Introduction Healthcare and social welfare workers are confronted with violence of patients and clients. In a cross-sectional study the frequency and consequences of aggressive assaults on employees in the German healthcare and welfare system were investigated.

Methods At the workplace employees were asked to fill in a standardised questionnaire concerning the frequency and consequences of verbal and physical aggressions within the last year. The questionnaire was adopted from the Staff Observation Aggression Scale-Revised (SOAS-R).

Results 1943 employees from 81 different facilities participated in the survey (response rate 40%). Verbal aggression was experienced by 75% and physical aggression by 55% of the participants. Both forms of aggression occurred more often in workshops and homes for persons with handicaps (95% and 63%) than in nursing care (59% and 56%) or hospitals.

(41% and 43%). 39% of the employees were hit within the last 12 months. About one third of the participants (34%) felt highly strained by recurring aggressions. 38% reported that they were trained at the workplace for dealing with these critical incidents and 81% felt supported by their co-worker after such an incidence. De-escalation training and supervision had a positive effect on experienced stress (OR 0.6, 95% CI: 0.4 to 0.8).

Conclusion Violence towards nursing and healthcare personnel occurs frequently. Every third respondent felt severely stressed by violence and aggression. Occupational support provisions to prevent and provide aftercare for cases of violence and agression reduced the risk of incidences and of perceived stress. Research is needed on occupational support provisions that reduce the risk of staff experiencing verbal and physical violence and the stress that is associated with it.