Violence against health-care workers is pervasive within the walls of hospitals across Ontario, suggests a study that examined the experiences of nurses, personal support workers and other staff.
Researchers conducted focus-group interviews with more than 50 hospital staff members who had experienced verbal, physical or sexual assault, mostly perpetrated by patients.
“There were terrible physical traumas, people whose lives have been changed forever, people with post-concussion syndrome, people whose faces had been smashed and they now are disfigured,” said Margaret Keith, an occupational and environmental health researcher at the University of Windsor and the study’s co-author.
“We spoke to a nurse who had — all in separate incidents — a fractured leg, a fractured arm, a deep bite wound, a stab wound.
“And these were not unusual stories,” added Keith, noting that research shows such assaults take place in institutions across Canada and in other developed nations.
Violent incidents can occur in virtually any part of a hospital, perpetrated by patients and even by visiting family members. While attacks often involve patients with psychiatric issues or those high on illicit drugs, they also can occur when patients frustrated by long waits and what they see as inadequate care react with abuse or violence, research shows.
In fact, said Keith, there seems to be a culture within the hospital system that has “normalized” violence as just being part of the job.
“Somehow people have been told in a lot of ways that they are to expect this sort of treatment,” she said.
“But what I see, looking at it in a broader way, is it’s very similar to what’s coming out now in Hollywood, that there’s this culture of silence and shame,” Keith added, referring in particular to women who long kept quiet about being sexually victimized by powerful men in the film industry.
Co-author Jim Brophy, also an occupational and environmental health researcher at the Ontario university, said the number of incidents is vastly under-reported because many health workers who have experienced violence said they are afraid of reprisals from hospital management if they speak up.
“Even when the incidents were reported, there was very little action taken to remediate the situation to prevent it from happening again,” he said.
During the focus groups, many workers were in tears as they relived their experiences of being assaulted, Keith said.
“One of the things that came out is they received so little support,” she said. “It was really different from one community to another, one facility to another.
“There were some people who said they had had very sympathetic supervisors who helped to support them through that difficult post-incident period, but I would say the majority felt that they got no support and, in fact, it was the opposite.”
Many participants reported that when they were debriefed by managers about an attack, they felt as if they were being blamed, she said.
“The first question was: ‘What did you do? How did you provoke this incident?’ which compounded the trauma that they felt.”
In every focus group, Brophy added, there was a consensus that understaffing due to reduced funding to the health-care system had “set the stage for this toxic environment.”
The study, entitled “Assaulted and Unheard: Violence Against Healthcare Staff, is published in the Journal of Environmental and Occupational Health Policy. The research was initiated by the Canadian Union of Public Employees through its Ontario Council of Hospital Unions (OCHU).
An OCHU poll of almost 2,000 members earlier this month found 68 per cent reported being physically assaulted while on the job in the previous 12 months, with 20 per cent saying they had been assaulted at least 10 times over the same period.
The union has been in contract negotiations with the Ontario Hospital Association, but talks stalled in September, with workplace violence a major sticking point.
An OHA spokesperson was not available to comment on the study, but in an emailed statement, the organization said the health and safety of employees is a priority and it takes “the concerns brought forward very seriously.”
“While we know that the work performed by health-care providers is often challenging and demanding, acts of violence are never accepted as something that staff members should expect to face within the workplace,” the OHA said.
Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario (RNAO), said this is not the first study to highlight the issue, yet the devastating effects of violence in the workplace continue.
“In fact, the biggest (workplace) hazard for which front-line health-care workers are exposed is violence,” she said.
In 2015, Ontario’s ministers of health and labour announced the Workplace Violence in Health Care Leadership Table, to investigate the threat to hospital workers and come up with solutions. Earlier this year, the group released the Workplace Violence Prevention in Health Care Progress Report, which endorsed 23 recommendations and outlined steps needed to make hospitals safer.
While Grinspun acknowledged a lot of work has been done to develop those recommendations — the RNAO has its own set of proposed solutions — they aren’t enough.
Keith called for more government funding to address understaffing in hospitals, changes under the province’s Occupational Health and Safety Act to provide better protections for staff, and whistleblower protection for those who speak out.
Supervisors also need to be more sensitive to the trauma experienced by staff members, who should have ongoing counselling and support following any assault, she said.
But Brophy and Keith said that until the public becomes aware of the widespread and severe nature of violence against those who care for them — and press government and hospitals for concrete actions — little is likely to change.
“It’s a barometer of what is going on in the health-care system,” Brophy said.
“And if we don’t want our mothers and fathers and our neighbours and ourselves being treated that way, then I think we really have to be seriously thinking about what the culture is that all that occurs in.”