Health Care Workers Face Workplace Violence-is it part of their job?

The following is an essay written by Heather Ryner, an occupational safety nurse based in Ontario. This essay was one of three winners of this year’s Dick Martin Scholarship Award by the Canadian Centre of Occupational Health and Safety. (Editor's note: The following is an essay written by Heather Ryner, an occupational safety nurse based in Ontario. This essay was one of three winners of this year’s Dick Martin Scholarship Award by the Canadian Centre of Occupational Health and Safety. [Watch Ryner talk about the essay]

Workplace violence is a large problem in workplaces, but even more  so in health care facilities.  

The Ontario Nurses Association defines workplace violence as “Violence, also known as abuse, can be defined as any act of violence, including physical, verbal and sexual abuse, harassment, including sexual harassment, threats, intimidation or anything that offends or humiliates etc.” (ONA, 2003, p.3)   Workplace violence can also include rumours, swearing, pranks, arguments, vandalism, sabotage, pushing, rape, arson, anger related incidents and murder.

In 2004, 20% of all reported workplace incidents were related to workplace violence. (COS, 2007). These violent acts are more common in certain industries; one third involved someone working in social assistance or health care services such as hospitals, residential care or the nursing field.   

The international council of nurses states that two million people die each year as a result of violence and nurses are three times more likely to experience violence than any other professional group (ONA, 2003).  Health sector makes up only 10% of the workforce yet account for 40% of accepted WSIB violence claims.
Incidence of violence can be greater at certain times of the day, month or year. 

There is a remarkable increase in assaults during the Late hours of the night and early morning due to decreased activity and lower staffing levels.  Annual events such as Tax return season or Christmas can cause increased stress.  People faced with debt, struggling to pay the bills, or faced with utilities being shut off for none payment can be overcome by stress.  Pay days can cause people to act unusual , perhaps by increased intake of alcohol or drugs or other harmful practices.  Performance appraisals at work, if negative, can cause people to act out.   

Any one or a combination of these factors can cause a change in a person’s behaviour that may result in violence.

Nurses are working under stress due to nursing shortages, higher patient acuity, and staffing changes. These factors can lead to an increased incidence in burn out, which can cause nurses to act out in a negative fashion towards other nurses and staff members. 

Nurses are viewed by society as having a lower status in the medical profession.  Many nurses are also subject to daily verbal abuse from physicians.   Nursing is a female dominated profession in a society that devalues and sexualizes women which can cause oppression in nurses. 
When people are oppressed, they feel a lack of control and use desperate measures to try and regain control.  This may be expressed by intimidation or abuse of their co-workers. 

There are many factors why nurses are more exposed to violence. They work alone or in isolation when dealing with patients. They have to interact with the public, be it patients, family or visitors.

Nurses work with valuables such as drugs that are a much sought after commodity, especially narcotics. The hospital is an open concept facility in which people may enter and exit without being challenged. These people can be intoxicated, depressed or angry and looking for someone to blame.   

The very nature of the business means that health care workers are required to deal with people in distress; many angry and frustrated due to their illness and pain.

Nurses also work under vulnerable conditions such as downsizing, job loss and increased work load.    

Many are so overworked that they do not have time to deal with small crisis before they escalate into actual acts of violence. The trend to de-institutionalize people with mental illness causes a greater number of them to visit the emergency department. 

The aging population also causes an increase in the number of people that are admitted to hospital suffering from dementia. 

Physical violence has long been acknowledged and is being dealt with in many cases, but psychological violence is now emerging as a priority issue.  Violence generates distress in victims, which can lead to long term health problems such as insomnia, headaches, allergies and substance abuse but can easily progress to hypertension, depression and even suicide.  

The suffering and humiliation the victim suffers can cause a lack of motivation, loss of confidence and reduction in self esteem. This can result in lost production and reduced efficiency in the workplace.   

It is estimated that the cost of violence involving nurses, including absence from work, emotional distress and medical expenses is $35,000 per assault related injury. 

Ontario is currently experiencing problems recruiting and retaining nurses.   When violence is accepted or ignored in a facility nurses do not want to work there.   

Violence affects the community by causing unemployment, increasing health care costs, retraining and rehabilitation costs. 

Health care workers do not always report violent incidents as they accept it as part of their job.    

Their job is to care for the patient, and if the patient acts out in a negative way, the workers accept it as part of the patient’s illness, although it appears that this attitude is slowly changing.  In Canada, precedents have been set for holding a patient accountable for their violent actions.   

Although patients account for the majority of assaults against nurses, 56.7% of emotional abuse was caused by co workers as was 53.6% of verbal sexual abuse. (CBC, 2006). Nurses tended not to report the incident if it was perpetrated by a co-worker.  

This low reporting fails to raise awareness of the problem and therefore no institutional changes are being initiated.

If change is to occur, nurses need to speak up and refuse to accept violence and harassment. The reporting process must be free from reprisal.  

The victim receives a variety of reactions from their co-workers; some are supportive while others blame the victim.  If organizations continue to cover up and deny that events have occurred it can demoralize front line staff.

A safe and secure work environment must be every worker’s right. This is essential for quality care to be offered by health care workers. 

Dick Martin fought to ensure that workers had safe, clean, healthy and stress free work environments.   With this in mind, Mr. Martin would have been a champion for workplace violence prevention.

Mr. Martin encouraged relationships between organizations, the community and society at large.  

Workplace violence affects each of these populations in a negative way, as was described throughout this essay.     

Governments need to create legislation and dedicate adequate resources to ensure safe workplaces.    
Organizations require written policies and procedures outlining unacceptable behaviour, how to report violent incidents and who to contact to report it.     Preventive measures need to be put in place covering workplace design, administrative practices and work practices. 

Some workplace design changes include physical barriers, emergency signals and alarms, adequate lighting at building entrances and minimizing the number of people having access to certain areas of the facility. 

Administrative practices can include limited access to narcotics and keeping cash on hand to a minimum. Also, offering Employment Assistance Programs and counselling to victims.  Work practices can include working alone restrictions and not entering into a situation where workers feel unsafe or threatened.

The Occupational Health and Safety Act states the employer must take all reasonable precautions to protect the health and safety of the employees.  This includes preventing workplace violence. 

Some provinces have specific workplace legislation such as British Columbia, Saskatchewan, Nova Scotia and Alberta.  The Canada Labour Code also states managers and supervisors must take steps to prevent workplace violence.

Workplace violence is a large problem in the health care field and incidents need to be dealt with when they occur.  

Staff need to be trained and encouraged to report every incident and management need to support employees when incidents are reported. Over the past century health and safety measures have helped reduce injuries for various types of accidents. 

Workplace violence needs to be the next priority in Health and Safety. 

Workplace violence is on the rise and now is the time to stop it.  Provincial and Federal efforts are needed to assist the Nursing profession’s journey to create a safe and healthy working environment.