A killing in Jefferson University Hospital early Monday was a devastating reminder that for many health-care professionals, workplace violence is too frequently a part of their lives.

“It is a tragedy that violence came to the workplace that we fight hard to keep safe,” said Chris Woods, president of the National Union of Hospital and Health Care Employees Local 1199C.

Both the shooter and the victim were Jefferson staff members and longtime members of the union, he said.

Health-care providers are among the most likely people to be subjected to violence at work, according to data gathered by the Occupational Safety and Health Administration. From 2002 to 2013, OSHA reported, workplace violence requiring the injured person to take time off to recover was four times more likely in health-care settings than the average of other private industries.

» READ MORE: A nursing assistant was killed by a coworker at Jefferson University Hospital, and two Philadelphia police officers were shot

“A hospital is supposed to be a safe place,” said Maureen May, a Temple University Hospital nurse and president of the Pennsylvania Association of Staff Nurses and Allied Professionals. “There are measures in place to respond to it but those measures are just not enough at this point.”

But, as in the case at Jefferson Monday where a certified nursing assistant is accused of shooting a coworker in the hospital, just 3% of health-care worker injuries at work are the result of coworker violence, OSHA reported.

“It’s definitely a new level of concern for a lot of us, to know that somebody can walk in with a weapon like that, or multiple weapons, and can do that to one of our own staff,” said Shae Spicer, a Jefferson nurse.

Far more common, OSHA found, was violence committed against workers by patients. Those account for 80% of all cases, and are considered commonplace in some hospitals. One 2017 survey found 88% of Level 1 trauma center staff had been the victim of workplace violence or witnessed it within a six-month period. A post from 2019 on Jefferson’s own website noted that 60% of workplace assaults occur in health care settings, though those personnel make up just 13% of the country’s workforce.

At Temple, May said, staff know a coworker has been involved in a physical altercation when they hear a “Code Gray” announced.

“There are times we hear it four, five or six times in a day,” she said.

Among the more high profile incidents of violence against health-care workers in the region, a patient killed a caseworker and injured a psychiatrist at Mercy Fitzgerald Hospital in Delaware County in 2014. The psychiatrist had a gun and returned fire, injuring the patient.

In 2017, a Lehigh Valley Hospital-Muhlenberg nurse required surgery after being stabbed in the neck by a man the nurse had treated earlier in the month.

» READ MORE: Nursing assistant gunned down by coworker at Jefferson Hospital was the father of three

Jefferson’s security precautions include metal detectors in the emergency department, security turnstiles at all its main buildings that require visitors to check in, and its own armed police force formed about six years ago.

“There are so many incidents involving firearms happening in today’s world,” said Joseph Byham, Jefferson vice president of public safety, in that 2019 post, “we knew we needed to be able to respond quickly in the event of something happening.”

The hospital also gives some staff Bluetooth-equipped badges that, when pressed, send a signal to security and the unit’s nurse manager to alert security personnel that a staff member needs help. Jefferson did not say whether that system was used during the shooting.

The causes of violence can include psychiatric disorders, people being under the influence of drugs and alcohol, or the high emotions that can overwhelm people in critical care units. Families facing bad news about a loved one can lash out, experts said. Emergency departments, geriatrics, and behavioral health wards were particularly at risk, OSHA reported.

Kendra Barkasi, president of Nurses and Techs United at Eagleville Hospital in Montgomery County, which handles psychiatric patients and those in addiction, said last year a patient hit her in the face with a container used to hold needles.

“The rest of the night she threatened to hurt me,” she said.

She’s also been subjected to vulgarity and threats of rape from patients, she said.

Reports of such encounters likely don’t represent the full extent of the problem, experts said. Incidents that don’t result in injuries often aren’t recorded, the American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA) reported last year. Hospitals or health-care providers lacking clear policies for workplace violence reporting can leave workers feeling like there’s no point to documenting a violent encounter.

Hospitals are typically loathe to install metal detectors at entrances other than at the emergency department, said Lauris Freidenfelds, a former security director at Rush University Medical Center in Chicago who now leads health-care security consulting projects for Telgian Inc.

“Leadership has always wanted to say health care should always be an open and inviting type of atmosphere,” he said.

But metal detectors would stop only a fraction of workplace violence in health care settings, AAEM/RSA reported, as most assaults don’t involve use of a gun.

The COVID-19 pandemic, sending surges of patients to overwhelmed hospitals that can allow only limited visits by family members, has only heightened the tension in many facilities.

“It’s been a very hard year, 18 months, for health care,” Spicer said. “This definitely hasn’t made it easier.”

Staff writer Erin McCarthy contributed to this article.