Health care workers are being attacked on the job. It’s getting worse

Jordan You’d imagine more than 18 months into a global pandemic that has claimed millions of lives, that those health care workers for whom we all banged pots and pans so diligently in 2020 would by now be even further venerated and celebrated for their continued dedication to a dangerous and thankless job. You’d be totally wrong about that.

News Clips …in the last year, 82% of emergency room nurses were victims of physical assault, and every single one of them reported being verbally assaulted while at work…

…it’s terrifying that you want to go home to your family and you think as a nurse, I don’t have to worry about that. But we do have to worry about that every day we come in…

…our masks are being pulled off or we’re being spat on or we’re being ridiculed. A colleague this week was run off the road because she had an Interior Health parking sticker on the back of her vehicle. Scary times…

Jordan Violence against health care workers, particularly nurses and particularly those who work in emergency rooms, is not solely a creation of the pandemic. These workers have been dealing with abuse on the job for decades, often in silence, often without support. But now, as this pandemic creeps towards two full years and workers everywhere in the health care system face burnout and exhaustion, more of them are finally speaking up. They are in danger at their jobs more than any of us imagine. And it’s getting worse.

So why has this issue so rarely been tackled or even spoken about openly? What can be done? What has at least been tried so far? who owns responsibility for the safety of these critical workers who have saved so many lives over the past year and a half? And what happens to our health care system if more and more of them decide this is simply too much.

I’m Jordan Heath-Rawlings, this is the Big Story. Flannery Dean is a writer, reporter and editor. Her work has appeared in basically every major publication in Canada, including for this feature, The Globe and Mail . And she joins us from the typical pandemic-era busy household. Hello, Flannery.

Flannery Hello. Thank you. And you will probably hear one of my dogs or my son who’s home sick.

Jordan That is life these days. Thank you for joining us.

Flannery Thank you for having me.

Jordan Why don’t you start where your article begins and tell me about Sarah Basuric, who is she? What happened to her?

Flannery Well, Sarah is a 30 year old, Edmonton-based ER nurse. In April of this year, she was working a shift at an emergency department in Edmonton and was dealing with what had been described to her by the departing nurse as just kind of a tricky patient, an irritable patient who was getting increasingly more agitated as he had to wait for his test results. And at one point during her shift, that patient deployed a can of bear spray in the emergency department. And for some reason, Sarah seemed to suffer the most serious consequences of that. She struggled to breathe. She had to be admitted to ICU, where she spent the night, and she hasn’t returned to work since that incident. Has been diagnosed with PTSD, and that man was charged with one count of possession of a weapon for dangerous purpose.

Jordan Can you tell me a little bit more about what it’s like to be on the front lines of emergency services and medical care these days?

Flannery Well, I think emergency services have always had this problem. When I looked at research related to workplace violence, emergency rooms account for 50% of these types of incidents. And Sarah herself, she’s only been a nurse for five years, and she told me that two years prior to the bear spray incident, a patient picked up a side table and threw it at her head.

Jordan Jesus.

Flannery Yeah. A workplace violence is a relatively common experience, so much so that it’s often been framed as part of the job. If you work in health care, your risk of experiencing some form of assault is four times greater than any other public facing profession. Even when I started working on this story, I just started randomly Googling the words nurse assaulted, and within a span of a few minutes, I had probably ten links talking about incidences across the country. Even in September, that headline about a man punching a Sherbrooke, Quebec nurse for Vaccinating his wife, that made international headlines. But that’s just another example of what is an unfortunately, I don’t want to say common experience, but fairly common experience within the health care sector.

Jordan We’re talking about it now, obviously, because of some of the violence we’ve seen during the Covid-era, especially as you mentioned around vaccinations. But you’re speaking to me like this is not a new problem. How far back does it date? And how long have we been trying to get a handle on this?

Flannery Well, a while. I think when I spoke to Linda Silas, the President of the Canadian Federation of Nurses Unions, she told me she started working on a campaign in the 90s or the early 90s. And it’s an issue that has just sort of been dealt with, that’s been sort of the burden of healthcare workers who are largely female. 80% of the health care workforce is female. 90% of nurses are female. It’s been an endemic problem for a long time, and Covid has kind of broken the seal of silence around it or the taboo about speaking about it publicly, I think.

Jordan Right. And we’re going to talk about Covid specifically in a second. But in general, the people you spoke to, the research you looked at, does any of it give an idea of what’s going on when these people become violent? Do we know what’s causing it? You know, why this setting in particular?

Flannery Well, a lot of different advocates have identified there are sort of two sub heads that the violence is sort of explained through and that’s societal factors, things like poverty, social inequity, mental health issues, substance addictions. Those are coming into emergency rooms, but they’re also coming into a health care sector, the context of a healthcare sector that is working at capacity. Some hospitals have been working at 100% capacity or over that for decades. There are nursing shortages. Emergency rooms across Canada close for weekends or for hours because they don’t have sufficient staffing. So when you bring those issues into this strained context, it can be explosive. And then when you layer on something like wait times, which anybody who has ever gone to an emergency room understands that frustration of waiting and waiting and waiting. And that seems to be a real trigger point for people.

Jordan And what do we know, I guess maybe in terms of statistics, but also just in terms of the experts you talked to, about how COVID and the pandemic has exacerbated this problem?

