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Nurses face dozens of incidents of violence in hospitals

Chair of nurses' union Linda Pipe is increasingly concerned by the levels of violence at Abbotsford Regional Hospital and Mission Memorial
Linda Pipe, chair of the B.C. Nurses’ Union is concerned about the level of violence by patients against nurses.

During her 23-year career, Linda Pipe has been spat at, bitten, cussed out, and punched in the abdomen and head. An aggravated patient once pulled a knife on her.

The chair of the B.C. Nurses’ Union is gravely concerned by the levels of violence she sees at Abbotsford Regional Hospital, as well as at Mission Memorial, where she works.

“Nurses are getting hurt,” she said. “We didn’t go into nursing to do this. We went into nursing to take care of people.”

Every year, there are dozens of incidents of violence and aggression toward staff at the Abbotsford Regional Hospital and Cancer Centre, according to Fraser Health data obtained by The News. These incidents include everything from verbal abuse, to biting and spitting, to hitting and other assault.

When the hospital opened in August 2008, there was one such incident reported for the year. That figure jumped to 22 in 2009, then to 42 by 2012. February 2011 was the most violent month in the history of Abbotsford Regional, with nine incidents occurring that month alone.

Last year saw a decline, with 33 incidents of violence and aggression at Abbotsford Regional.

The majority of cases – 73 per cent – were physical abuse. A quarter were verbal, and two per cent were psychological.

Mark Goudsblom, site director at Abbotsford hospital, said, “Violence in the workplace is always a concern. It has to be front and centre in all the considerations we make for changes. It is something that I think we’re seeing somewhat more of.”

One nurse who has worked at Abbotsford Hospital for years said that “absolutely” violence is getting worse.  “Are we scared? Absolutely. Because the things we’re scared about now is stuff we never thought we’d see,” said the nurse, who requested anonymity since staff do not have unrestricted permission to speak with the media.

“I’m coming home and saying to my family, ‘I’m getting scared.’ I didn’t get into this line of work to be subjected to abuse.”

She expects violence in some departments, but what’s happening now is “way outside the normal boundaries of what we should be tolerating.

“There’s been serious acts of violence at that worksite on my floor that nurses have never returned to the practice environment.”

An agitated patient often starts with verbal abuse. The situation can then escalate. Patients will throw things, push linen carts.

When it seems as if a patient might become aggressive, staff call a “Code White” over the public intercom – a signal for all trained nurses, care-aides, and security guards to converge for immediate assistance. The hope is that the united front will intimidate the patient and cause him or her to back down. If that fails, those responding physically immobilize the patient.

November and December 2013 saw a total of 24 Code Whites, 10 of which were false, according to Goudsblom. He added that the holiday season is traditionally a high-pressure time, with many people admitted to hospital and many hospital staff on vacation. Comparatively, August and September saw 14 Code Whites with four false calls. According to Goudsblom, each Code White is audited.

Pipe said nurses are reluctant to get involved in such situations. She cites insufficient training, nurses getting older, and fear of being hurt.

Sometimes, when hospital staff feel they cannot handle the situation, they call in Abbotsford Police. For the past few years, there were one to seven calls per month to Abby PD from the regional hospital, according to Const. Ian MacDonald.

Pipe said the situation is similar in Mission Memorial Hospital. Mission RCMP responded to 50 calls in 2013, or an average of four per month, according to media relations officer Sgt. Shaun Wright. That’s a decrease from 59 calls in 2012.

Fraser Health’s vice-president of people and organizational development, Wendy Strugnell, said that the health authority is “always concerned about situations of violence from patients towards staff.”

As to whether the rates at Abbotsford Regional are normal, Strugnell said: “Incidents of violence and aggression towards staff vary significantly between hospitals, depending on the size of the hospital, the population it serves and the services it provides ... We address each hospital individually.”

Pipe, who has worked at Mission Memorial since 1980 and has close contacts with Abbotsford Hospital, maintains the official stats on violence are low.

“It’s totally under-reported. I do know that security has more incidents than what is reported on the Code White report forms,” she said.

Only a portion of incidents result in WorkSafeBC claims. Anecdotally, nurses at Abbotsford’s emergency department tell Pipe there’s at least one violent incident per day. But nurses are most likely to file an official report only about those resulting in injuries.

“They accept it as part of the job – being sworn at, or being spat at. In some cases, I think they think that, at least that’s all they got ... They weren’t hit.”

