Rising violence against staff in Vancouver hospitals leaves stakeholders searching for explanations

Employees of B.C.’s health-care system face aggression and unsafe behavior with increasing frequency, according to statistics obtained under freedom-of-information legislation

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      This project was produced in partnership with Cited Podcast with the assistance of Cited's Sam Fenn and Gordon Katic. Listen to a related audio documentary.

      One day in March 2015, Virna Joy Bation began her shift as a registered nurse at Vancouver General Hospital like any other. On her list of patients was an 80-year-old woman who was scheduled for a bath. Reviewing the woman’s chart, Bation read that she could be verbally abusive. There was nothing so unusual about that, but she brought a second nurse plus a care aid with her, just in case.

      Interviewed at the Georgia Straight, Bation recounted how she introduced herself to the woman and asked if she was ready to be washed. “And she said, ‘Okay, no problem,’ ” Bation continued.

      Suddenly the patient kicked her legs. The action was so forceful that Bation feared the woman would fall from her bed, so she attempted to hold her down.

      “I let go one of her hands, and then she dove on me and she bit my right thumb,” Bation said. She looked down and the tip of her thumb was missing and she was bleeding badly.

      “Our fingers have lots of nerve endings,” Bation said. “When you cut it, it’s so painful.” A year-and-a-half later, Bation said she remains badly shaken by the incident.

      “She was so nice,” Bation explained. “It’s always coming back, flashing back, what I have encountered and experienced. It’s so traumatizing to me.”

      Statistically, a B.C. nurse is more likely to encounter violence on the job than a police officer, a point that the B.C. Nurses’ Union has emphasized publicly in recent years. And the situation appears to be getting worse.

      According to statistics obtained under freedom-of-information legislation, employees of B.C.’s health-care system face violent situations with increasing frequency.

      In B.C., when a nurse like Bation experiences an incident like the one she did in March 2015, they’re instructed to create a report in what’s called the Patient Safety Learning System (PSLS) under the category of “unsafe behaviour/aggressive behaviour”.

      At Vancouver General Hospital, the number of those reports created each year increased from 63 in 2010 to 212 in 2016 and a projected 198 in 2017.

      At St. Paul’s Hospital, the same statistic rose from 166 in 2010 to 353 in 2016 and a projected 354 in 2017.

      Concerning but not a surprise

      Through additional freedom-of-information requests (more than two dozen for this two-part series), the Straight obtained a sample of the incident reports that comprise those statistics covering a six-month period in 2016. In more than 50 pages, they detail hundreds of incidents.

      “Confused aggressive belligerent pt [patient] trying to get out of bed, pulling oncvc and o2 punched nurse in chest when trying to assist the pts primary nurse in preventing him in harming himself,” reads a June 2016 report from Vancouver General Hospital. “Dr present and pt sedated. No known follow up required at this time.”

      Some entries detail acts of violence committed by one patient against another. From Vancouver General Hospital in April 2016: “Patient went into dining room and started punching co-patient on the left side of the head and face. This was unprovoked.”

      Incidents involving aggressive or unsafe behavior at Vancouver hospitals recorded in the province's Patient Safety Learning System (PSLS). While health authorities maintain increases present in statistics tracking violent incidents in Vancouver hospitals are largely the result of changes in reporting practices, others, including the B.C. Nurses Union, maintain staff face unacceptable risks.
      Travis Lupick / Vancouver Coastal Health / Providence Health Care

      Many incident summaries do not involve an injury incurred by staff but describe the sort of stressful situations that occur every day. For example, this March 2016 report from St. Paul’s Hospital:

      “Patient demanded to be discharged [redacted]. When it was explained to him he would not be discharged patient escalated quickly by reaching into nursing station and knocking over the water cooler. Patient then proceeded to pick up objects in the TV area/kitchen and throw them at co-patients, he also knocked over the large linen cart which broke, tossed the smaller linen carts as well as the garbage cans and garbage strewn all over the floor. Patient also charged the front door and tried to get into the nursing station. He also picked up a small linen cart and charged at a nurse whom believed the cart was going to be thrown at him. Patient was frantically running around unit trying to fins anything he could get his hands on until security arrived.”

      A problem everyone has dealt with

      When B.C. Nurses’ Union (BCNU) acting president Christine Sorensen meets with a group of her members, she often takes a quick straw poll. “How many of you have been exposed to violence within the last month?,” she asks.

      “Inevitably, probably 90 percent of the nurses in the room will put up their hand,” Sorensen recounted in an interview at the BCNU’s headquarters in Burnaby.

