When she heard someone call her a “f—— b—-” a few weeks ago, Debra Lefebvre stopped in her tracks, and turned around to get a better view of her accuser. Then, she did a double take.
Standing there, just inside the doorway of her room in an Ontario hospital, was a tiny, elderly woman, who didn’t seem like she’d know a cuss word. Let alone fling one with gusto.
“I did not expect it from her,” said Lefebvre, an acute care nurse with more than 30 years of experience both on the floor and in management and advocacy positions. “It was a shock.”
Then again, she added, it wasn’t really.
That kind of vitriol — and worse, Lefebvre said, is, sadly, not new to her, her colleagues or her profession.
In fact, it has long been an everyday occurrence.
“Has it been escalating because of COVID? And it is. Patients and their families are completely stressed, and tense situations can arise,” said Cathryn Hoy, president of the Ontario Nurses’ Association. “But workplace violence has always been under-reported, and I would suspect even more so during the pandemic because there are so many issues and gaps in staff to help diffuse situations.”
Each and every day, across the country, Hoy said, nurses are sworn at, threatened, touched inappropriately, kicked, punched, spit on — and assaulted with weapons, including knives, brass knuckles, machetes and even guns. People conceal them in pant legs, for instance, she said, and sneak them into emergency rooms if they walk in as opposed to being brought into hospital by paramedics.
Recently, Hoy said, one of her members was stabbed. Twenty years ago, Hoy said, she was attacked by a patient, “grabbed and punched several times.”
“It is very scary and you are usually alone in a room with somebody when it’s happening. And you wonder. Is someone going to hear me scream and can I get away?”
While nurses are trained to deal with upset, emotional and difficult patients and their families — and, to a certain degree, it is part of their job — the violence nurses deal with on their shifts is out of hand, Hoy said.
“If you are hit by your partner, that’s called domestic violence,” she said. “If a person were to hit a police officer in the line of duty they’d be grabbed and handcuffed and be in a cruiser on their way to jail before you know it. But somehow it is allowed to happen in a care setting because you have a nurse’s uniform and a name tag.”
A recently released survey conducted by the Canadian Federation of Nurses Unions in 2021 found that 93 per cent of 4,500 nurses said they’d experienced aggression of some type, be it verbal abuse, sexual harassment, bullying or physical assault, in the past year.
Another federation survey, conducted in 2019 to probe nurses’ mental health, found that physical assault was the top traumatic event nurses said they’d been exposed to out of 20 others including death of a patient, death of a child and a life-threatening natural disaster. It also showed that nearly half of the 7,358 nurses who participated in the survey said they’d been exposed to physical assault 11 or more times in their career.
But it is hard to say whether the more current surveys point to an uptick in the amount of violence nurses have faced during COVID because the wording in each survey is different, said Linda Silas, president of the Canadian Federation of Nurses Unions. More importantly, she said, the bulk of violent incidents are likely not reported.
“That’s because violence has been normalized in the profession and, unfortunately, too many health-care workers just consider it part of the job,” she said. “We have to change the culture.”
For years, she said, the federation has been pushing for more de-escalation training for nurses to help them understand how to cope with the violence they face, but, the real problem behind the violence is the chronic staffing shortage that plagues nursing as well as a need for enhanced security.
Tackling this issue, will take a “multi-pronged approach,” she said. “Nurses can and should be trained in de-escalation, but we can’t put the entire onus on them — on the victims.”
Brianne Donohue, a nurse with three years of experience, said until someone figures out how to eliminate the violence, nurses are the ones who have to deal with it.
Last fall, she was left with a bloodied nose, bruised “raccoon eyes” and a concussion after a patient — an agitated, elderly man — kicked her in the face.
Donohue brought along two other colleagues to help her get him cleaned up. She spoke to him in her gentlest tone, she said, and waited for his verbal consent from her before approaching.
Nonetheless, she said, “once I got close to his legs, he slammed his heel in my face.”
Alissa French, an emergency room nurse in Hamilton with 13 years of experience, said hospitals should take a zero tolerance approach to violence on the job. She had been fighting for that before COVID, but now she fears the momentum may be lost.
Worse, she said, is that it does seem COVID has empowered people to take out their stresses on nurses.
In addition to the anti-vaccine protests and convoy that, for the first time in Canadian history, made health-care workers a target of political ire, French said she and her colleagues feel a palpable shift in aggression directed toward them.
Patients have even threatened to cough in their face and give them COVID, she said.
“It is incredibly frustrating, demoralizing and demeaning,” she said. “But I fear we are not going to see any change because our system as a whole is so broken.”
Nurses have always been the front lines of health care but never more critical than during the COVID-19 crisis. In this ongoing series, we explore the many issues affecting nursing.
JOIN THE CONVERSATION