(WJLA) - Virtually any emergency room is a kind of controlled chaos, with crowded waiting rooms and busy treatment areas.
"Has that X-ray been run yet, do you know?" shouts one doctor.
Yet it's also an enclave of healing.
"As a nurse, I'm supposed to be compassionate and caring," says former ER nurse Ed Stern.
And for some nurses and medical staff, it's also a place of harm and injury.
"Hit, punched, spit at. Objects thrown at us," says de-escalation instructor Mike Bowen.
Just ask 21-year ER nurse Tammy Fitch. In March 2011, she was trying to calm down a drunk, agitated patient when suddenly she was kicked in the face.
"At the time, I didn't see that one coming," she recalls.
"She arched her back and kicked out and I was in the position where I got kicked right in the face," she says.
And Fitch isn't alone. A 2010 Bureau of Labor Statistics found that seven out of 10 ER nurses have reported physical or verbal assaults by patients or visitors while at work. The Emergency Nurses Association (ENA) estimates that the number of weekly assaults nationwide is in the thousands.
"Punch a guy in the bar, you're going to jail. Punch a nurse in the face, maybe not," Stern says.
And Stern estimates he has been assaulted 10 times during his 30-year healthcare career.
Although there's no data showing that the number of incidents nationwide is rising, Stern suspects the problem is getting worse.
"The violence in the street can easily roll over," he says. "We're the ones sitting there, usually at least initially, unprotected."
Now, organizations like the ENA are fighting back, successfully lobbying to make an assault against an emergency nurse a felony in 30 states.
In Virginia, it's a misdemeanor charge - punishable by up to 14 days in jail. D.C. and Maryland have no special statutes as of yet regarding ER nurse assaults.
"This is not part of being an emergency nurse. This is unacceptable behavior," says ENA President Deena Brecher.
Brecher says by changing the law to make an assault against an ER nurse a felony, it will perhaps force some would-be attackers to think twice.
"It does lend to that seriousness, that yes, we're not kidding. It's something that carries a penalty that carries some weight with it," she says.
Ask almost any nurse, and he or she will tell you that workplace violence is an accepted part of the job. But experts say many nurses are actually reluctant to report incidents.
INOVA Hospitals researcher Karen Speroni investigated the issue in 2011 and 2012. Approximately 762 nurses responded to her questionnaire.
"We found 76% had experienced either physical or verbal workplace violence over the last year," she says.
The problem? Speroni says only two-percent reported an incident.
"It's in part, nurse perception. 20% percent thought that violence comes with the job."
ABC7 visited several hospitals in the metro area, and most have secure patient care areas in their emergency departments. Many have swipe entries for doors, and Plexiglas-protected triage areas.
Mike Bowen is an Iraq war veteran and licenses practical nurse who teaches de-escalation classes at INOVA Loudoun Hospital.
"It teaches verbal and physical restraint techniques," Bowen says.
The idea is to train staffers how to defend themselves and calm down patients and visitors before things get out of hand.
"It's not okay to be verbally attacked. It's not okay to be physically attacked. Now we're changing that mindset," Bowen says.
Medical care professionals say they believe that all these steps - including tougher assault penalties, stronger building security, improved staff training - will make a difference, perhaps making any emergency room a place of healing without harm.
And Stern is hopeful:
"It will bring that level of respect up for a profession that is out there risking their own personal safety to take care of you," he says.