suit or a criminal case coming out of a protest.

Legal observing can also, in theory, deter officers who are policing protests, since they know they are being watched and data is being collected on their actions, including potential rights violations.

How can education serve as a means of self-defense at protests?

Education is the most powerful weapon for people involved in protest movements – that is, knowledge and understanding of what their rights are as well as the risks. Equally important is collecting bail fund money before someone is actually arrested, having a network of people ready to do the work after a protest to defend arrested activists, and holding law enforcement officers accountable for violating people’s rights. Protesters or observers can then know that if they are arrested or injured by law enforcement officers, that people are already there ready to help them.

In my view, the level of disrespect that federal immigration officers are currently showing to people exercising their rights to protest and to film and otherwise monitor public officials is unprecedented. But it has always been the case that just because a legal right exists, it does not mean that it is followed by law enforcement or the government more broadly. Then, and now, it has always been organized groups of individuals who make those rights real through exercising them and working to hold those accountable who violate them.

Heidi Reynolds-Stenson receives funding from the William T. Grant Foundation.

– ref. Even when people’s rights are ignored, understanding the law can keep protesters engaged – https://theconversation.com/even-when-peoples-rights-are-ignored-understanding-the-law-can-keep-protesters-engaged-274489

Source: The Conversation – USA (2) – By Hengrui Liu, Postdoctoral Scholar in Economics and Public Policy, The Fletcher School, Tufts University

At the 2026 Detroit Auto Show, the spotlight quietly shifted. Electric vehicles, once framed as the inevitable future of the industry, were no longer the centerpiece. Instead, automakers emphasized hybrids, updated gasoline models and incremental efficiency improvements.

The show, held in January, reflected an industry recalibration happening in real time: Ford and General Motors had recently announced US$19.5 billion and $6 billion in EV-related write-downs, respectively, reflecting the losses they expect as they unwind or delay parts of their electric vehicle plans.

The message from Detroit was unmistakable: The United States is pulling back from a transition that much of the world is accelerating.

That retreat carries consequences far beyond showroom floors.

In China, Europe and a growing number of emerging markets, including Vietnam and Indonesia, electric vehicles now make up a higher share of new passenger vehicle sales than in the United States.

That means the U.S. pullback on EV production is not simply a climate problem – gasoline-powered vehicles are a major contributor to climate change – it is also an industrial competitiveness problem, with direct implications for the future of U.S. automakers, suppliers and autoworkers. Slower EV production and slower adoption in the U.S. can keep prices higher, delay improvements in batteries and software, and increase the risk that the next generation of automotive value creation will happen elsewhere.

Where EVs are taking over

In 2025, global EV registrations rose 20% to 20.7 million. Analysts with Benchmark Mineral Intelligence reported that China reached 12.9 million EV registrations, up 17% from the previous year; Europe recorded 4.3 million, up 33%; and the rest of the world added 1.7 million, up 48%.

By contrast, U.S. EV sales growth was essentially flat in 2025, at about 1%. U.S. automaker Tesla experienced declines in both scale and profitability – its vehicle deliveries fell 9% compared to 2024, the company’s net profit was down 46%, and CEO Elon Musk said it would put more of its focus on artificial intelligence and robotics.

Market share tells a similar story and also challenges the assumption that vehicle electrification would take time to expand from wealthy countries to emerging markets.

In 39 countries, EVs now exceed 10% of new car sales, including in Vietnam, Thailand and Indonesia, which reached 38%, 21% and 15%, respectively, in 2025, energy analysts at Ember report.

In the U.S., EVs accounted for less than 10% of new vehicle sales, by Ember’s estimates.

U.S. President Donald Trump came back into office in 2025 promising to end policies that supported EV production and sales and boost fossil fuels. But while the U.S. was curtailing federal consumer incentives, governments elsewhere largely continued a transition to electric vehicles.

Europe softened its goal for all vehicles to have zero emissions by 2035 at the urging of automakers, but its new target is still a 90% cut in automobiles’ carbon dioxide emissions by 2035.

Germany launched a program offering subsidies worth 1,500 to 6,000 euros per electric vehicle, aimed at small- and medium-income households.

