Thank you for being ill... | Letter to the Premier of Ontario

Who cares for the caregivers?

Canada’s health care system fails when it comes to protecting our health care workers.

Every nurse has faced the situation at least once in their career. Every nurse has experienced violence, aggression or harassment of some sort while providing care. The culprits are patients, family members, coworkers and employers. The violence in question occurs in any health care setting – the irate patient waiting at an ER or walk in clinic for too long, the frustrated parent of a child in the hospital, psychiatric patients, post-surgical patients awaiting pain medication, or residents in a long term care facility suffering from dementia.

Nurses and front line caregivers bear the brunt of people’s frustrations, whether it results from short staffing in facilities, long wait times for treatment, or disillusionment with the treatment received. Nurses are the first and only person at the patient’s bedside, and the first person to be attacked.

I have had nearly 12 years experience in many health care settings. My first day as a nurse, I was kicked in the stomach by a cognitively impaired patient resisting care. I have had patients urinate on me, hit, scratch, bite, kick, grab and slap me. I have been groped and propositioned. I have been called every name you can think of, and then some you don’t even know about. Not once have I lost my temper and yelled back. I have attempted to break the deadly grip of an elderly patient who was digging her nails in to me, my first concern being to not injure her in the process.

Surprisingly, the 2 years I worked in psychiatry I was only injured once, and it was not severe. Not so surprisingly, I have sustained more injuries, emotional and physical (about 1 new scratch or bruise per week), in the past year I have worked in long term care. The only rationale I can find for this discrepancy is that psychiatric facilities are prepared for the eventuality that patients may become violent, and provide staffing and security to ensure the safety of their employees. In long-term care, there is no such security. Our residents are aggressive because of issues beyond their control – dementia and cognitive deficits – and many are not aware of their actions. Yet, when the health care team recommends treatment to enhance their quality of life and decrease the aggression towards staff, there is resistance by the family, substitute decision makers and managers of the facility. No issues are resolved, and caregivers continue to burn out as a result.

Recently, I have been involved in and witness to a situation where my coworkers have been verbally abused and threatened by the visitor of a patient. In researching the issue of violence against nurses, I have discovered that the issue of violence in the workplace is not addressed in the Employment Standards Act, the Labour Relations Act, the Occupational Health and Safety Act, or the Regulated Health Professions Act. The only reference I have found to addressing this issue is in Bill 70, an amendment to the Occupational Health and Safety Act. Even then, the interpretation of this amendment is to prevent violence on the part of the employer and employees, and does not address the significant violence nurses face while performing their job.

What recourse do nurses have? There is minimal media exposure on this issue. Outside of nursing advocacy groups releasing statistics, and the sporadic article detailing the abuse that one nurse has suffered, there is no information available. Our own College of Nurses of Ontario released a single 16-page document addressing the issue – and how we MUST deal with it, versus the numerous brochures, posters, facilitator guidebooks and videos addressing client abuse.

With the recent reports in the media of abuse and neglect in facilities, and over sedation of elderly clients, caregivers have been left asking the question “What about what we go through? When is someone going to speak up for us?” Yes, abuse of our clients is a serious issue, which should be investigated and the caregivers held accountable for. Yet, in my years as a nurse I have not witnessed any abuse of a client at the hands of a caregiver. I witness abuse of the caregivers on a daily basis, and we are left with no recourse – we can’t withdraw care because it places our clients at risk; we can’t file charges, because our clients are not competent, and we cannot violate confidentiality to accurately report what happened. When we do complain to our managers, we are treated as though the aggression we face is our fault – that somehow we are not handling the situation properly if a client injures us. We are questioned harshly, by a panel of managers, and our concerns are dismissed or shrugged off.

With what we face every day, it is certainly not surprising that there is a nursing shortage, and that facilities are understaffed. It is extraordinary that there are still dedicated, compassionate caregivers who go to work every day and face this adversity, and that we do it without regret or resentment for what we have to face. Even more astounding is that we still love our jobs, and the people we care for.