Incidents of violence and harassment against health care workers appear to be increasing in intensity and frequency based on recent national and provincial headlines. A nurse in North Bay reported being pinned against a door by a patient and being repeatedly punched. A patient who was in crisis was brought into the Perth and Smiths Falls District Hospital and stabbed a hospital employee with blunt end scissors.
Statistics from the Workplace Safety and Insurance Board show that health care workers have the highest number of injuries resulting in claims due to workplace violence and harassment, with 808 lost-time claims made in 2016. This number is far above other industries, such as the service industry (149 claims), manufacturing (138) and agriculture (50). Nurses are especially vulnerable, as shown in a 2017 report from the Canadian Federation of Nurses Unions. According to the report, 61% of responding nurses said they experienced abuse, harassment or assault in the workplace over the preceding 12 month period.
The Ontario government introduced Bill 168 in 2010, amending the Occupational Health and Safety Act in order to protect workers from violence and harassment by mandating employers to conduct ongoing risk assessments and implement policies which included reporting mechanisms and provided for investigations. The impetus for this bill was the 2005 murder of a nurse, Lori Dupont, who was stabbed to death by a physician with whom she was in a relationship. This took place at the hospital at which they both worked.
The bill also included provisions to impose fines on corporations that did not comply. Since 2010, there have been three charges against hospitals for incidents of workplace violence. For example, in 2014, the Ministry of Labour fined the Centre for Addiction and Mental Health an amount of $80,000 related to a workplace violence incident involving a nurse who was pushed to the ground and attacked by a patient.
The grim reality of these regular occurrences of violence and harassment faced by health care workers has been widely acknowledged by the provincial government and health care associations. The Ministry of Labour partnered with the Ontario Hospital Association, the Ontario Nurses’ Association and the Ontario Public Service Employees Union to identify ways to reduce and prevent workplace violence for health care professionals. The report with recommendations was released in May 2017, with the provincial government making a commitment to make hospitals safer and improve attitudes and workplace safety culture.
Why are violence and harassment so prevalent in health care?
Considering this context, you may be wondering what is it about the context of health care that makes assault and harassment so prevalent? Health care facilities are distinct from other workplaces in a number of ways.
- Patient/client demographics – more often than not, patients who lash out at their health care workers are individuals with mental health issues, elderly patients with dementia, chronic pain sufferers, as well as patients who come in under the influence of drugs or alcohol. Health care workers in emergency departments, psychiatric units, long-term care facilities and dementia units are particularly at risk.
- Frustrations and other emotions – fear, pain and trauma can cause unpredictable emotional and physical reactions. Health care facilities and staff can trigger highly emotional reactions, which are experienced not only by the patient, but also by their family members.
- Close contact with patients – interventions with patients are often “hands-on.” For patients with the risk factors identified above, conducting invasive procedures or placing restraints on patients can trigger violent reactions.
- Long wait-times – these are often part of a visit to a health care facility and can contribute to escalation in behaviour.
A recent study in the Journal of Environmental and Occupational Health Policy explored some additional risk factors that are unique to the health care setting. The authors of the study also identified environmental and organizational issues, such as the layout of a hospital or facility and staffing concerns, to be contributing factors.
An additional consideration within health care is the fact that the majority of health care workers are women. In 2014, Statistics Canada reported that four out of five paid workers in health care are women. Over 90% of nurses are women. Within hospitals and long-term care facilities, nurses, personal support workers and other health care aides have the most “front-line” interaction with patients. As is shown by the figures, these roles are mostly occupied by women.
The endemic nature of sexual harassment and violence in the workplace towards women is now undeniable in the #metoo era. Survey results from the Ontario Nurses’ Association confirm this reality in the health care setting, with 54% of its members saying they experienced physical violence or abuse in the workplace; 39% reporting other forms of violence or abuse and 19% experiencing sexual violence or abuse in the workplace. These figures suggest that incidents of harassment and violence in health care are higher because of the gendered nature of the workforce.
Best practice for any investigator is to remain mindful of the unique setting within which they are conducting an investigation and to understand the dynamics at play. This is especially true when investigating in a health care facility in order to understand what factors may be at play when a complaint of violence or harassment arises.
In my next blog, I will explore some of the specific challenges an investigator may face when embarking on an investigation in a health-care setting, considering issues such as the legislative context, under-reporting and interviewing.