      Sorensen said the anecdotal reports from the union’s membership match the statistics obtained by the Straight. She maintained that nurses are experiencing violence with growing frequency and that hospitals and community facilities in B.C. are increasingly dangerous places to work.

      “We are seeing increasing reports of nurses suffering posttraumatic stress disorder, or PTSD, based on repeated exposure to trauma,” she said. “Nurses should not be exposed to violence at any time. So this really needs to change. We can’t continue to have the rates of violence continue to rise.”

      Sorensen suggested the rise in incidents is largely explained by stress created by a system that is spread thin and lacking adequate resources.

      “There’s just not enough health-care professionals and certainly not enough nurses to provide timely care,” she said. “So patients aren’t getting the care they need: they act out; family members act out.”

      Presented with the statistics, Vancouver General Hospital’s operator, Vancouver Coastal Health, declined to grant an interview. It referred questions to Providence Health Care, a partner that operates St. Paul’s Hospital.

      A sample of “unsafe behavior / aggressive behavior” reports created by St. Paul's Hospital staff via the province's Patient Safety Learning System (PSLS) and obtained by the Straight under freedom-of-information legislation.
      Travis Lupick / Providence Health Care

      Elaine Yong, a spokesperson for Providence Health Care, said the statistics aren’t as bad as they look. She argued that the increase is largely the result of changes in reporting practices and better staff compliance to incident-reporting standards. Yong also emphasized that another statistic—staff-time-loss claims—has barely increased at all. That number was 16 in 2013, nine in 2014, 12 in 2015, and 17 in 2016.

      Ties to mental health and addiction

      Dr. Brian Lahiffe works in the emergency room at St. Paul’s Hospital. In a telephone interview, he spoke frankly about the challenges posed by the environment of an inner-city hospital.

      “On an average shift that I'm working, I'm kind of happy if there's not a Code White at some point,” he said, using the health-care system’s name for an event where security is called. “I just kind of expect to have incidents of violence and confrontation, unfortunately, on a pretty common basis."

      Lahiffe reviewed the statistics obtained by the Straight and noted the numbers there grew during the same period that statistics in related areas similarly increased.

      The first of these other sets of data concerns drugs.

      In 2010, there were 42 fatal drug overdoses in the City of Vancouver. Then 65 in 2012, 101 in 2014, and 232 last year. Now the city is on track for 375 fatal overdoses in 2017.

      Meanwhile, hospitals are resuscitating more patients who experienced an overdose. In the fiscal year 2014/15, Vancouver General Hospital and St. Paul’s Hospital together saw 5,361 “substance misuse” patients, according to data provided by Vancouver Coastal Health. The following year, that number grew to 6,133, then to 7,345 in 2016/17.

      Police officers in B.C. can use Section 28 of the Mental Health Act to detain an individual that they deem a threat to themselves or others. (The number for 2017 is a projection by the Georgia Straight based on the the year's first six months of VPD data.)

      The second set of related data concerns what former Vancouver Police Department (VPD) chief Jim Chu described as a "mental-health crisis".

      During roughly the same period that overdoses climbed, Vancouver police officers also brought increasing numbers of mental-health patients to the city’s hospitals.

      In 2010, there were 2,276 VPD apprehensions under Section 28 of the B.C. Mental Health Act, which allows an officer to take an individual into police custody if they are deemed a threat to themselves or others. The number grew each year until 2015, when it hit 3,050. (Since then, it’s been on a downward trend, projected to his 2,754 in 2017.)

      All of this—drug overdoses, mental-health emergencies, and hospital violence—Lahiffe described as “intertwined”, going “hand in glove”.

      He said there are simple solutions that would see hospital staff better protected from aggressive behavior. Physical barriers could be erected at nursing stations where medications are dispensed, for example. And health-care facilities could deploy greater numbers of security guards. But he emphasized that those types of responses to hospital violence come with a tradeoff: they degrade patient care.

      “Nobody wants to work in a place with violence,” Lahiffe said. “The flip side is, we could have an ubersafe, overpoliced [emergency] department where we've put up massive barriers to people. That's not what any of us want either. I don't know if we've found the correct balance. But that's what we deal with."

      This article is part one in a series. It has explored an increase in patients’ aggressive behavior directed toward health-care staff. Part two examines similar trends in physical force used by hospital security guards against patients.

      This project was produced in partnership with Cited Podcast with the assistance of Cited's Sam Fenn and Gordon Katic. Listen to a related audio documentary.