In developing economies, EV policy has largely been sustained through industrial policies. In Brazil, the MOVER program offers tax credits explicitly linked to domestic EV production, research and development, and efficiency targets. South Africa is introducing a 150% investment allowance for EV and battery manufacturing, giving them a tax break starting in March 2026. Thailand has implemented subsidies and reduced excise tax tied to mandatory local production and export commitments.

In China, the EV industry has entered a phase of regulatory maturity. After a decade of subsidies and state-led investment that helped domestic firms undercut global competitors, the government’s focus is no longer on explosive growth at home.

With their domestic market saturated and competition fierce, Chinese automakers are pushing aggressively into global markets. Beijing has reinforced this shift by ending its full tax exemption for EV purchases and replacing it with a tapered 5% tax on EV buyers.

Consequences for US automakers

EV manufacturing is governed by steep learning curves and scale economies, meaning the more vehicles a company builds, the better it gets at making them faster and cheaper. Low domestic production and sales can mean higher costs for parts and weaker bargaining power for automakers in global supply chains.

The competitive landscape is already changing. In 2025, China exported 2.65 million EVs, doubling its 2024 exports, according to the China Association of Automobile Manufacturers. And BYD surpassed Tesla as the world’s largest EV maker in 2025.

The U.S. risks becoming a follower in the industry it once defined.

Some people argue that American consumers simply prefer trucks and hybrids. Others point to Chinese subsidies and overcapacity as distortions that justify U.S. industry caution. These concerns deserve consideration, but they do not outweigh the fundamental fact that, globally, the EV share of auto sales continues to rise.

What can the US do?

For U.S. automakers and workers to compete in this market, the government, in our view, will have to stop treating EVs as an ideological matter and start governing it like an industrial transition.

That starts with restoring regulatory credibility, something that seems unlikely right now as the Trump administration moves to roll back vehicle emissions standards. Performance standards are the quiet engine of industrial investment. When standards are predictable and enforced, manufacturers can plan, suppliers can invest in new businesses, and workers can train for reliable demand.

Governments at state and local levels and industry can also take important steps.

Focus on affordability and equity: The federal clean-vehicle tax credit that effectively gave EV buyers a discount expired in September 2025. An alternative is targeted, point-of-sale support for lower- and middle-income buyers. By moving away from blanket credits in favor of targeted incentives – a model already used in California and Pennsylvania – governments can ensure public funds are directed toward people who are currently priced out of the EV market. Additionally, interest-rate buydowns that allow buyers to reduce their loan payments and “green loan” programs can help, typically funded through state and local governments, utility companies or federal grants.

Keep building out the charging network: A federal judge ruled on Jan. 23, 2026, that the Trump administration violated the law when it suspended a $5 billion program for expanding the nation’s EV charger network. That expansion effort can be improved by shifting the focus from the number of ports installed to the number of working chargers, as California did in 2025. Enforcing reliability and clearing bottlenecks, such as electricity connections and payment systems, could help boost the number of functioning sites.

Use fleet procurement as a stabilizer for U.S. sales: When states, cities and companies provide a predictable volume of vehicle purchases, that helps manufacturers plan future investments. For example, Amazon’s 2019 order of 100,000 Rivian electric delivery vehicles to be delivered over the following decade gave the startup automaker the boost it needed.

Treat workforce transition as core infrastructure: This means giving workers skills they can carry from job to job, helping suppliers retool instead of shutting down, and coordinating training with employers’ needs. Done right, these investments turn economic change into a source of stable jobs and broad public support. Done poorly, they risk a political backlash.

The scene at the Detroit Auto Show should be a warning, not a verdict. The global auto industry is accelerating its EV transition. The question for the United States is whether it will shape that future – and ensure the technologies and jobs of the next automotive era are in the U.S. – or import it.

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. America is falling behind in the global EV race – that’s going to cost the US auto industry – https://theconversation.com/america-is-falling-behind-in-the-global-ev-race-thats-going-to-cost-the-us-auto-industry-274422

Source: The Conversation – USA (2) – By Sloan Speck, Associate Professor of Law, University of Colorado Boulder

In December 2025, the Trump administration accelerated the process of reclassifying marijuana from Schedule I to Schedule III under the Controlled Substances Act – a shift that would reduce restrictions and penalties associated with the drug.

