The fact that violence is considered “just part of the job” for staff at the Centre for Addiction and Mental Health (CAMH) in Toronto is part of the problem, according to workplace safety experts.
The hospital came into the spotlight at the end of 2014 after a registered nurse was beaten and critically injured by a patient.
This happened days after the Ministry of Labour laid four charges under the Occupational Health and Safety Act for another assault by a patient directed towards a nurse that occurred at CAMH in January 2014.
The ministry found the centre failed to provide sufficient information and supervision to protect a worker from workplace violence and failed to implement measures and procedures to protect workers from workplace violence. CAMH plans to defend those four charges in court.
These incidents seem to be on the upswing and management agree more light needs to be shed on the overtaking concern regarding safety of health-care professionals in like establishments.
The problem is an inherent one — nurses think violence is just part of the job, said Andy Summers, registered nurse and vice-president of the Toronto region at the Ontario Nurses’ Association (ONA) who helms the occupational health and safety portfolio.
“These instances have been going on for some time. These instances of violence continue unabated,” Summers said. “Number one: Our employers need to value safety. They need to value the care that the nurses and other staff provide, and get it out of their heads that violence is acceptable.”
Lack of staff, resources
One major contributing factor to the recent incidents at CAMH could be a lack of staff and resources, he said.
“Nurses are working way too hard right now to also add being beaten at work,” said Summers. “We don’t have appropriate staffing, we don’t have appropriate training and we don’t have appropriate equipment. We need all of those things.”
Workplaces such as CAMH, including mental health institutions, rehabilitation clinics, hospitals and long-term care facilities, pose very specific risks unique to their field.
That means some violent occurrences can be more likely or more dangerous than the average office run-in. Violence at CAMH is “exceptionally high,” Summers said.
“I’m not talking about violence in the sense of somebody swearing or even somebody spitting. I’m talking about nurses actually being punched, being hit, being knocked unconscious,” said Summers.
“We are talking about serious levels of violence at CAMH.”
While the hospital declined to comment on the latest attack, citing the ongoing Ministry of Labour investigation, it did say the problem goes beyond staffing levels.
Staffing is not a universal problem, said Rani Srivastava, CAMH’s chief of nursing and professional practice, and issues occurred even when there was a full complement of staff on duty, according to past internal investigations.
Immediately following any such event, management conducts its own incident analysis, focusing on securing the situation, debriefing and coming up with prevention methods and lessons learned to mitigate future hazards, she said.
“That helps us look at, ‘What are the contributing factors?’” Srivastava said.
“There’s no cause, there’s no blame. This is where we try to think, ‘Can we change all the factors of the clients? No. But could we step up observation, change medication, back off because we’re being too intrusive?’ Those are factors we can control.”
Though she acknowledged a mental health facility will have distinct challenges, Srivastava noted it has various commonalities with a run-of-the-mill office.
“I don’t want mental health to be more stigmatized than it already is,” she said. “Some of the challenges we have that are similar to others are aggressive behaviour, and one of the other sectors (experiencing) that is long-term care.”
That said, the health-care industry is its own safety beast. Hazards that a nurse might face include chemical, biohazards, physical, psychosocial, as well as the dangers associated with shift work or working alone.
Also, nurses have to deal with individuals, sometimes teenagers, sometimes the elderly, who have the potential for violence, with a history of mental illness, or they could have been brought in involuntarily, according to the Canadian Centre for Occupational Health and Safety (CCOHS) in Hamilton.
“There may be a change in behaviour or temperament — but you can’t really know. There is no cookie-cutter, there are so many variables,” said Emma Nicolson, a specialist at CCOHS.
She pointed to three possible variables that could potentially cause a patient to become aggressive.
These include internal factors (a person’s background, age, gender, predisposition and psychopathy), external factors (the environment, loudness, crowding) and actual interactions between a nurse and patient.
Then again, it depends on each individual case, said Nicolson.
Such a volatile and unpredictable work environment has led many in the industry to accept it as part of the job.
“A lot of health-care professionals feel that this type of violence is just part of the job. Let’s say a patient swore, they wouldn’t consider that a violent incident because there is no injury associated with it,” Nicolson noted.
“However, we need to remember and understand that violence also happens on a continuum.”
Eliminating the notion that violence is common is the first step toward safer workplaces.
“Nursing doesn’t have to be dangerous work,” Summers said.
“All (nurses) do is talk about providing quality care — they don’t think about their own safety at all. We think selflessly about the clients, the patients and the residents. We need to start letting nurses know that if their workplaces are not safe and they are dangerous, then they are dangerous for their patients and their clients too."
Sabrina Nanji writes for Canadian Safety Reporter, a sister publication of COS.