A history of workplace violence: Canada’s health care sector in “deep crisis”

The pandemic has brought to light a long-standing problem but workers are afraid to speak out, says author and researcher

A history of workplace violence: Canada’s health care sector in “deep crisis”
“They have lost complete faith in the government and their employers to protect them.” (Image credit: University of Stirling)

As well as bearing the brunt of an ongoing deadly pandemic, health care workers have also recently had to contend with anti-vax protestors angrily demonstrating in front of hospitals.

While lauded as heroes by many, Canada’s health care workers have been hugely impacted by the virus.

There is a narrative that the COVID-19 pandemic has fuelled an increase in violence toward health care workers, but a recent bombshell book has revealed that health care workers have been victims of workplace violence long before the current pandemic.

Code White: Sounding the Alarm on Violence against Health Care Workers, co-authored by husband-and-wife duo James Brophy and Margaret Keith (they met at a meeting about asbestos in the workplace) was started long before the pandemic, but its release couldn’t be more timely.

And though violence is so prevalent, this is not a topic that has often come up in mainstream discourse as health care workers are too afraid to speak out:

“We're unmuting the voices of healthcare workers. They're not allowed to speak, the fear of reprisal and even job loss is so great in the health care culture that they are fearful of speaking publicly about what's happened,” says James Brophy of the University of Windsor and co-author of Code White. 

“Violence is a major indicator of the deep crisis that's in a health care system [and it] won't be resolved strictly by just healthcare workers,” he says.

Unmuting voices

“Margaret and I, we wrote [Code White] very much with healthcare workers in mind, because we are trying to give them a voice […] if anyone reads the book, we hope [health care] workers read it, and we hope that it affirms their concerns and ideas and experience,” says Brophy.

But Brophy says that the public is also very much on their mind:

“We want the media, we want people in the community, people whose parents are in long-term care or people that access our health care system that are concerned about what’s going on, to read it because I think we tried to explain in the book how we got to this crisis.

Finally, we hope that nursing facilities and health care training institutions will see fit to start to talk about this issue and [train] a new generation of healthcare workers while being mindful that these are issues that current staff and healthcare facilities are facing.”

He hopes that the book will bring the topic to the mainstream.

“I think that this normalization of violence and how pervasive it is, is a really important takeaway from the book,” he says.

Insulted, punched, groped

And if you weren’t already infuriated by the treatment of Canada’s health care workers, the book will certainly fuel your anger.

Amid its well-researched critique of the country’s healthcare system, the book features numerous testimonials from health care workers who have been insulted, punched, groped.

These are workers suffering from lasting injuries, from PTSD and from burnout – who fear getting fired if they speak out. In these stories, the treatment by patients and fellow staff is shocking.

Code White points to under-funding and under-staffing as root causes of violence in health care.

The book goes in depth about the history of health care in Canada, noting that Saskatchewan was a leader in the domain of public health. Recent issues such as de-funding have dampened Canada’s reputation as a health care provider.

The book draws a portrait of a sector in crisis, where violence is part and parcel of the job.

“Violence has become so pervasive, so widespread, that it has now become normalized, it's seen as part of the job, and it's largely ignored,” says Brophy.

READ MORE: Healthcare workers facing violence, PPE shortages, burn-out

Gendered violence

Violence is exacerbated by sexism, racism, gender and sexual orientation. Sectors largely dominated by female workers such as long-term care are particularly vulnerable to violence (and were very hard hit during the pandemic, according to a shocking military report).

The authors highlight that one of the most dangerous health care environments to work in is long-term care, citing a January 2019 OCHU-CUPE poll of 1,223 Ontario long-term care staff.

The poll revealed that a staggering 89 per cent of personal service workers (PSWs) and 88 per cent of registered private nurses (RPNs) experience physical violence on the job, 62 per cent and 51 per cent respectively at least once per week.

Boiling point

The Canadian Institute for Health Information (CIHI) reports that over 90,000 health care workers have been infected with COVID-19 at the start of the pandemic. In addition, Canada’s proportion of health care workers as its total share of COVID-19 cases is larger than that in France, Germany and even the U.S.

Ultimately, it seems that the pandemic has brought this crisis to a boiling point. In the book, Brophy and Keith write that “for many health care unions, medical professionals, researchers, and advocacy groups in Ontario, the crisis in health care generated by the pandemic was no surprise.

"These groups were all too aware of the slow-moving deterioration of the system, the decades-long but consistent process of defunding, understaffing, deregulating, privatization, and trading of efficiencies for care. The full consequences of these governmental decisions were being exposed for all to see.”

Brophy says that he and Margaret had already undertaken a number of studies on health care violence prior to COVID, and so when the pandemic broke out, “we knew that long-term care was going to be a complete disaster because we had interviewed people about their state of mind, their emotional wellbeing and the fact that so many were burned out and felt so unsupported […] they have lost complete faith in the government and their employers to protect them.”