Workplace Violence Against Nurses in Texas: What the Law Requires, How to Report, and the Support You Are Owed

The visitor was shouting before you reached the doorway. By the time security arrived he had shoved a chair into your hip and called you names you will not repeat at home. Your charge nurse asked if you were okay, you said yes, and you finished the shift. On the drive home you realized nobody had filed anything, and you were not sure whether you were supposed to, or whether it would even matter.

For years the unspoken rule on many units was that being hit, grabbed or threatened came with the job. Texas law no longer accepts that. Since 2023, state law has required hospitals and several other kinds of facilities to run a written workplace violence prevention program, to involve bedside nurses in building it, to respond when an incident happens, and to protect the people who report.

This guide explains what Senate Bill 240 requires, who it covers, how to report so it counts, and the support you can expect. It is general information, not legal advice; your facility's own plan and policy are the documents that apply to you.

Why this law exists: the scale of the problem

Health care is the most violence-exposed sector of the US workforce by a wide margin. The US Bureau of Labor Statistics reports that in 2021 and 2022 there were 41,960 nonfatal workplace violence cases in the health care and social assistance industry serious enough to require days away from work, job restriction or transfer. That was 72.8 percent of all such cases in private industry over the two years, at an annualized rate of 14.2 cases per 10,000 full-time workers.

Those counts include only injuries serious enough to cost time. Threats and the shove that leaves a bruise but no lost shift rarely reach them, which is one reason the Texas law leans so hard on reporting.

What Texas SB 240 changed

Senate Bill 240, passed by the 88th Texas Legislature in 2023, added Chapter 331 to the Texas Health and Safety Code. The chapter took effect on September 1, 2023, and covered facilities had until September 1, 2024 to have their programs in place. The Texas Health and Human Services Commission (HHSC) has since adopted rules to implement it, including a hospital rule at 26 TAC §505.55 published in October 2024.

Who is covered. The law applies to licensed hospitals (including mental hospitals), ambulatory surgical centers, freestanding emergency medical care facilities, and, where they employ at least two registered nurses, home and community support services agencies and nursing facilities. A physician's office or small clinic outside those categories may not be covered.

What a covered facility must do. In plain terms, the statute requires four things:

• A committee (Section 331.002). Each facility must set up a workplace violence prevention committee, or give the job to an existing committee. It must include at least one registered nurse who provides direct patient care, a physician who provides direct care (with a narrow exception for some facilities that have no physician on staff), and, if the facility has one and it is practicable, an employee who provides security.
• A written policy (Section 331.003). The policy must give significant consideration to the committee's plan, encourage staff to share confidential information with the committee, and protect those who do from retaliation.
• A written plan (Section 331.004). The plan must fit the practice setting, define workplace violence to include both acts or threats of physical force likely to cause physical injury or psychological trauma and any incident involving a firearm or other dangerous weapon, require violence prevention training at least once a year for staff who provide direct care, set out a system for responding to and investigating incidents, address physical security, and require the facility to ask frontline staff for input. It must allow reporting through existing occurrence reporting systems, and it must require the facility to adjust patient care assignments so that a nurse is not made to keep caring for a patient who has intentionally physically abused or threatened them.
• A response (Section 331.005). After an incident, the facility must at a minimum offer immediate post-incident services, including any necessary acute medical treatment, to each provider or employee directly involved.

The committee must review the plan every year and report the results to the facility's governing body, and the plan must be available to employees on request, with security-sensitive details allowed to be redacted.

Your protections when you report

Section 331.005 contains the two protections that nurses most often do not know about. First, a facility may not discourage a nurse or other employee from contacting or filing a report with law enforcement about an incident of workplace violence. Whether to involve police is your decision, and nobody at the facility may talk you out of it.

Second, a person may not discipline (including by suspension or termination), discriminate against or retaliate against someone who in good faith reports an incident of workplace violence, or who tells a colleague about their right to report. That second part protects the charge nurse, the preceptor or the coworker who says, "You should write this up."

Enforcement runs through licensing: under Section 331.006 the appropriate licensing agency, usually HHSC, may discipline a violator as if it had broken its own licensing law.

Criminal law adds another layer. Since September 1, 2023, when Senate Bill 840 took effect, Texas Penal Code Section 22.01 has made assault on a person the actor knows is hospital personnel, while on hospital property, a third-degree felony rather than a misdemeanor. Hospital personnel includes nurses, physicians, receptionists, janitorial staff and others working in a licensed general or special hospital.

How to report an incident so it counts

A report is what turns one bad shift into data the committee has to look at. Under Chapter 331 your facility may use its existing occurrence or incident reporting system, so in most hospitals the route is the same electronic form used for falls and medication events. Ask your manager or educator where workplace violence reports go if you are not sure.

