BOSTON, Massachusetts (CNN) -- Nurses understand that they have a tough job, but getting attacked and abused is not what former Boston area emergency room nurse Ellen MacInnis says she signed up for.
This harmonica was turned into a switchblade-like device and used to attack psychiatric emergency room nurse Karen Coughlin.
"It was very frightening," said the 18-year veteran. An angry and frustrated patient had grabbed MacInnis' hand, dug her nails in and made a chilling threat. "If you have children, I'll find them and I'll kill them."
This was not the only time MacInnis was assaulted on the job. Last summer, an intoxicated, H.I.V.-infected female patient tried to hit her and wound up covering her in blood.
MacInnis said the thought that her life was in danger never occurred to her until after the situation was under control. "Then it sort of hit me," she said, "And I fell apart."
Nurses are often on the receiving end of physical assaults, because they are typically the first and most frequent medical personnel by the bedside of ill and sometimes angry or frustrated patients.
Emergency rooms seem to be the hot spots for violent assaults, according to experts interviewed for this article, but general practice nurses are not immune.
Fifty percent of nurses surveyed by the Massachusetts Nurses Association (MNA) -- a union of registered nurses -- and the University of Massachusetts said they had been punched at least once in a two-year period. Some reported being strangled, sexually assaulted or stuck with contaminated needles.
In the past, the biggest problems reported by nurses had to do with back injuries or work related asthma, but that's changed, said Evelyn Bain, head of the MNA's Occupational Health and Safety Office.
"Workplace violence has really just been head and shoulders above that," said Bain.
It's not just a problem in Massachusetts. A national survey, conducted last year by the Emergency Nurses Association, a national association for emergency room nurses, found 86 percent of its nurses reported being a victim of workplace violence during the prior three years; 19 percent said it happened frequently. Watch how nurses cope with violent patients »
Boston-area psychiatric emergency room nurse Karen Coughlin said she was forced to restrain a disturbed female patient who had fashioned a switchblade-like knife out of a harmonica. Another time she had to fight off an aggressive, violent male patient.
"He had gone after me," she said. "I really thought he was going to kill me."
This became almost routine, she said.
"I've been punched, I've been kicked, I've been spit at," she added.
Coughlin had always stood up to the tough challenges of her job, but her family was scared.
"My son asked me, did anybody try to kill you today?" she said.
Coughlin, who claims she hasn't seen this level of violence in her 23 years on the job, started questioning her work environment. "My kids shouldn't have to ask me that, you know."
The MNA claims budget cuts, resulting in a shortage of nurses, are partly to blame for this problem. The Massachusetts Hospital Association (MHA), an organization representing hospitals and health systems, agrees that violence in the workplace is a problem, but officials there don't blame staffing levels.
Karen Nelson, senior vice president of clinical affairs at MHA, says assaults on nurses are more a product of a violent society, where mass shootings are no longer rare, than a nursing shortage. She calls the push to hire more nurses "a knee-jerk reaction."
Nelson said stepped-up security and safety training for nurses is a more practical solution. Many nurses are being trained to recognize a potentially violent situation and then find ways to deescalate it.
MacInnis, who had to undergo a debilitating cocktail treatment to prevent contamination from the H.I.V-infected blood, supports a proposed law in Massachusetts that would toughen safety guidelines at hospitals across the state.
"Legislation will be helpful," she said. But the MHA said legislation would only duplicate what the federal Occupational Safety and Health Administration and other regulatory agencies already require.
"It's pretty much redundant with existing rules, regulations, standards," said Nelson.
As this issue is debated in Massachusetts and in other states, more nurses are standing up to their attackers and reporting assaults, according to Bain of the MNA.
In the past, some nurses and hospitals have tolerated a lot of abuse by patients, she said. Nurses were sometimes discouraged from taking action and told that unruly and sometimes violent patients were part of the job. They were guided by a duty to help and heal sick patients, not prosecute them.
Now, the MNA is encouraging nurses to press charges. "Perpetrators should be held accountable," said Bain.
Despite the safety concerns, most nurses are relatively satisfied with their jobs. The ENA says its survey indicates that 64 percent of emergency room nurses are very or somewhat satisfied with their job, and 75 percent expect to be in the nursing profession in 10 years.
MacInnis, who now works in a different unit at the same hospital, says nursing is in her blood. "It is what we do; we take care of people." E-mail to a friend