Attacks on A&E nurses have almost doubled over the last six years, with incidents often involving patients frustrated at waiting so long for care.

Nurses have been punched, spat at, pinned up against a wall, had a gun pointed at them and been threatened with having acid thrown at them, according to the Royal College of Nursing (RCN).

NHS figures show that the number of incidents of violence against nurses in A&E units in hospitals in England rose from 2,122 in 2019 to 4,054 in 2024 – a 91% increase.

“Behind these shocking figures lies an ugly truth,” said Prof Nicola Ranger, the general secretary of the RCN, which obtained the data using freedom of information laws.

“Dedicated and hard-working nursing staff face rising violent attacks because of systemic failures that are no fault of their own. Every incident is unacceptable,” she said.

Rachelle McCarthy, a charge nurse in the east Midlands, said that in her A&E department “even patients you would expect to be placid are becoming irate because of just how long they have to wait”.

Once she was punched “square in the face” by “a drunk, 6ft 2in bloke”, she said.

In another incident a patient in the waiting room of the A&E where the senior sister Sarah Tappy works in east London punched her in the head, knocking her unconscious. “The violence is awful. And it’s just constant. Nurses. Doctors. Receptionists. None of us feel safe,” she said.

A senior A&E nurse in England’s south-west said she had seen violence against staff in her wards many times, including a patient “pinning a nurse up against a wall” and another colleague being punched by a patient “in the groin and stomach”.

The number of attacks on A&E staff at Southmead hospital in Bristol rose from 83 in 2019 to 152 last year. They doubled at Manchester Royal Infirmary from 39 to 79 over the same time period, and increased from 13 to 89 at Maidstone hospital in Kent, NHS figures given to the RCN showed.

Daniel Elkeles, the chief executive of hospitals group NHS Providers, said: “These findings are absolutely shocking.

“NHS staff need a safe and respectful environment to look after patients, free from any threat of violence or intimidation, be they in hospital, mental health, community or ambulance settings.

“Delays for treatment are frustrating for patients and staff. Every effort is being made to keep these to a minimum.”

The union demanded immediate government action to curb the “rising tide of violence”. It wants a reduction in the long waits for patients in A&E, an end to overcrowded hospitals having to use “corridor care” and a solution to the shortages of nurses that are common across the NHS.

A separate RCN analysis shows the number of patients who had to wait more than 12 hours in A&E soared twentyfold between 2019 and 2014.

Growing numbers of hospitals have hired more security staff, issued clinical staff with stab vests and installed more closed-circuit television.

Rebecca Smith, the director of system and social partnership at the NHS Confederation, said the near doubling in attacks exposed by the figures was “deeply worrying”.

“No one should have to face violence at work – it is totally unacceptable. These kinds of incidents not only have a huge impact on staff health and wellbeing but also retention of staff as well as NHS services and patient experience.”

The RCN sent an freedom of information request to the 129 NHS trusts in England that have at least one emergency department. Of those 89 (69%) replied. However, the true figures will be higher as the union only asked for data relating to the biggest A&E the trust runs.

Their figures show a relentless rise in incidents over the six years, from 2,122 in 2019 to 2,297 in 2020, then 2,851 in 2021, 3,120 in 2022, 3,405 in 2023 and finally 4,054 in 2024.

NHS Protect issued annual figures for violence, harassment and abuse of NHS staff until it was disbanded in 2016.

The most recent NHS staff survey, published in March, found that one in seven workers (14.4%) had suffered physical violence from patients, their relatives or other members of the public in the previous year.

Duncan Burton, chief nursing officer for England, said it was “totally unacceptable that NHS staff are facing acts of physical violence from patients and the public while at work”.

He added: “NHS staff do an incredible job every day to care for others – and they have the right to come to work without fear of being harmed. We would encourage staff to report all incidents to their employer and for employers to inform the police where appropriate so that perpetrators can be brought to justice.”

The health secretary, Wes Streeting, said: “I am appalled by these findings. Nurses dedicate their lives to helping others and deserve to go about their jobs free from violence or intimidation. Anyone who violates this core principle will feel the full force of the law.”