Flannery Well, it sounds like it’s gotten worse. And there’s a lot of evidence to suggest that’s the case. CUPE, which is the Canadian Union of Public Employees, polled their workers twice during the pandemic, and each time they found that a large percentage, 66% of those people polled said that they have seen an increase in workplace violence, which includes everything from harassment to assault and verbal abuse. And nearly half of that number said that they’d seen it increase a lot. And if you’re a Black nurse or if you’re an Indigenous nurse or a racialized health care worker, you’re going to report that at even higher rates.

Jordan How is this affecting, first of all, I guess morale among people who are already working in emergency rooms? But second, we’ve done episodes of this podcast on a critical nursing shortage, and I imagine this has to affect recruitment efforts.

Flannery Well, I can’t speak to the recruitment, but I can speak to the retention problem. And I do believe that it is a factor in retention, for sure, because it has been linked to burnout. It’s been linked to mental health issues in health care workers, high rates of absenteeism. And it is demoralizing because the people I spoke to, have said this has largely been framed as just part of the job. And there’s a real sense of hopelessness about the consequences. If you report this incident, nothing happens or there’s no real support. So it is demoralizing. And I think that you’re seeing that in nurses quitting.

They also are doing that in the context in Ontario of legislation that’s putting a cap on their earnings and effectively handicapping their ability to freely bargain, which is an important power because as essential workers, they can’t strike. I’m not surprised. I’ve often heard healthcare advocates say that nurses are voting with their feet: they’re leaving.

Jordan What would help? When you speak to the unions or the advocates or even just the nurses themselves, what do they want to see to protect them?

Flannery Well, one of the things that people were asking for primarily was just a public acknowledgement that this is a problem, that it has been a problem, and that it’s a multilayered problem that requires a lot of different solutions from different sectors of government, different policies. So I think that’s why Sarah came forward because she wants this to be a public conversation that will then stimulate activity on the side of hospitals, provincial and federal governments.

Jordan Do we know about any initiatives that have actually helped with this? Do we have any success stories we can look to as hospital associations across the country try to protect their workers?

Flannery I had a hard time getting people to talk to me for this piece. But the one health authority doing something that I could get to talk to me and fairly transparently, was in Nova Scotia. The woman I spoke to her name is Angela Keenan, and she’s the provincial director of occupational health safety and wellness for the Nova Scotia Health Authority. And I was impressed by her because she made it very clear that this is a problem, it’s always been a problem and that they’re applying themselves in a staggered way to tackle the problem.

And they’re trying to employ a lot of different methods and approaches, from self defense classes to teaching nurses and health care workers deescalation techniques. So I was impressed by her because she never really assured me that things are okay. That being said when I did speak to a nurse in Nova Scotia who works in ER, when I said, do you feel safe at work? He said no. So that suggests to me that a provincial health authority can only do so much, that there are external pressures that need to be addressed, too.

Jordan Was that a common refrain? Kind of what you mentioned, that Nova Scotia was unusual because they weren’t trying to pretend that everything was under control. Was that something you heard from other provinces or hospitals?

Flannery It’s not, because when I reached out to other hospitals, no one would speak to me. With the exception of St. Mike’s in Toronto, I did speak to an emergency room doctor who was also very transparent and very frank. But I can’t speak to whether or not Nova Scotia is doing a better job. I think the fact that we are even speculating on that shows how what one doctor said to me was how balkanized we are in terms of our approach. So if you live in Nova Scotia, you might have a better system or more support than you might in Ontario or in Saskatchewan.

Jordan In terms of the bigger picture, you touched on something we talk about a lot like who actually has the power to fix this, is it the administrators? Is it one level of government or two? And I know when we start talking about which level of government is responsible for various health care stuff, this gets messy really quickly.

Flannery Yeah, it’s confusing, too. I mean, jurisdictional issues are a real concern, but they’re also often, or they feel like an excuse for stasis in some of these areas. I think when I think about who I spoke to and all the different approaches that they mentioned for change, like going down from the federal government really taking a lead and saying to the provinces and the territories, okay, let’s establish best practices for this. Let’s establish a baseline definition of what we believe workplace violence is because there isn’t really a standard definition across the provinces and territories. So that’s one thing the federal government can do.

The provincial government through their ministries of health and long term care, for example, can also make strides. But then the hospitals themselves could take up things like environmental design changes. It’s an all hands on deck problem. Additionally, there are concerns about social inequities, like bolstering social supports so that people aren’t coming to ERs in this state. And then there’s this tendency to want to criminalize this behavior. And I understand that. But you can’t really police your way out of poverty, inequity and racism.

Jordan Yeah. Last question. And I’ll ask it maybe to end on a positive note, though, maybe we won’t. When you spoke to nurses and doctors and the people who would speak to you, was there any optimism that at least thanks to the pandemic and thanks to the fact that we’re paying more attention to essential frontline health care workers, that this might actually lead to us finally tackling the problem?

Flannery Well, I did hear one emergency room doctor. His name is Alan Drummond. He’s an emergency room doctor in Perth, Ontario, and he was encouraged by the anger of health care workers. He was encouraged by that because they’ve had enough. And I think he felt that that anger was going to be put toward positive action and positive pressure to finally solve this problem.

Jordan Flannery, thank you so much for talking to us today. And thanks to the healthcare workers who spoke out to you.

Flannery Thank you.

Jordan Flannery Dean writing on this issue, at least, in The Globe and Mail . That was the big story. For more head to thebigstorypodcast.ca. Find us on Twitter at @TheBigStoryFPN. Talk to us via email, thebigstorypodcast@rci.rogers.com [click here!].

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Thanks for listening. I’m Jordan-Heath Rawlings. We’ll talk tomorrow.

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