Nurses' association links workplace safety issue to understaffing and calls for ratios
A new Ontario Nurses’ Association (ONA) campaign is putting a stark spotlight on workplace violence in health care, as union leaders push for mandatory staffing ratios and warn the issue is driving nurses out of the system.
The “Code Black & Blue” public service campaign features nurses describing assaults and threats they say have become routine on the job. ONA president Erin Ariss, a registered nurse with two decades of emergency department experience, says the problem is pervasive across the 68,000 members the union represents in Ontario.
“Violence is on the rise in nursing and in healthcare broadly,” she said. “Our members…are experiencing violence daily, sometimes more than once daily, in workplaces everywhere across Ontario.”
Violence despite controls
Health and safety leaders in hospitals, long-term care and community settings have implemented a range of controls in recent years, from flagging systems to identify high‑risk patients to metal detectors and 24‑hour security at some sites. Ariss said the union has worked with both employers and government on such measures.
“The fact is, though, violence has increased despite those efforts,” she said.
Survey data cited by ONA indicate that 63% of nurses in Canada have experienced physical abuse in the past year, while 89% have experienced verbal abuse. More than 31% of nurses failed to report incidents because they feared being blamed by their employer, according to the same data.
In Ariss’s view, the statistics mirror her own clinical experience. She described being assaulted “countless times” in the emergency department, including incidents involving “machetes and box cutters” and threats with other weapons.
Staffing levels and risk
Ariss links rising violence directly to chronic understaffing and long waits for care.
“Nurses are working in environments that are understaffed,” she said. “We are heading into dangerous situations on our own in every sector of health care and putting us at risk every single day.”
ONA argues Ontario would need approximately 25,000 additional registered nurses just to reach the national average of nurses per capita. The province currently has the lowest ratio of registered nurses per capita in Canada, Ariss said.
“When patients wait longer for care, when they don’t receive the care that they feel they should have… the likelihood of violence increases exponentially,” she said.
The union is calling for legislated nurse‑to‑patient ratios, arguing that other high‑risk occupations such as police and fire already have staffing standards designed to manage safety. ONA points to research from California and Australia, where mandated ratios are associated with significant reductions in vacancies and improvements in staffing.
In California, implementation of ratios was followed by a 69% decrease in nursing vacancies, Ariss said. In Australia, the number of employed nurses grew by more than 24% after ratios were introduced.
Ariss contends that better staffing and safer conditions could draw nurses who have left the sector back into practice. Some former nurses, she said, are working in other fields such as retail or emergency services to escape the risks and workload in health care.
“They would prefer to be working as a nurse,” she said. “But because of the conditions, and in particular violence, they have chosen safety over their profession.”
Economic and system impacts
The union argues that violence against nurses is also a cost and productivity issue for health and safety leaders. Between 2021 and 2024, more than 130,000 days were missed due to violence‑related incidents, according to figures cited by ONA.
Ariss said reducing violence would help decrease workers’ compensation claims and absenteeism, while stabilizing work environments and improving continuity of care.
“We do have an ability with appropriate resources and appropriate investment to turn this ship around,” she said. “We just have to work together and not just post stickers and posters that say zero tolerance, [but] actually enact and enforce the legislation that we have and improve the legislation that we have so that violence is actually not tolerated anymore.”
Government response
ONA has raised the issue of staffing ratios directly with the provincial government. Ariss said that when she spoke with Ontario’s Minister of Health, she emphasized that nursing is statistically more dangerous than some other occupations that already have mandated staffing standards, and that ONA is “not asking to reinvent the wheel.”
According to Ariss, the province has not made a commitment to implement ratios. She characterized the government as having “washed its hands of the safety of nurses” at this point in time.
Canadian Occupational Safety requested comment from Ontario’s Ministry of Health and from the Minister’s office regarding staffing ratios and workplace violence in health care, but did not receive a response by publication time.
“All hope is not lost”
Despite the current pressures, Ariss stressed that the situation is not irreversible.
“I would say that all hope is not lost,” she said. “We have the ability to stabilize the work environments…so that violence is actually not tolerated anymore. I have faith that we can do that.”
For health and safety leaders, the Code Black & Blue campaign underscores the continuing challenge of protecting clinicians in high‑risk environments—and the extent to which staffing, reporting culture and enforcement of existing legislation may shape the next phase of violence prevention in Ontario’s health‑care system.