Staffing shortages, stress and abuse

On the morning of Dec. 29, 2013, a Sunday at the height of the holiday season, Abbotsford Regional Hospital found itself short of nurses.

A lot of the regulars called in sick. Managers contacted casual staff and part-timers to come in. They offered standard overtime, then triple overtime. By late morning, there was insufficient staff.

Site director Mark Goudsblom invoked a seldom-used provision in the collective bargaining agreement in which overtime became mandatory. That meant that some nurses already on site could not leave.

Linda Pipe, chair of the B.C. Nurses’ Union (BCNU), said that situation is typical. According to her, a chronic staffing shortage, combined with an unpleasant work environment, created a situation where nurses were unwilling to come to work, regardless of the pay.

“It’s not a pay issue at all. They’re just burned out. They’ve had it.”

Nurses at Abbotsford Hospital report dozens of incidents of violence and aggression from agitated patients each month.

Pipe and hospital site director Mark Goudsblom agree that three hospital departments have the highest rates of such incidents: emergency, psychiatric, and residential care.

The emergency department at Abbotsford Hospital receives anywhere from 30 to 60 admitted patients each day, according to Pipe. That means that the 300-bed regional hospital is overcapacity on the in-patient units.

Erin Labbé, public affairs consultant with Fraser Health, said the hospital typically runs near or at capacity. The hospital’s emerg sees about 40,000 patients annually.

The BCNU has been warning of dangerous congestion at Abbotsford, Mission and other Fraser Health hospitals for years. The daily battles between departments on how to handle so many patients create tensions and work stress – both between patients and nurses, and between nursing staff.

“People are agitated because they’re waiting four, five hours to be seen. And as soon as they’re agitated, there’s only so much you can do patient-wise to essentially calm them down,” said an Abbotsford Hospital nurse, who spoke on condition of anonymity because she didn’t have Fraser Health approval to speak with the media.

The residential care unit is another that has always had a higher than average amount of violence because many patients have dementia or other psychiatric conditions.

According to Fraser Health, 21 per cent of all incidents of violence or aggression in Abbotsford were due to the patient being confused or unable to follow directions. Another 24 per cent occurred when a patient was being moved.

The Abbotsford Hospital’s large psychiatric department draws its share of incidents as well.

“There is an increase in psychiatric patients that are unable to access services within the community, so by the time they get to emerg, they’re in a psychiatric snap,” said the Abbotsford nurse.

The hospital was built as a regional facility, with a catchment area from Hope to Langley, explained Goudsblom.

“We’ve seen a growth of the mental health and substance abuse program… We’re seeing an increase in the patient population that is pulled toward Abbotsford Regional because of its growth and capacity as a regional centre for mental health and substance abuse.”

Pipe has criticized her employer for not recruiting enough nurses to cope with the rise in patients, but Fraser Health disagrees.

“Fraser Health recognizes the need for adequate nurse staffing levels to ensure the quality of patient care delivered in our hospitals. Abbotsford Regional Hospital is adequately staffed,” replied Labbé.

There were 969 registered nurse positions at the hospital as of Oct. 31, 2013 – nearly nine per cent higher than in 2011. An average of 40 positions were open during each month in 2013. Abbotsford hospital is currently looking to fill 10 registered nurse positions in ER alone.

Pipe has also said that the hospital’s two security guards aren’t enough, and that nurses don’t receive the training they need to be able to handle aggressive patients.

In November 2012, a WorkSafe BC inspection found that two of five workers interviewed at the hospital last did their mandatory training on aggressive patients more than 18 months prior, whereas the Workers Compensation Act requires that the training be done annually.

Fraser Health has had a violence prevention policy since 2006 that includes risk assessments, training, and the use of Code White emergency calls. The agency works closely with the Joint Occupational Health and Safety Committees, and members of the Fraser Health Regional Violence Prevention Committee meet regularly, according to Wendy Strugnell, the agency’s vice-president of people and organizational development.

“We thoroughly review every situation of violence that takes place at the site and work with the leadership teams to ensure that the level of security required is appropriate to keep patients and staff safe,” said Strugnell.

A nurse who sees it daily at Abbotsford isn’t convinced, and says what would help is more security guards.

“There’s lots of talk about what they’re going to do. But I haven’t seen any gross improvements to the safety and security of the staff in there.”