Workplace factors associated with abuse of nurses by patients: StatsCan survey

Workplace factors including a shortage of personnel and inadequate support from supervisors and colleagues are associated with physical and emotional abuse of nurses by patients, a Statistics Canada study released Wednesday suggested.

The report focuses on those working at hospitals and long-term care facilities across Canada, and adds new context to 2005 figures that showed one-third of nurses said they were physically abused and 47 per cent reported being emotionally abused in the previous year.

Nurses are front-line workers and this puts them more at risk when patients become angry, explained Rachel Bard, CEO of the Canadian Nurses Association.

“If you have a patient who’s been waiting, let’s say ringing … and wanting some service and has been waiting because of limited resources, evidently the level of frustration raises, and I guess the nurses are the first ones to respond,” Bard said from Ottawa.

Solutions need to come from employers and government, she said.

Study co-author Kathryn Wilkins said the survey revealed a number of factors in the workplace related to violence.

“Nurses who perceived that there was a shortage of personnel or a shortage of support staff, those who feel that they have a low level of support from their supervisor, or from their colleagues, are more likely to report physical violence within the past year from patients,” she said.

Nurses who usually worked night or evening shifts, and those who usually worked a 12-hour shift were more likely to report abuse than those working days.

Fifty-six per cent of nurses perceived that there were not enough nurses on staff to provide quality patient care and 47 per cent believed that the calibre of support services did not allow them time to spend with patients.

In addition, almost one in five nurses reported a lack of teamwork between doctors and nurses. Thirteen per cent disagreed that physicians and nurses had good working relations.

Bard said the statistics are informative to nurses, and the factors all relate to problems with human resources and workplace environment.

At Toronto East General Hospital, the administration has taken steps to reduce workplace violence by introducing the Vocera communication system, providing every staff member with a lightweight clip-on device.

By pressing a button twice, it automatically calls every security officer in the building and opens up a two-way communication line so that security officers can hear what’s going on. In addition, the Vocera badges of security officers have a screen that shows where a serious incident or “code white” is taking place.

“It’s like a GPS,” said hospital CEO Rob Devitt. “If you’re in a situation – for whatever reason you’re unable to speak – they all know where you are and where to go to help you.”

“What it’s done is reduced our response time on a code white by 61 per cent. So it used to be that from the point that the call was made to the arrival of the officers on the scene would take about 2 1/2 minutes. Now we’re down to 59 seconds.”

“A faster response time means there’s a better chance that the incident will be de-escalated.”

From a nurse’s perspective, Bard said technical gadgets like Vocera are one way to address the problem but they don’t change what’s at the root of workplace violence.

“We need to go beyond that … to correct the factors that have been identified,” she said.

Devitt agreed that it’s just one piece of a comprehensive hospital program for violence reduction. “I don’t want to in any way leave the impression that there’s a single fix for the issue.”

Numerous initiatives are needed, he said, including zero tolerance policies, designing patient-care facilities with an eye to violence reduction, staff education on de-escalation and self-defence and appropriate workplace health and safety policies.

“We need to talk about it and be very clear that this is an issue, it has been going on for years, and that as employers and as society, we don’t think it’s acceptable.”

Bard said nurses currently have “serious concerns” about the economic downturn. She said she wants to make sure that the mistakes of the 1990s aren’t repeated.

“The last thing we want is to meet their budget crunch is to start reducing nursing resources.”

Data for the study came from a subsample of 12,200 respondents to the 2005 National Survey of the Work and Health of Nurses

Bard wants the government to repeat the nurses survey so that comparative data on the issue of workplace violence will be available.

Related: Full report from Statistics Canada: Factors related to on-the-job abuse of nurses by patients