Although Berger told her supervisor she was concerned the patient might attack her, her fears were dismissed. Instead she was told to escort him to a smoking room at the dead end of an isolated corridor.

"I was opening the door when he threw a blanket over my head and bashed me against the wall," Berger recalls. "He had me on the ground, pummeling me and smashing my face into the floor." She screamed, but no help came. The patient began strangling her. "That's when I started to say the Lord's Prayer," says Berger. Just as she was about to lose consciousness, another patient -- a schizophrenic who'd been locked in his room for weeks -- came to her rescue. "Otherwise," Berger says, "I'd be dead."

Berger, a petite woman in her 30s, took weeks to recover. When she finally returned to work, she made a routine request to have a security guard assigned to the high-risk unit. The notion was dismissed: "That's your trauma talking, Jessica," said her supervisor. "You've gone off the deep end."

Bizarre as it was, the assault on Jessica Berger is not an isolated incident. Nationwide, workplace violence is a job hazard increasingly familiar to registered nurses -- from frontline E.R. and surgical nurses to pediatric and home-care workers. According to the National Institute of Occupational Safety and Health, each day more than 9,000 nurses and healthcare workers are injured or verbally or physically attacked on the job.

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The American Nurses Association, which has been tracking assaults on R.N.s, says that reports of workplace violence from ANA members have been steadily increasing over the past few years. The Occupational Safety and Health Administration confirms the rising rate of assaults, and says that the risk of job-related violence against healthcare and social workers is presently higher than for any other field.

Hard numbers on the trend are hard to come by. The Bureau of Labor Statistics shows workplace assaults on nurses holding fairly steady over the past decade, but researchers note that those numbers only include nurses who lose work time thanks to an injury and report it to their employer, when many nurses do neither. OSHA's own guidelines on preventing violence against health workers express great "concern" about "the likely underreporting of violence and a persistent perception within the health care industry that assaults are part of the job."

The trend is old news to R.N. Debbie Corning. During 11 years as an intensive care nurse, Corning has been clawed, punched, choked with a stethoscope and threatened with death too many times to count. Twelve weeks ago, at the Crescent City, Calif., hospital where she works, a patient kicked Corning in the spleen and sent her flying across the room. Reeling from the attack, the R.N. wound up being treated in her hospital's own E.R. unit.

"Today, there's road rage, desk rage, office rage," says California Nurses Association president Kay McVay. "The social fabric is breaking down. Healthcare workers are feeling the effect. With our short-staffed units, it's more difficult to face, and control, an attacker. It's no surprise that the assault rate is rising."

Indeed, in a recent seven-state study carried out by the Colorado Nurses Association Task Force on Workplace Violence, over 30 percent of registered nurses surveyed said they had been assaulted on the job -- mostly by patients. These nurses, queried in Alabama, Colorado, Delaware, Hawaii, Illinois, Kansas and Missouri, reported attacks with everything from scissors to chairs, urinals, knives and guns. And while the vast majority of attacks on nurses are not fatal, last April, in front of colleagues, Port Lucie, Fla., nurse Alda Ellington was brutally murdered by a patient admitted for hospital care.

Such violence has at least partly contributed to an exodus of nurses from their chosen calling, compounding what University of Chicago public health experts have warned will soon be a "terrifying" shortage of R.N.s. A recent study sponsored by the National Institutes of Health revealed that one in three nurses under 30 -- and 20 percent overall -- plan to quit their jobs within the next year.

And while workplace violence against doctors is also on the rise, the lion's share of assaults hit R.N.s. A four-year Bureau of Justice Statistics study showed that between 1992 and 1996, 69,500 nurses were assaulted, compared with 10,000 physicians -- nearly seven times as many. And while the legal penalty for harming an M.D. can be stiff, many states offer little deterrent when it comes to attacking nurses. "In the state of Massachusetts, it's a felony to attack an E.R. doctor," workplace violence expert Marilyn Lanza points out, "but only a misdemeanor to assault a nurse."

Despite the epidemic of assaults against the country's 2.5 million R.N.s, hospital violence is still little known to the general public. It's an ugly problem that's unpleasant to confront -- and one that many healthcare institutions would just as soon keep under wraps. "Over 80 percent of all assaults on R.N.s go unreported. It's rampant," says Lanza, whose decade of research on the subject underlies the Occupational Safety and Health Administration's current voluntary safety guidelines.

In general, hospital administrators reportedly have little interest in investigating assaults, which they know will mean high costs in insurance, workers' compensation and public relations, Lanza says. All too often, nurses refrain from reporting assaults for fear of being blamed or losing their livelihood. And although thousands of assaulted R.N.s suffer from nervous flashbacks, terror, insomnia and other symptoms of post-traumatic stress syndrome, they often receive little if any help in dealing with psychological damage. Indeed, those who do report it are often told that violence against them is "part of the job."

"I've changed. I'll never be the person I used to be," said one California nurse whose jaw and leg bone were shattered during an assault. Like many, she has felt stigmatized by hospital management after the attack, considered a "defective" worker. Her psychiatrist, in fact, warned her not to tell management that she sought counseling after the attack if she wished to keep her job. "Don't tell them you were in therapy or on psychiatric medication, because they can fire you for it," he told her. She believes the warning was not unfounded.

Rick Wade of the American Hospital Association concedes that for hospitals, knowing that an employee is getting psychological treatment can be "one of the toughest situations human resources can face." With regard to psychologically injured workers, Wade says, "hospitals are in a funny position. They're there to encourage employees to seek counseling and help for stress and other 'on the job'-related problems. But they also have their own responsibilities about patient safety. An employee can begin taking medication for a legitimate reason, and then become addicted. Let's look at reality. The medication's effect varies from person to person. If the employee goes back to work -- does the hospital know what their employee is really doing?"

"For an assaulted and traumatized nurse, it's a Catch-22 situation," responds the CNA's Allen Fitzpatrick. "Why would you seek help -- or notify your employer that you're getting help -- if you're jeopardizing your job?"

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