Ontario nurses facing rising rates of violence from patients

Healthcare workers are experiencing ‘worsening violence’ while on the job. Faiza Amin reports on the rise in incidents, and the tool one hospital is using to assess the risk of violence in emergency departments.

By Faiza Amin and Meredith Bond

Ontario nurses are calling attention to the violence they face every day from patients on top of the overcrowding in hospitals and burnout over staff shortages.

The Ontario Nurses’ Association (ONA) found that there were 1,010 lost time claims for workplace violence for nurses in 2020, an increase of 21 per cent since 2016.

According to Workplace Safety and Insurance Board, healthcare workers were seven times more likely to be injured from violence than manufacturing workers and 45 times more likely than construction workers.

The Ministry of Labour, Immigration, Training and Skills Development (MLITSD) has laid a total of 546 orders under the Occupational Health and Safety Act relating to violence and harassment in the healthcare sector in 2022 so far.

Erin Ariss, a registered nurse, and vice-president of Region Four with the ONA said healthcare workers are facing increased violence while on the job.

“It has been a daily occurrence for my whole career. I’ve been a registered nurse for 20 years. I myself have been assaulted many times. I had my hand broken. I’ve been beaten, spat upon,” said Ariss. “It is something that has been going on for a very long time. And yet it’s gotten worse since the pandemic.”

Ariss explains everyday as units deal with being short-staffed and wait times increase, patients and their families become more and more impatient as treatment is delayed.

She said for every instance that’s reported, there are several more that have not been.

“It is difficult to report. The reporting systems are not user-friendly. And certainly when you report them, I can tell you from my own experience as a nurse and experience of other nurses, when you report abuse or assault, often you’re blamed for what happened.”

“You’re asked what you could have done differently to prevent the assault or the abuse. You’re asked you know what you did to contribute to it? It’s an unacceptable pattern of victim blaming,” explained Ariss.

Not only is the violence affecting them physically, but it has also had a serious impact on workers’ mental health. A 2020 study from the Canadian Federation of Nurses Unions found “disturbing rates of mental disorder symptom” with physical assault being the traumatic event reported most, affecting 92.7 per cent of nurses.

“It’s just very hard for those who are victims of violence, nurses that are victims of violence, to be a victim. But it’s also very, very difficult to watch and experience. The trauma and what comes of that. We have had our safety threatened we’ve had the safety of our families threatened and the safety of other patients threatened,” the nurse shared.

“This has become a nurse’s problem because they’re on the receiving end of this abuse. But it is certainly the system that needs to help prevent it. Take steps to stop it. It is not part of our job,” Ariss said.

St. Michael’s Hospital is doing something about it. The safety committee for workers has launched a Patient Safety Dashboard.

This allows staff to identify patients who may be at a higher risk of violence in the emergency department and abusing our staff.

Dr. David Kodama, an Emergency Physician and Trauma Team Leader with St. Mikes, said they have noticed an uptick in violence, aggressive behavior, and verbal abuse towards staff as the COVID-19 pandemic has dragged on.

“This has led to us being much more active in the committee, pushing forward with initiatives such as the patient safety dashboard, amongst others, to really start to figure out how we can best support our staff while at the same time maintaining a high level of clinical care,” said Dr. Kodama.

He said they don’t have a full explanation of why they have seen this uptick in aggressive behaviour.

“I wish I had an answer because that would provide some solutions for us. But all I can say is that we have just seen as the pandemic’s kind of dragged on, and it’s still ongoing, that people are under pressure. They’re stressed. They’re unwell. They’re presenting to emergency departments, with even greater numbers, and we’re just seeing more and more abusive behavior towards our staff.”

He said this was their internal solution based upon on their own internal healthcare record system. Dr. Kodama explains this risk is evaluated just like any other vital sign they look at when a patient is first admitted.

“The goal is to allow our staff to have an understanding of who might be more volatile, who might be more apt to assault us, verbally abuse us, and then that way, start to implement strategies to reduce that risk,” he explained. “The goal really is twofold. It’s to prevent these events and it’s to protect our staff, but also to ensure that each and every one of our patients receive the appropriate care that they deserve.”

He adds unless someone has been flagged as having a high-risk event, once you’ve been discharged from the hospital you are removed from the dashboard.

“We understand that people have bad days in the emergency department and we don’t want to label anybody. Once you’re discharged or you move out of the department, you fall off that board and every time you present, unless you’ve had a high-risk event, which is a code white, you get a fresh start.”

When asked if he thinks more can be done by the government to prevent some of these workplace violence issues, Dr. Kodama said bringing awareness to the problem is extremely important, first and foremost.

“Before solutions can be implemented, we need to understand what the problem is, what the root cause of this is. And so it would be great to have more and more involvement from various levels of government, whether that is provincial, municipal, or federal, shared Dr. Kodama. “But until we understand what the problem is it’s tough to know exactly what to what to ask of our of our leaders.”

The MLITSD has been conducting an initiative that is focused on the prevention of violence that began in June 2022 and is scheduled to run until the end of March 2023. There are more than 500 health and safety inspectors visiting workplaces across the province daily.

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