Violence against health-care workers a growing problem

By Jennifer Pritchett, Associate Editor

With incidents of violence against health-care workers by patients and their families seemingly on the rise, Toronto health lawyer Mary Jane Dykeman says it’s critical for sector organizations to develop best practices, training tools and strategies to mitigate the risks and effectively deal with incidents when they occur.

“Health-care organizations are spending great amounts of time, energy and resources dealing with difficult situations and we need to make sure that staff know how to respond and de-escalate. If the behaviour continues, there must be a fair but timely process to reduce the risks,” she tells

Dykeman, a partner with DDO Health Law, points to a new study conducted by the Ontario Council of Hospital Unions (OCHU), a division of the Canadian Union of Public Employees, that highlighted workplace violence for health-care workers is a major concern.

It found that 68 per cent of front-line health-care staff surveyed said they were physically assaulted in the past 12 months, reports CBC News. The poll, which surveyed 1,976 of the OCHU’s members (1,568 were women), also showed that 86 per cent reported they were subjected to verbal violence in the same period, says the article. As well, 43 per cent said they experienced sexual harassment or sexual assault in the last year and 20 per cent reported they were physically assaulted more than nine times in the same period, says the newspaper.

Dykeman says the numbers are shocking and point to a serious problem.

“We, at DDO, get calls from health-care teams and other organizations about tensions that have resulted in pervasive verbal assaults with profanity and/or racialized comments, and in some cases, physical assaults," she says.

“This study caught our eye, given that we serve health-care organizations, including hospitals, long-term care homes, and community mental health and addictions agencies. Having practised in the area for 20 years, it’s fair to say we are seeing an increase in these tough situations.”

Dykeman also comments on the issue in advance of a conference called, 'Managing Conflict in Health-Care Settings,' to be held on Feb. 7 in downtown Toronto and via webcast, with twice monthly webinars through December 18 to help support attendees.

The conference, hosted by DDO’s training arm Cove Academy, aims to bring together lawyers, health-care professionals, risk managers and patient relations officers who work in the sector to develop strategies and tools to deal with the growing problem. Hotseats with human resources, employment, advocacy and health lawyers, along with representatives from clinical leadership, community mental health and addiction, and long-term care round out the day. A free pre-training session via webinar is set for Jan. 9, 2018.

While health-care organizations have existing policies to lay out patient and family rights and responsibilities, plus deal with altercations, more work needs to be done in this area, Dykeman says.

In some cases, staff are not responding well and their own behaviours may be contributing to the situation, she says.

“There are ways to de-escalate tense situations, but how do we help patients and their families, while at the same time equip staff to respond appropriately?" she asks.

Organizations often want to know how they can respond to such situations legally, and in a manner that does not risk their reputations, Dykeman says.

"If the person is a patient in the hospital, what can you do?" she asks.

“Who is behaving this way? Depending on the health-care setting, is it a patient, client or resident? Are they cognitively intact or are they not? The impact on staff may be the same, on the one hand, but the response may be different as a result.”

It also matters if the aggressor is a patient’s substitute decision-maker or a visitor, Dykeman says.

“If they’re a visitor, that’s slightly easier to deal with because to my mind, while visiting is something we encourage, it remains a privilege,” she says. “If the individual is a substitute decision-maker, their roles and rights are enhanced – but it can’t be the case that they have free rein to be abusive and aggressive toward staff. There is a big difference between advocacy and abuse and we need to help them, and staff, know when the line is crossed and what are the consequences.

“These issues are a challenge because they have to be raised in a way that is respectful of people who understandably may be stressed. But, by way of example, if the behaviour would ultimately be criminal in any other setting, where does that leave staff?"

While health-care organizations generally understand it’s not always the ideal situation for a patient or family because it is innately stressful, there has to be a code of conduct for everyone, Dykeman says.

She points to the fact that in some cases, violence in health-care settings is not directed to staff, but staff may still be in harm’s way.

Dykeman cites a recent incident in Cobourg where police were called to a hospital emergency ward because shots were heard coming from a triage room where an elderly couple was lying side by side on gurneys, reports the Toronto Star. In that case, the elderly man was fatally shot by police. The woman was also reported dead, but few details were provided about the circumstances of her death, says the newspaper.

“That situation is thankfully not typical, and is an extreme example, but it raises questions about how well health-care workers are equipped to deal with the types of situations they may encounter and what training would make sense,” she says.

Health-care organizations are “struggling” to figure out ways to deal with the increasing incidents of harassment and violence against the people who work for them, or to manage family conflicts that peak during a health-care crisis, Dykeman says.

"Health-care organizations are in a unique situation: they want to provide patient-centred care, have a duty to provide a safe environment for everyone and there are health and safety rules that apply," she says.

A compounding or additional pressure may also be the extreme overcrowding currently affecting the sector, as reported in the Toronto Star.

"All said, despite the pressures and competing rights, health-care organizations have to create a balance to address behaviours that would certainly not be tolerated elsewhere in society. We need to help develop some system solutions to move this issue forward," Dykeman says.

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