Nurse Ben Spencer heard the plea from across the hospital unit — "We need Ben!" — and hustled to a room where an angry patient punched him in the face.

The former footballer dodged the patient's next lunge and tackled him, feeling conflicted about fighting a patient while protecting coworkers.

"To be put in a position like this, it's tough," said Spencer, who suffered a concussion from the punch and missed two weeks of work.

This was not the job Spencer expected when he became a nurse at North Memorial Health Hospital in Robbinsdale a year ago on a cardiac unit mostly filled with patients recovering from chest pain or surgery. But assaults are becoming more of a problem across Minnesota hospitals.

In 2020, about 280 attacks injured hospital staff in Minnesota and forced them to miss work, according to the latest data from the U.S. Bureau of Labor Statistics. That triples the 90 assault-related injuries in 2019.

Several forces are conspiring to increase risks. Patients with mental and substance abuse disorders are exceeding inpatient treatment capacity and growing agitated instead in emergency departments and spillover units. The backup leaves other patients waiting in ERs, increasing their stress.

Politically sewn distrust over the COVID-19 public health response has made patients and families argumentative. All of this has prompted more hospital workers to quit, which exacerbates staffing shortages and patient wait times. Hospital job vacancies have tripled this year in Minnesota.

The increase has thwarted a decade of efforts by hospitals to improve safety. More solutions are needed, including legislation that would make it a federal crime to assault or intimidate hospital workers, said Jennifer Schoenecker, associate vice president of quality and safety for the Minnesota Hospital Association.

"Ensuring a safe and secure environment for our workforce is essential to providing quality care," she said.

The federal data accounts for injuries bad enough to force hospital workers off the job. A survey of 950 nurses by the Minnesota Nurses Association (MNA) suggested a broader problem: 75% observed or experienced physical violence at work over the past two years. Almost half who encountered violence said they didn't report it because they were busy with patients or didn't think their hospitals could do anything.

"It seems like it's inevitable in bedside nursing that you are going to be assaulted at some point," said Kelsey Boeshans, an ICU nurse at HCMC in Minneapolis.

A drug overdose patient on a ventilator panicked when he awoke this spring and headbutted Boeshans when she tried to help. Turnover has left less-experienced nurses to deal with volatile patients. A veteran might have known how to rouse the man calmly, she said.

Nobody was available to cover her patients, so Boeshans tried to finish her shift. A supervisor found her vomiting in a bathroom from a concussion that took her out of work for a month.

Safety concerns gain publicity every three years when the MNA negotiates contracts for 15,000 nurses in Twin Cities and Duluth hospitals. Nurses during a three-day strike this fall demanded safer conditions and increased pay to compensate for the heightened risks.

"The amount of workplace violence that our profession is experiencing now is unacceptable," said Mary Turner, MNA president, at a union rally last week. "And it is driving our nurses away from the bedside."

The threat transcends nurses. Workers compensation claims have increased from 187 in 2018 to 236 in 2021 among hospital staffers who suffered disabling injuries from assaults, according to the Minnesota Department of Labor and Industry. Nurses filed 82 claims in 2021, but security officers saw the biggest increase over four years from 33 to 77 claims.

Minnesota's adverse event reporting system tracks severe assaults that result in patients or workers losing consciousness, breaking bones or teeth, requiring hospitalization or needing psychological counseling. Fourteen injuries were reported over the past two years, compared to 20 over the prior 15 years.

Two incidents spurred safety efforts. Security video captured a patient charging through St. John's Hospital in Maplewood in 2014 and striking workers with a metal rod. A year later, a psychiatric patient at St. Cloud Hospital wrestled a gun from a sheriff's deputy and killed him. Both patients died in the aftermath of the attacks.

All Minnesota hospitals by 2016 completed plans that detailed their preparedness for violent incidents and staff training. Most patient caregivers are now taught de-escalation techniques to tamp down tense situations.

Several hospitals reconfigured entrances, including the installation of metal detectors this spring outside HCMC's ER in Minneapolis. Nearly 1,000 knives and 13 guns were detected in three months, according to a summary report, along with brass knuckles, hatchets, and socks filled with rocks.

Boeshans said a group of angry people swarmed an HCMC ICU earlier this year, resulting in a standoff with nurses until security arrived.

The intolerance of the COVID-19 era has made visitors and relatives more likely to make threats, but physical conflicts mostly involve confused or upset patients, said Josh Gramling, HCMC's director of occupational health and wellness.

Risk varies by location. In the ER, it is highest when patients on psychiatric holds are told they aren't being discharged. In the ICU, the risk comes when patients are weaned off sedation — or receive grim prognoses.

"If you can tackle the problem at its root and figure out where and why patients are escalating in the first place, you have a better chance of reducing violence rather than meeting it when it happens," Gramling said.

Sometimes, the solution is more security, he added. HCMC started posting a 24-7 guard in the section of the ER for intoxicated patients who are less likely to respond to rational de-escalation techniques.

Spencer said he was called for help at North because he is a bigger nurse and security officers were farther away, but he tried in the seconds before he was punched to calm the patient.

"I was trying the de-escalate-the-situation type things, but in a split second somebody let go of his arm and he caught me," he said.

North Memorial screens patients for safety risks multiple times per day, according to a hospital statement, and makes notes in medical records and places visual cues on doors when patients present risks.

Caregivers were nonetheless injured at the hospital Tuesday while attempting to wean an agitated ICU patient from sedation. The patient kicked nurse Kayla Erickson, knocking her into cabinets, and then got free from the bed and restraints and charged at Erickson.

The patient had a history of attacking caregivers, but Erickson said the information wasn't passed along before she tried to remove the patient's breathing tube. Erickson is off work, recovering from back and leg injuries.

"This could have been preventable," she said, "and a lot of it should be preventable."