On March 19, 2025, staff members at Central Vermont Medical Center called 911 for help when a woman threatened to stab them. According to the police report, they were also assaulted with food and milk. The hospital placed another emergency call less than 48 hours later. A study from the Bureau of Labor Statistics revealed that health care workers are five times more likely to be assaulted than any other occupation, including police and correctional officers, which have led to increasing rates of turnover in hospitals and emergency care settings. Mari Cordes introduced House Bill 259 in the Vermont legislature this session, which would require violence prevention strategies in all hospitals. Cordes splits her time between UVM Medical Center and the statehouse as a progressive care nurse and a representative of Addison County."Vermont has the highest rate of health care workers being transferred or leaving their job due to workplace violence," Cordes said. "We have the highest rate of that in the country."The bill is on track to reach the governor's desk this week. It gives hospitals a framework to conduct security risk assessments and identify the best strategies to prevent violence based on patient volume, community crime, and law enforcement availability. Each hospital team would be responsible for establishing its own culture of safety, but basic standards like de-escalation and incident reporting would be required. Another provision would give staff the option to omit their last name from an ID badge if they work in direct patient care. Cordes said that patient care will always be a priority, but it was important to give nurses a voice throughout the process. Betsy Hassan, the director of nursing education at the UVM Medical Center, helped write the text of the legislation. It was largely based on regulations from other states and federal agencies, with elements from some of the hospital's most successful violence prevention programs. However, Hassan acknowledged that different hospitals have different needs and resources. "An organization could implement some of the things that we have , like security buttons. So, if a staff person is alone in a room or in a situation where they're not comfortable, they can press that and it will send a team to the room," Hassan said. "But again, it needs to be based on the individual risk of the organization and what works best for them."As for the cost, the bill acknowledges the financial impact on hospital budgets, and asks the Green Mountain Care Board to take those impacts into consideration. Another key element would remove or exempt workplace violence initiatives from the care board's "certificate of need" process. "If you have to put ballistic glass into an emergency department, that's going to be very costly and it can't be held up by an administrative process," Hassan said. "It needs to be implemented as soon as possible to help protect those staff."UVM Medical Center has implemented lockdown doors, metal detectors, and clear bag policies, according to the hospital's workplace violence and de-escalation coordinator, Amanda Young. Over the last decade, health care providers have reported an increase in assaults, but there was a significant shift after the COVID-19 pandemic. "I've been a nurse for six years. I've certainly seen it gradually increasing," Young said. "And then since COVID, it's like a rocket ship to the moon."Young leads classes that include Professional Assault Crisis Training and Management of Aggressive Behavior Training (MOAB). The program consists of mental conditioning and situational awareness, as well as a physical safety component."Sometimes there is the need to physically restrain people. We want to make sure we do it as safely as possible for the patient and for the staff," Young said. The hospital has expanded the types of classes offered, as well as class sizes. Some of those programs set a framework for H.259, but the bill is not the first attempt to cement hospital safety provisions in Vermont law. In 2023, the legislature passed Act 24, which clarified the role of law enforcement in Vermont hospitals. "There were times when law enforcement couldn't come or wouldn't come and didn't know if they had the authority to make arrests in specific situations," Cordes said. The passage of Act 24 cleared the path for a broad study on violence prevention standards in all of Vermont's hospitals, but it didn't set the standards included in H.259. "The legislation works really well together," Hassan said. "Not one of them is going to be the silver bullet or what fixes the problem in and of itself because it's so multifactorial."If approved and signed by the governor, the bill would take effect in July of 2025.