I think it depends on the facility to a certain extent, and the realization that the health care budget is not endless and hospitals are struggling to provide basic care sometimes. Such things as security of health care workers sometimes assumes a low priority when you can't balance your budget for operative procedures. So it's always an afterthought.
There are about 850 emergency departments in this country, divvied up into about five levels of classification from tertiary trauma centres to small rural hospitals such as my own.
Clearly the urban hospitals, with the issues of gangs and substance abuse, often have a very clear and present security presence. Rural communities often don't, and rely on local police detachments for some kind of immediate response, should it be required.
There is often not a direct line to the local police detachment; you have to call 911 to get a policeman to come. The delays can be quite extensive.
My colleague mentioned administrative response to violence in our hospital. Two years ago the nurse in our sister hospital in Smiths Falls was stabbed by a violent patient. Our hospital, then and only then, installed lockdown access to the emergency department. You had to be buzzed in after hours to be allowed in. Only then did they hire a security company to sit after hours, because that's usually when a lot of this stuff happens. The security personnel are octogenarians wearing a jacket, and are probably not of much use, but it looks good in the hospital. Our nurses still feel unsafe.
Why is it an afterthought? I believe administrations embrace the concept that it's part of the job. We have to get beyond that once and for all. As you've heard, a broad consensus of health care workers.... The extent of violence in the emergency department or in the emergency sector or in the hospital sector or in the community sector is such that our most talented and experienced people are saying they'll forget about it. They're leaving their job.