Pandemic Periods and Their Reflection on Violence Against Healthcare Workers: Analysis of Nine Years of “White Code” Data

Aim: This study aims to examine the changes in violence against healthcare workers in a tertiary education and research hospital during the pre-pandemic, pandemic, and post-pandemic periods through "White Code" notifications, and to evaluate the course of violence against physicians, especially those working in emergency departments, over time.Material and Methods: In this retrospective descriptive study, White Code notifications recorded between January 1, 2017, and May 31, 2025, were analyzed. Incidents were classified according to type of violence, targeted personnel, and location. To control for variability in patient admission numbers, incidence rates of violence were normalized to 100,000 admissions. Chi-square test, two-ratio z-test, and trend analyses were used in statistical analyses.Results: A total of 1,005 violence incidents were reported. A significant difference was found in the distribution of the number of cases and types of violence between periods (p = 0.001). Verbal violence was the most common type of violence across all periods, reaching its highest rate in the post-pandemic period (84.8%; p < 0.05). While the normalized incidence of violence against physicians showed a significant difference between periods (p < 0.001), no significant difference was found for non-physician personnel (p = 0.230). Although the physician/non-physician violence ratio was numerically higher in the post-pandemic period, it was not statistically significant (p = 0.079). Specifically, in the emergency department, a significant decrease in the incidence of violence against both personnel groups was observed in the post-pandemic period (p < 0.001). Annual trend analyses revealed that violence did not show a linear and sustained decrease during the 2017–2024 period (p > 0.05).Conclusion: Violence against healthcare workers has been affected by the COVID-19 pandemic and continues to exist as a multifactorial problem in the post-pandemic period. The findings show that violence does not decrease spontaneously and linearly over time. This finding points to the need for targeted, sustainable preventive strategies, especially for physicians working in emergency departments.