Under the move, medical and recreational marijuana would still remain illegal at the federal level. At the state level, medical use is currently legal in 40 states and the District of Columbia, and recreational use is permitted in 24 states and Washington, D.C. While the administration touted the medical research benefits of rescheduling, the medical and recreational marijuana industry lauded it for an entirely different reason: income tax savings.

Indeed, one of rescheduling’s most significant – and most immediate – effects would be tax relief for all legal marijuana businesses in the states that host them.

But business taxes do more than raise revenue – they also create incentives that shape how companies organize and operate. For legal marijuana businesses – both medical and recreational dispensaries alike – rescheduling marijuana would relax these implicit restrictions, serving as a quiet form of deregulation that removes tax pressures that currently shape the industry’s financing, structure and compliance. From this perspective, rescheduling would cut taxes but also remove one of the federal government’s levers over an industry principally regulated by the states.

I study how tax rules shape what businesses do and the social effects of changing those rules. In my view, the tax implications of rescheduling marijuana alone are likely to have consequences that go far beyond the tax bill that businesses pay.

Why marijuana businesses are taxed differently

Under federal law, state-legal marijuana businesses face unique tax burdens.

Most businesses can deduct, or write off, ordinary and necessary expenses. For example, businesses generally can subtract the costs of rent and utilities from the income they earn. But that’s not the case for businesses that deal in Schedule I and II controlled substances, including marijuana.

In effect, legal marijuana businesses pay federal income tax on their gross income rather than their net income like other companies.

Imagine a business with US$100,000 of income before expenses and $80,000 of otherwise deductible expenses. Ordinarily, the business would pay $4,200 in tax on $20,000 of net income, assuming a 21% tax rate. The business’s cash profits would be $15,800 for the year – a healthy net profit margin.

If this hypothetical business legally sold marijuana, Section 280E of the Internal Revenue Code would deny any income tax deductions for the business’s $80,000 in expenses. This rule applies even though the business’s expenses are real costs, and even though the business is legal under state law. In this scenario, the business would owe $21,000 in tax on $100,000 of gross income. This would put the business in the red for the year, with a negative cash flow of $1,000 and a negative net profit margin.

For many legal marijuana businesses, making the math work isn’t a hypothetical challenge. Indeed, some enterprises have reported real-world effective tax rates as high as 80% – more than twice the top statutory rate for individuals.

This state of affairs traces to two court decisions handed down more than five decades apart. In 1927, the Supreme Court held that income from illegal activities remained subject to tax – a decision later leveraged in mob boss Al Capone’s 1931 conviction on criminal tax evasion charges. Then, in 1981, the U.S. Tax Court affirmed that illegal activities were taxable on their net income after deductions, like legal businesses. Lawmakers objected, and Congress enacted Section 280E the following year in response.

Essentially, the move gave drug traffickers a Hobson’s choice: face civil or criminal penalties for failing to properly report their income, or pay punishingly high effective tax rates. Just as Treasury Department enforcers used tax law to combat organized crime during Prohibition, tax law’s dual disincentives expressly discouraged illicit drug sales.

Because Section 280E applies only to Schedule I and II substances, rescheduling to Schedule III would tax legal marijuana businesses like other businesses. According to advocates, this would better align federal tax law with widespread state-level legalization of marijuana. In effect, rescheduling could equate to a tax break of around $2.3 billion dollars for the marijuana industry, according to one estimate.

How the tax code quietly regulates marijuana

Despite these high effective tax rates, the state-legal marijuana industry has more than tripled in revenue over the past decade and supports more than 400,000 jobs. Tax law, however, has shaped how this industry operates.

In this way, tax law serves as a form of quiet regulation – not directly, by setting licensing standards or policing potency, but indirectly. If marijuana were rescheduled, the federal government would give up this mechanism for indirect regulation.