A useful report is factual and specific. Use this checklist while the details are fresh:

Include	Why it matters
Date, time and exact location	Patterns by place and time drive security changes
What was said or done, in plain words, including threats	Threats count under the statutory definition, not only physical contact
Whether a weapon or object was involved	Any firearm or dangerous weapon incident is workplace violence even with no injury
Who was involved and who witnessed it (roles, not gossip)	The investigation needs corroboration
Any injury, even minor, and whether you were seen by employee health	Supports any workers' compensation claim later
Whether you asked for an assignment change, and the answer	Shows whether the plan's assignment rule was applied
Whether law enforcement was contacted	Your choice; the facility may not discourage it

Keep your own note of the date and the report's reference number. Stick to facts; a clear account is more useful to the committee than one written in anger. Patient privacy rules still apply, so describe the patient or visitor the way your reporting system asks, and keep the incident off social media.

Support after an incident

The legal minimum is immediate post-incident services, including any acute medical treatment you need. Good programs go further, so know what to ask for.

Medical care. Get any injury assessed, even if it seems minor, usually through employee health.

Workers' compensation. Texas is unusual in that many private employers can choose not to carry workers' compensation insurance. If your employer does carry it, the Texas Department of Insurance, Division of Workers' Compensation, says you must report a work injury to your employer within 30 days, and file a claim with the Division within one year, to protect your rights. If your employer is a nonsubscriber, ask human resources what injury benefit plan, if any, applies.

Emotional support. Being assaulted or threatened can leave you jumpy, sleepless or dreading the next shift. That is a human response, not a weakness. Ask whether your facility offers an employee assistance program (EAP), peer support or a structured debrief. If distress is lasting or getting worse, talk to your own healthcare provider. If you are in crisis, call or text 988, the Suicide and Crisis Lifeline. Our article on the silent struggles nurses carry home explains why asking for help is a professional strength, and our piece on moral distress in nursing covers the related harm of being unable to act on what you know is right.

Your next shifts. Ask your manager directly about your assignment if the person involved is still a patient on your unit. The statutory duty to adjust assignments exists precisely for this situation.

For nurse leaders and educators: making the plan real

A compliant binder is not the same as a safer unit. Three steps help the plan work on the floor:

• Make the reporting route obvious and close the loop. Name the route in huddles and orientation, and tell staff what changed because of reports. Nurses keep reporting when they see results.
• Make training practical. The annual requirement is a floor. De-escalation and team response are skills that improve with rehearsal, and simulation lets a team practice them without real risk. Our article on psychological safety in simulation explains how to run those sessions without re-traumatizing staff.
• Use the bedside RN seat well. Rotate it, or gather input from several units, so it reflects more than one shift's experience.

Chapter 331 sits alongside other expectations: The Joint Commission's workplace violence prevention requirements for accredited hospitals took effect in January 2022, and the federal Occupational Safety and Health Administration publishes guidelines for preventing violence in health care settings. If your concern is a coworker rather than a patient or visitor, our guide to bullying and incivility in nursing covers that ground.

Key takeaways

• Texas SB 240 (2023) created Health and Safety Code Chapter 331; covered facilities needed a violence prevention committee, policy and plan by September 1, 2024.
• The committee must include a direct-care RN; the plan must require annual training, an incident response system, security measures and assignment changes after abuse or threats.
• Facilities must offer immediate post-incident services, may not discourage you from calling police, and may not retaliate against good-faith reporters.
• Assaulting hospital personnel on hospital property is a third-degree felony under Texas Penal Code Section 22.01.
• Report factually, keep your reference number, tell your employer about any injury within 30 days, and use EAP or peer support.

Frequently asked questions

Does Texas SB 240 apply to my workplace? It applies to licensed hospitals, mental hospitals, ambulatory surgical centers and freestanding emergency medical care facilities, and to nursing facilities and home health agencies that employ at least two registered nurses. If unsure, ask your manager or compliance office for your facility's Chapter 331 plan.

Can my hospital stop me from calling the police after a patient assaults me? No. Texas Health and Safety Code Section 331.005 says a facility may not discourage an employee from contacting or filing a report with law enforcement about workplace violence. The decision is yours.

Does a verbal threat count as workplace violence under Texas law? It can. Each facility's plan must define workplace violence to include a threat of physical force likely to cause physical injury or psychological trauma, and any incident involving a firearm or other dangerous weapon, even if nobody is hurt.

Can I be disciplined for reporting an incident? Not for a good-faith report. Section 331.005 prohibits discipline, discrimination or retaliation against anyone who reports workplace violence in good faith or tells a colleague about the right to report.

Do I have to keep caring for a patient who hit me? Each facility's plan must require adjusting assignments so you are not made to care for a patient who intentionally physically abused or threatened you. How fast that happens depends on staffing and procedure, so ask your charge nurse as soon as it is safe.

Practice the response before you need it

Knowing the law helps after an incident; rehearsing the response helps during one. Wahero's live training brings scenario-based sessions to Texas facilities, including team communication and escalation practice in a safe simulated setting, and our services for facilities support educators building annual training that staff actually remember. For your own resilience, our self-care and work-home balance course is a practical place to start. Leaders who want to discuss a program for their units can contact us.