The Hidden Link Between Financial Stress and Workplace Violence in Healthcare
Written by Clifford Cartagena, CEO & Founder
Clifford Cartagena, RN, BSN, is a psychiatric nurse, safety trainer, and founder of Gentleway Systems LLC. Co-founder of Arizona Care Horizon Institute, he is completing his PMHNP degree at Walden University. Author of The Gentle Art of Crisis, he advances trauma-informed, dignified approaches to workplace safety.
In healthcare, we often separate clinical care from the realities of everyday life. We treat symptoms, stabilize conditions, and manage behaviors, but sometimes overlook what is happening beneath the surface. One of the most overlooked contributors to distress, both in patients and healthcare workers, is financial stress. It is rarely documented, it is not always discussed, and yet it is almost always present. Moreover, when left unrecognized, it can quietly escalate into one of the most serious issues facing healthcare today, workplace violence.
The converging pressures in healthcare
Healthcare environments today are complex, high-pressure systems where multiple stressors intersect. Patients are not just dealing with illness, many are also experiencing fear of medical bills, loss of income due to illness, housing or food insecurity, and limited access to ongoing care. At the same time, healthcare workers face their own pressures, including staffing shortages, burnout and fatigue, emotional exposure to trauma, and financial responsibilities outside of work. These pressures do not exist in isolation, they meet, in real time, at the point of care.
Financial stress as a behavioral trigger
Financial stress is more than an economic condition, it is a psychological state. Research shows that financial strain is strongly associated with increased anxiety, reduced well-being, and impaired decision-making.[1] It affects how people think, feel, and react, increasing anxiety and irritability, reducing patience and tolerance, heightening perception of threat, and impairing emotional regulation. In clinical settings, this may present as verbal aggression, refusal of care, emotional outbursts, or distrust toward staff. What may appear as “difficult behavior” is often a response to overwhelming pressure.
A clinical reality: Reframing behavior
Consider a common scenario, a patient becomes frustrated, raises their voice, and refuses treatment. The chart may label them as “noncompliant.” However, what if the underlying concern is not defiance but fear, fear of the cost of care, losing income, becoming a burden to family, or not knowing what happens next? When we shift our perspective, the response changes. Instead of reacting to behavior, we begin to understand it.
The trauma-informed perspective
Trauma-informed care teaches us that behavior is shaped by lived experience. Financial instability can create a continuous sense of threat, including lack of control, uncertainty about the future, and fear of consequences. A systematic review has shown that financial hardship and personal debt are closely linked to poorer mental health outcomes, including depression and psychological distress.[2] When these pressures are present, even routine interactions can feel overwhelming.
Why this matters for workplace violence prevention
When financial stress is not recognized as a contributing factor, staff may respond too quickly with control-based interventions, communication becomes directive rather than supportive, and situations escalate unnecessarily. This increases the likelihood of physical confrontation, use of restraints, and emotional harm to both patient and staff. Effective prevention begins with understanding, not reaction.
A more effective approach
Workplace violence prevention is not just about policies or response protocols. It is about how we engage people, especially in moments of stress. Practical approaches include regulating our own response, using therapeutic communication, recognizing context, and preserving dignity. A calm, grounded presence can influence the entire interaction. Tone, timing, and word choice matter, as people respond to how they are treated. Behavior often reflects deeper concerns, financial, emotional, or environmental. Respect reduces defensiveness and builds trust, even during difficult moments.
The bigger picture
Financial stress is often viewed as a personal issue, but in healthcare, it becomes a shared reality. It influences patient behavior, staff response, and overall safety within the environment. Addressing it is not just about economics, it is about mental health, human behavior, and workplace safety.
Conclusion
Before labeling a situation as aggression, it may be worth asking, "What pressure is this person under? What fear are they carrying? What need is not being addressed?" Because when we understand the “why,” we change the outcome of the “what.” Workplace violence prevention is not just about managing behavior, it is about recognizing the conditions that shape it and responding with awareness, skill, and compassion.
Read more from Clifford Cartagena
Clifford Cartagena, CEO & Founder
Clifford Cartagena, RN, BSN, is a psychiatric and medical-surgical nurse, hospice provider, safety trainer, and founder of Gentleway Systems LLC. He is also the co-founder of the Arizona Care Horizon Institute. He was authorized by the ADHS (Arizona Department of Health Services) to deliver the Memory Care Services Training in Arizona. Cliff is currently completing his Psychiatric Mental Health Nurse Practitioner (PMHNP) degree at Walden University. He is the author of The Gentle Art of Crisis. With more than 20 years of nursing and leadership experience, he developed the Gentleway System, a trauma-informed approach to preventing and managing assaultive behaviors across healthcare and beyond.
References (APA Style):
[1] Netemeyer, R. G., Warmath, D., Fernandes, D., & Lynch, J. G. (2021). How am I doing? Perceived financial well-being, its potential antecedents, and its relation to overall well-being. Journal of Consumer Research, 48(2), 336–357.
[2] Richardson, T., Elliott, P., & Roberts, R. (2022). The relationship between personal unsecured debt and mental and physical health: A systematic review and meta-analysis. Clinical Psychology Review, 96, 102188.
Disclaimer:
This article is provided for educational and awareness purposes only. It is not intended to promote or sell any specific product, service, or business. The goal is to share insights into the relationships among financial well-being, mental health, and workplace safety.