As it currently stands, Section 280E has three important regulatory effects:

First, Section 280E limits businesses’ financing options. Like other enterprises, legal marijuana businesses need capital to grow. By constraining after-tax profits and cash flow, the status quo makes it harder for these marijuana businesses to finance growth internally using their own money from operations, known as “retained earnings.” This tax-induced capital scarcity may help explain mature legal marijuana industries’ relatively low rates of year-over-year growth. After taxes, there’s simply very little cash to reinvest.

This constraint pushes legal marijuana businesses to finance growth through external – and often unconventional – funding sources. Because marijuana businesses remain illegal under federal law, commercial banks and public capital markets may treat otherwise legal businesses as off-limits or high-risk. These businesses often turn to private capital for loans, specialized leasing arrangements and equity investments. Given the federal restrictions on marijuana, private investors tend to scrutinize these transactions closely, often insisting on protective covenants and operational restrictions.

Second, Section 280E encourages legal marijuana businesses to isolate activities that “don’t touch the plant” from marijuana production and sales. If the nonmarijuana activities are truly separate – legally, spatially and operationally – they may be able to claim business expense deductions that direct marijuana-related activities cannot.

Legal marijuana businesses have implemented these separate structures for activities from back-office support and real estate management to licensing for branding and merchandise. In addition to affecting tax burdens, these structures require ongoing operational oversight by outside parties – lawyers, accountants and other providers – and enforce the siloing of marijuana-touching activities away from other activities.

Finally, Section 280E raises the stakes of accurately accounting for the marijuana sold by these businesses. Courts have affirmed that legal marijuana businesses can reduce their gross income by the “cost of goods sold” – the direct production and acquisition costs of inventory. Even under Section 280E, these businesses can subtract the costs to grow, process and package marijuana from their sales revenue. As a result, these businesses meticulously monitor direct production costs throughout their supply chains.

This supply chain management offers another pathway for indirect regulation. Many state regulatory regimes already require inventory tracking. But Section 280E adds a financial reward for rigorous documentation, controls and auditing. Although some of this tax compliance work is mere paper-shuffling, public policy may favor multiple forms of regulation by multiple stakeholders – a diversity of oversight for an industry where lapses or inconsistencies can have serious social costs.

Federal tax rules for state-legal marijuana businesses operate as a form of indirect, or quiet, regulation: a national overlay that complements – and amplifies – state regulatory regimes. Rescheduling would remove this federal overlay by taking marijuana out of Section 280E’s reach.

From this perspective, the debate over rescheduling is about more than just tax normalization versus public health risks. Rescheduling raises bigger questions of institutional design: whether the federal government should yield one of its most practical points of leverage over the legal marijuana industry – and, if so, whether another regulatory mechanism should replace it.

Sloan Speck does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Rescheduling marijuana would be a big tax break for legal cannabis businesses – and a quiet form of deregulation – https://theconversation.com/rescheduling-marijuana-would-be-a-big-tax-break-for-legal-cannabis-businesses-and-a-quiet-form-of-deregulation-274022

Source: The Conversation – USA (3) – By Carolyn Dickens, Nurse practitioner and Associate Dean, University of Illinois Chicago

Imagine being a dentist, and your clients roll their eyes at you, comment that you don’t know what you’re doing – or even spit at you.

Unimaginable, right? But that’s what nurses experience when patients or their families do the eye roll or hit, bite or spit at them. What’s more, a bedside nurse may repeatedly endure bad behavior from a patient or their loved ones for a shift of eight to 12 hours.

Workplace violence is frequently underreported, in part because many nurses see it as being part of their job.

Nurses experience violence and incivility due to a combination of factors, such as working in high-risk clinical environments like the emergency department, or dealing with patient-related challenges such as altered mental status. As a result, nursing is the health profession most likely to experience workplace violence, incivility or threat of violence. This includes physical violence, harassment, intimidation or other types of disruptive behavior.

A 2024 report found that more than 80% of registered nurses said they had experienced at least one instance of workplace violence in the previous year; 68% said they were verbally threatened. The vast majority of the workplace violence stemmed from patients or family members of the patient.

Workplace violence and harassment are major contributors to a growing shortfall in the nursing workforce.

