Imagine doing your job in fear. For many healthcare professionals, this is the reality they face every day.
It is no secret; workplace violence is a leading form of occupational injury and results in reduced job satisfaction and fear to perform necessary duties within healthcare. For far too long, violence against healthcare workers has occurred below the radar and has not received the attention it deserves. Employers, employee representatives and policy makers must tackle this major problem and work together on solutions to make our healthcare workplaces safer. Our patients depend on it.
A recent member survey conducted by the Ontario Nurses Association (ONA) revealed that 54 per cent of respondents had experienced physical violence or abuse and 85 per cent had experienced verbal abuse in the workplace. In addition, 2013 Data from the Workers Safety and Insurance Board (WSIB) of Ontario revealed there were 2,087 lost-time injury claims for violence and aggression for all sectors and greater than 30 per cent (or 639 lost time injury claims) of all violence-related lost-time injuries in Ontario occurred in the health-care sector. The Canadian Nursing Advisory Committee (CNA) in their report says, “Nurses are more likely to be attacked at work than prison guards or police officers.” Beyond the significant human cost to members of the healthcare team, the economic cost of workplace violence should make all employers take notice.
In Ontario, employers are required to implement policies related to workplace violence, develop programs and ensure there are assessments and reviews of those assessments on a regular basis. Despite these legislated requirements, violence against healthcare workers continues as recently reported in the media. What must healthcare employers do to make a meaningful improvement in staff safety with respect to violence?
There are concrete steps healthcare employers can take to make their workplaces safer. For example, Code White (hospital code for a violent patient) response time can be dramatically reduced by introducing communication/alarm devices for staff. After introducing these at our hospital, we saw Code White response time fall by more than 53%, to an average of 57 seconds. Another concrete step employers can take is to offer de-escalation training for staff. This training, combined with alarms and patient flagging, has helped reduced use of force incidents at our hospital from 30% in 2007, to 8.9% last year. These practices create a safer environment not just for staff, but also for our patients.
We believe the most important elements of reducing workplace violence are transparency and urgency when workplace violence incidents do occur. Immediately following an incident at our hospital, a number of key stakeholders, both labour and management, are made aware of the incident and are involved in incident debriefing and action planning processes to understand the incident and identify ways to avoid a similar case in the future. Incidents of violence are treated with the same urgency and escalation within the hospital that major patient care critical incidents receive. By increasing reporting and then transparency of those reports we are able to work together across sectors to address a problem that has long existed, but been avoided or swept under the rug.
We believe a comprehensive violence prevention program includes staff de-escalation training, self-defense training, multi-purpose communication devices/alarms for staff, integrated information system between security and occupational health and flagging of patients with a history of violence. At the heart of this needs to be a strategic partnership with internal staff and physicians and organized labour. At our hospital, this takes the form of a broadly constituted workplace violence prevention committee comprised of management and front line staff as well as representatives from outside the organization drawn from some of our labour partners, who have all overseen this evolution. In our experience, this kind of collaboration enables the creation of a culture of zero tolerance for workplace violence.
Ultimately, healthcare workers have the right to work in an environment that is free from all forms of abuse and to not fear coming to work at risk of being injured physically or verbally by patients, visitors or their peers. As leaders we must have zero tolerance to all forms of violence in our workplaces. We must take personal responsibility for building the partnerships between staff, labour unions and other stakeholders to make violence reduction interventions a real success. After all, our healthcare professionals and patients are counting on it.