There are some professions with an expectation you might encounter violence in your working day. A soldier in wartime. A police officer. A nightclub bouncer. A nurse.
Wait, a nurse?
Nurses and others in the healthcare sector face what one union leader calls an epidemic of violence in Canada’s hospitals and long-term care facilities at the hands of patients, but he says little is being done to improve their safety and security.
“We have particularly in health care this pervasive culture of accepting risk of violence as essentially part of the job,” Andy Sommers, vice-president responsible for health and safety for the 60,000-member Ontario Nurses’ Association (ONA), tells Yahoo Canada News.
“Even nurses themselves somehow have bought into this sentiment that being hit or punched or bitten or even yelled at and abused is essentially part of their day-to-day work.”
The point was brought home in the last week as a nurse and a doctor were assaulted in two B.C. hospitals, and a nurse was injured at an Ontario facility.
B.C. Nurses’ Union (BCNU) president Gayle Duteil said these are not isolated incidents.
"I can tell you that daily nurses and doctors across B.C. face violent and volatile situations and we need to do better to protect them," she said.
A psychiatrist at Penticton Regional Hospital was attacked as he interviewed a patient alone. He was hospitalized with facial injuries, including a broken jaw and other fractures. A 30-year-old man (who is a martial arts expert) is facing aggravated assault charges in relation to the attack.
On Sunday, a nurse in the psychiatric wing of the Royal Inland Hospital in Kamloops, B.C., was assaulted by a patient.
“She was thrown against a wall, had hair pulled out and received emergency care and is home recovering and resting at the present time,” Duteil said.
In Ontario, a nurse at the Southland Regional Health Centre in Newmarket was attacked by a patient in the emergency department last week, while a nurse in Brockville was stabbed repeatedly with a pen by a psychiatric patient recently.
Problem goes beyond psychiatric patients
“One thing I do want to stress is it’s not just psychiatric patients,” said Duteil, referring to the two B.C. incidents.
"We’re seeing a level of violence in the health-care facilities across the province. You can be in the emergency room or on a medical surgical floor and have a violent incident.”
National statistics on the problem are hard to come by. Provincial worker-compensation agencies collect data but that only records incidents that result in health care workers taking compensated time off for their injuries.
“Simply being punched in the face, where you require an ice pack and you just have to go back to work tomorrow because if you didn’t you wouldn’t get paid, it’s never going to capture that sort of stuff,” said Summers.
A decade-old survey published as part of a 2009 Statistics Canada study found half of nurses working in geriatric and long-term care facilities reported being physically assaulted within the previous 12 months. The rate for those in palliative care, mental health, critical care and emergency rooms ranged from 42 to 47 per cent.
The safest department for nurses? Maternity and newborn care, where only six per cent reported assaults within a year. The average for all nurses was 34 per cent, one in three.
What they do know is that B.C. has several hundred cases reported to WorkSafeBC each year, with the numbers steadily on the rise.
Violence accounted for 11 per cent of claims filed by health care and social assistance workers from 2009 to 2009, according to WorkSafeBC.
Workplace violence made up less than a thousand of the 41,500 claims accepted by Ontario’s Workplace Safety and Insurance Board last year but accounted for 639 lost-time injuries among healthcare workers – number one among all Ontario job sectors, Summers pointed out.
Toronto’s Centre for Addiction and Mental Health have had 400 violent incidents this year, he said, and London Health Sciences reports 100 a month, he said. Just a snapshot of the overall problem.
“If these are the numbers from two facilities, how do I extrapolate that out for the province,” said Summers. “It has to be of epidemic proportions.”
B.C. hospitals have 10 ‘code whites’ a day
Last February, CBC News reported a review of WorkPlaceBC data showed hospitals in the province had at least 10 violent incidents – a “code white” – every day.
“That in no way reflects the actual number of violent incidences because sometimes things are handled without calling a full code white,” Duteil observed. “Certainly it’s alarming.”
She puts the increase down to a combination of factors, including the rise in the number of mentally ill patients, more residents with dementia in hospitals and long-term care facilities, coupled to staffing and budget cutbacks that increase stress on staff and patients alike.
Health care administrators have not responded adequately to the rate of workplace violence that would hardly be tolerated in other fields, Summers and Duteil said.
The Interior Health Authority, which overseas the Penticton and Kamloops hospitals, responded to the attack on the psychiatrist by stating that staff safety is a “top priority.”
"We strive to minimize any risks to staff, physicians and patients, but that is not always possible even with all of our safeguards recognizing patient behaviour can be unpredictable," its Tuesday statement said.
"We remain committed to working with our physicians, nurses and staff to debrief this incident and seek lessons learned in order to provide the
safest working environment possible while balancing the need to provide quality health care.”
Likewise, Southlake’s statement following the attack on its ER nurse stressed it’s been working hard to improve security for staff since a similar incident 18 months ago.
Despite measures that include personal alarm pendants, focused training and changes to the way high-risk patients are handled “this most recent incident underscores the fact that violence is present within the health care system,” the hospital said.
But the union officials say it needs a larger cultural shift before nurses and other health care workers feel less vulnerable. A commitment to safety has not been backed by action, said Duteil.
“We need to do more than talk and the health authorities need to do more than talk,” she said.
The BCNU on Monday proposed a range of improvements, including security staff assigned to psychiatric units, security cameras and risk assessments for potentially violent patients.
The Canadian Nurses Association and Canadian Federation of Nurses issued a position statement in 2008 calling on health care employers, clients and nurses themselves to work towards eliminating violence.
The starting point, said Summers, is the nurses themselves.
“I’ve got to persuade my own peers,” he said. “You don’t have to accept that nursing is a dangerous job.”