An exodus from nursing

As a nurse practitioner, I work closely with nurses and interact with patients and their families on a regular basis. A nurse practitioner – which is a registered nurse but with advanced training and a wider scope of treatment – typically doesn’t have as much direct interaction with patients and their families due to the difference in their job responsibilities compared with nurses.

However, I also experience incivility from patients and families when I can’t give them the answers they expect to hear, or when I’m late because the time I spent with the previous patient took longer than expected.

I recognize that much of their anger and impoliteness stems from fear and frustration. I also understand the difficulty in dealing with a health care system that’s bureaucratic and under-resourced. But my understanding why they feel this way does not make the behavior OK.

Workplace violence directed toward nurses has been studied for well over a decade. But the widespread prevalence of incivility remains poorly understood, in part because nurses are reluctant to report it. A 2022 survey of nurses across all care settings found that 60% had experienced bulling and incivility and nearly a third had experienced an incident of violence. Nearly half reported that they planned on or were considering leaving patient care in the next six months. And a significant number said that instituting a non-bullying program or no-tolerance policy toward violence would greatly improve their work satisfaction.

The feeling that they aren’t supported is another reason why nurses are increasingly likely to leave the profession, with 31% stating in the same survey that it would help their work satisfaction if their organization would listen to them.

This is unsustainable for a number of reasons, one being the growing shortage of nurses in the U.S.. The shortfall has gotten worse since the COVID-19 pandemic, with more and more nurses leaving due to burnout.

More nurses are needed to care for the aging population in the U.S., but fewer nurses are replacing the retiring ones. Over the next decade, the U.S. is projected a shortage of more than 63,000 registered nurses to care for its aging population.

Starting from the ground up

The idealized concept of the “good nurse” is that of an unfailingly polite caregiver, always accommodating and emotionally composed. This makes it difficult for nurses to set boundaries or object to rudeness.

No one-size-fits-all solution will address the incivility problem, although health care systems have tried. Some hospitals, for example, post signs in patient rooms and elevators with messages like: “This is a place of health and healing – please respect everyone.” And many health care organizations have behavioral emergency response teams – typically social workers and security personnel – to intervene when tensions escalate. Although such response teams are considered best practice, few hospitals and other health care organizations have them.

Other organizational efforts, such as resilience training and wellness lectures, are well-intended and in good faith, but they also reinforce the harmful notion that incivility is inevitable and must be endured, not addressed. Worse, they give the appearance that health care organizations are taking action. Instead, they place the burden of coping squarely on nurses, who are often unable to attend the lectures due to time constraints.

A way forward

There are some actions that health organizations can take to address the incivility directed toward nurses from families. For example, setting realistic expectations for patients and their families would decrease the frustration and change this destructive dynamic. Transparency is critical. For instance, if emergency room waiting areas have a screen showing the wait time – even if it’s 12 hours – it would cut down on a great deal of anxiety for patients and their families that can escalate into anger, disrespect and violence.

And when patients must spend the night in the hospital, it would help for families to be told what time the health care provider makes their rounds so that loved ones are not needlessly waiting around for hours.

Families also deserve to know if the hospital is understaffed, with perhaps only one nurse managing multiple patients. This could help loved ones be more understanding of a slower response to a call light.

These types of interventions could be delivered through educational videos with QR codes and placed in each patient room.

The nursing profession has a conflicting identity, and it’s one where some patients translate a nurse’s compassion and caring into a signal to disregard basic human boundaries. Only through organizational and societal shifts – beginning with employers – can change occur and incivility toward nurses become infrequent, rather than the norm.

Everyone can help address this problem, whether you or your loved one is hospitalized, by being understanding and respectful to others, especially when interacting with nurses.

Carolyn Dickens receives funding from UIC research innovation grant.
I am a board member of a federally qualified health care center.

– ref. A growing nursing shortage is made worse by nurses’ daily challenges of patients and their families rolling their eyes, yelling and striking – https://theconversation.com/a-growing-nursing-shortage-is-made-worse-by-nurses-daily-challenges-of-patients-and-their-families-rolling-their-eyes-yelling-and-striking-261521