The doctor is in

Doctors, nurses and paramedics work under incredibly stressful conditions. The hours are long. Night shifts wreak havoc on circadian rhythms. It’s impossible to predict what each day will bring.

“If you have a crazy day every once in a while we can handle it,” says Linda Silas, president of the Canadian Federation of Nurses Unions (CFNU) in Ottawa. “But if it’s crazy all the time, that’s more difficult to deal with.”

Organizations such as the Public Services Health and Safety Association (PSHSA) in Tillsonburg, Ont., and the Mental Health Commission of Canada offer resources to help health workers manage risks. (See sidebar “Four tools…”) But it’s important for the occupational health and safety specialists who support health practitioners to also understand these dangers. Here are some of the problems to keep in mind.

Angry clients and heavy loads

The greatest physical concerns are musculoskeletal disorders (MSDs) — soft-tissue damage including back pain and carpal tunnel syndrome. Nearly one-half of the MSDs among health practitioners result from lifting, transferring and repositioning patients, PSHSA says. 

Health professionals also face the potential of injury from violence. A confused patient might lash out. So might an upset loved one, or even a colleague. Many people will remember the case of Lori Dupont: She was a nurse at Hôtel-Dieu Grace Hospital in Windsor, Ont., who was killed at the workplace in 2005 by ex-boyfriend Marc Daniel, who was a doctor at the same institution. 

Consider the way the shift to in-home care affects safety for health providers as well. They run the risk of car accidents as they travel from house to house. A mat in a patient’s home could cause a trip. A snow-covered walkway could cause a slip.

Henrietta Van hulle remembers well the trouble one community care worker experienced at a patient’s home: the caregiver actually fell through the stairs, they were in such poor condition.

“In a hospital, you own the building, you can design it to make it ergonomic or to control fire and other risks,” says Van hulle, health-care sector lead at PSHSA. That’s not the case in homes. “And that’s one of the reasons slips, trips and falls are highest among community care workers.” 

For the most part, though, trouble stems from the people part of the job, instead of equipment issues or the physical environment. Discussing compensation claims related to health care, Stephen Symon, public sector manager with WorkSafeBC in Vancouver, points out: 

“The one thing they have in common is they are all around providing care for the patient. That is different from other sectors, where you’re dealing with dangerous equipment.”

Too much work, too little time

For health providers, mental stressors may be even more difficult to deal with than physical challenges. The quick pace and unpredictable nature of their work leaves many feeling overwhelmed. 

A 2010 study on Ottawa-area hospitals found that hospital staff suffer from role overload. They have too much work, not enough time and insufficient help. High levels of role overload lead to absenteeism, poor productivity and low commitment to work, found The Etiology and Reduction of Role Overload in Canada's Health Care Sector. The study consisted of a survey of 1,396 employees, along with in-depth interviews with 150 health-care workers.

 What’s the solution? In a word: control. Workers need to be able to regulate the factors that lead to too much work.

But control can be difficult to achieve. In hospitals, for instance, patients arrive unscheduled. Emergencies can occur at any time. If the team is short-staffed, members have to work faster, ever mindful of strict safety procedures.

The Ottawa hospital study suggested preparation makes a world of difference. Referring to the study’s participants, researchers said: 

“Planning, organizing and setting priorities increased the amount of control they had over the situation by reducing the unexpected, expanding the amount of time available and facilitating focus and decision-making.”

More healing hands

No question, control is important. But when the workplace is chronically understaffed and overworked, lack of control is more of a symptom than a cause. According to CFNU, governments and health organizations need to boost health-care staffing levels if they really want to improve safety.

In a study released in June, CFNU said that in 2012, the rate of absenteeism for full-time nurses was 7.7 per cent — 55 per cent higher than the average for all other occupations.

According to the PSHSA, health practitioners lose 50 per cent more workdays than the average Canadian worker. Viruses, muscle injuries and mental health challenges from stress can all keep health workers away from their jobs.

Silas sees a connection between role overload, high absenteeism and safety risks. Nurses are rushed, and that causes them to make mistakes that can lead to injuries. Nurses increasingly have to work alone, which means they may not have help to turn a patient or deal with violence.

In order to genuinely improve safety for health practitioners, organizations must increase staffing levels, Silas says. Otherwise, the harmful cycle involving high stress, absenteeism, risk of injury and mental health problems will continue.

She adds that nurses, doctors and occupational health and safety specialists also should make use of resources and tool kits offered by PSHSA and others. But ultimately, one of the best ways to ensure that health facilities and services are safe for patients is to ensure they’re safe for health workers first.

As Silas simply puts it: “We need to prioritize health and safety for the professionals providing health services.”



4 tools for better physical and mental health
Resources from health-focused organizations can help nurses, physicians and paramedical staff stay strong in their tough work environments. Here are four useful tools:

1. Action on Workplace Stress – A Worker’s Guide to Addressing Workplace Causes of Mental Distress

Developed by Occupational Health Clinics for Ontario Workers (OHCOW), this resource kit discusses how stress affects workers’ mental and physical health. It provides advice for identifying stressors and for developing an action plan that enables employees to manage stress. The legal section is specific to Ontario, but other parts speak to health workers across the country. Access the guide at

2. Mental Health First Aid

Created by the Mental Health Commission of Canada, this program offers courses to help people help others manage mental health problems. It provides advice on recognizing the signs of mental health difficulties and where to find professional support. Courses are available for individuals who work with adults, people who work with youth and people who want to instruct others in mental health first aid. Learn more at

3. Community care training

PSHSA has eight new web tutorials for community care workers. These free, online programs cover challenges specific to care in non-institutional settings, including matters such as driving, kitchen hazards, and slips, trips and falls. Access the tutorials at PSHSA also offers classroom courses for topics such as MSDs, fall prevention and working in the heat. Learn more at Additionally, PSHSA has assembled a list of resources to help community care organizations comply with the Ontario Ministry of Labour’s safety inspection blitzes for 2013 and 2014. See the resource list at

4. Safety at Work centre for the health care industry

WorkSafeBC has an entire website with resources to help prevent accidents and injuries in health care:

The site includes information about violence prevention, chemical and physical hazards, patient handling and ergonomics. Videos, courses and statistics reside here as well. 

Stefan Dubowski is a freelance writer based in Ottawa. He can be reached at [email protected].