Katrina Clarke | July 1, 2015 | Toronto Star
A nurse is punched in the face by a patient. Another is kicked in the breast.
One patient calls a nurse a “Nazi b—h.” Another throws urine.
One man fondles his genitals in front of a hospital staffer. Another spits in a nurse’s face.
These are all incidents of assault that hospital staff reported in 2014 at University Health Network, according to information obtained by the Star through an Access to Information request.
Over the past three years, reports of violence on hospital staff by patients and families of patients have been on the rise — in some cases doubling, according to information provided to the Star. In an email to the Star, a UHN spokesperson said the increases are likely due to changing violent incident reporting requirements. There are similar increases at other Toronto-area hospitals, statistics show.
The numbers underscore the need for improvements to hospital staff safety measures, something the Ontario Nurses’ Association (ONA) has long been calling for to better protect healthcare providers.
“Violence isn’t part of this job. It shouldn’t be part of this job,” said Andy Summers, vice president of health and safety with ONA. “Eventually, somebody will get killed.”
Summers called the current situation of violence against nurses in Ontario “completely unacceptable.”
At UHN, which includes Toronto General Hospital and Toronto Western Hospital among others, there has been a consistent increase in reports of assault in the past three years. The number of reported violent incidents doubled in two years, jumping from 166 incidents in 2012 to 331 in 2014, according to data provided to the Star. In 2014, a total of 11 workers who were injured were unable return to work for their shift following the assault.
Spokesperson Gillian Howard said changes in reporting standards are likely to blame for the rise. The changes include a Behaviour Safety Alert, implemented at UHN in 2014, which requires staff to put an alert on patient records if the patient has aggressive or violent behaviour. Howard also said increased reporting could be attributed to the fact that unions are encouraging staff to report every incident — “a very good thing,” she said.
“We do not want any staff member at risk from a patient — but given the care we provide, the medications used, the fact that some patients have cognitive impairment as a result of injury or aging, the impairment of some patients when they arrive, and the risks associated with some of the treatments, it is not likely that we will see a year with no incidents,” said Howard, adding that UHN employs approximately 13,000 staff and has over one million patient visits per year.
But ONA lashed out at this explanation, saying employers are trying to downplay the issue.
Erna Bujna, occupational health and safety specialist with ONA, said some employers “absolutely” still discourage staff from reporting incidents, by telling workers that violence is just part of the job.
ONA wants to see a violence strategy implemented at hospitals across the province. The strategy would include mandatory reporting of every violent incident reported to the Ministry of Labour — currently, employers are only required to report fatalities and critical incidents to the ministry — mandatory risk assessment of every patient, increased security and more healthcare providers hired. They also want the Ministry to charge individual hospital CEOs when workers are not adequately protected from violence.
“Healthy and safe work environments for nurses and other health care workers are a high priority for the ministry and the government,” the Ministry of Health wrote in an email to the Star, in response to ONA’s call for a violence strategy. “Healthy Work Environments are essential in enabling health care workers to deliver high-quality patient care.”
Craig MacBride, a spokesperson for Kevin Flynn, Minister of Labour, said the Ministry is working with ONA and is “preparing to take next steps to improve the health and safety of healthcare workers in Ontario, and we look forward to announcing those next steps in the near future.”
MacBride said the Ministry launched an “enforcement initiative” for the health care sector in July 2014 in which “All acute-care hospitals, as well as some long-term care homes and community-based health care services, will be inspected over three years.”
He added that law requires employers to assess the risks of workplace violence, create workplace violence and harassment policies, develop programs to implement those policies and to take every precaution reasonable to protect workers from violence in the workplace.
ONA’s call for an updated safety strategy comes on the heels of a decision by the Ministry of Labour to lay charges against Toronto’s Centre for Addiction and Mental Health (CAMH) in December 2014. The charges — laid under the Occupational Health and Safety Act and relating to failure to protect workers from workplace violence — stem from a violent incident in January 2014 in which a nurse was dragged, kicked and beaten beyond recognition, according to ONA.
Toronto police later charged the patient, who was found guilty of assault causing bodily harm, according to court documents.
“We don’t want staff ever to feel that aggression is the norm,” said Rani Srivastava, chief of nursing and professional practice at CAMH, in response to the comments. “We are committed to a culture of safety and recovery and that means safety for staff and patients.”
Jean Dobson, a nurse at University Hospital in London, Ont., said she’s been strangled with a stethoscope, stabbed with a metal fork and spat at by patients over the course of her 42-year career.
“People think that they can hurt a nurse and that’s OK,” she said. “We have to smile and take it.”
In one incident, Dobson was kicked in the face by a patient so forcefully she broke her nose. She was forced off work for weeks and suffered from PTSD, she said.
Dobson said she’s seen the frequency of patient-on-nurse assaults and the severity of violence increase during her career.
At Sunnybrook Hospital, reports of abuse against staff by patients and visitors jumped from 140 in 2012 to 320 in 2013. The hospital attributes the increase mainly to their move to electronic reporting, which makes it easier to record violent incidents, a spokesperson told the Star.
According to a 2005 national study from Statistics Canada, 34 per cent of nurses surveyed reported being physically assaulted by a patient in the previous year and 47 per cent reported experiencing emotional abuse. For those working in psychiatry/mental health settings, 70 per cent of nurses reported experiencing emotional abuse.