Evidence of meeting #144 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was emergency.
A recording is available from Parliament.
President, Canadian Support Workers Association
Absolutely. I think it would actually attract more people to the field.
Liberal
Robert-Falcon Ouellette Liberal Winnipeg Centre, MB
Thank you very much for your testimony.
According to the World Health Organization, gender plays a significant role in health care, as a risk factor for experiencing workplace violence. A large portion of employees in the health care sector are women. In addition, women tend to be concentrated in some of the lower-paying and lower-status jobs in the sector. Because they lack power and authority in their positions, this might place them at greater risk for being a target of violence, including sexual offences. Could you describe the role that gender might play in the risk of violence against health care workers?
President, Canadian Federation of Nurses Unions
Thank you for bringing up the World Health Organization, but also, this June, the ILO, the International Labour Organization is looking at a convention on violence in the workplace, and health care workers, and a gender analysis is being used. We have the federal, provincial and territorial governments, unions and employers who are going to be there debating that. It is an issue. It is also an issue in health care, because still today, 90% of health care workers are female, and there is that caring—that extra guilt—put on you.
As Miranda said, regardless of whether it's a home, long-term care or the acute care sector, if you're working alone, and you're female, you're in a more dangerous situation. Hopefully, we will have a convention in June with the ILO and Canadian government and—
Liberal
Robert-Falcon Ouellette Liberal Winnipeg Centre, MB
How much does race and being a woman—for instance, a Filipino, small, nurse...? Are they subject to more violence than a large male?
President, Canadian Federation of Nurses Unions
Yes. Like anywhere else in society, when you're racialized, it is even more dangerous. That's the discrimination that exists, sadly, everywhere. In home care, that's where we see a lot of nurses of all categories go because they haven't found a job in the acute care sector. They go and work alone in home care, and it's disastrous there, from what we hear.
Miranda could tell you even more horror stories.
Liberal
Pam Damoff Liberal Oakville North—Burlington, ON
Thank you, Robert.
Chief Mellow, you mentioned the work we've done around post-traumatic stress injuries, and that's something I've actually been involved with since the beginning. It struck me that a lot of the stuff we've talked about is actually provincial and comes through provincial funding.
In terms of looking at violence against health care workers—Dr. Drummond, you talked about training—is there standard training that could be provided to health care workers? Is there a role that we could play, first in raising awareness but also in being able to provide the best training for health care workers? I know that in Halton there's a program called COAST, where mental health workers go out with police. They're specially trained to deal with mental health issues or mental illnesses, and that partnership has dramatically reduced the injuries to the police officers.
I'd ask that to all of you, actually, to see if we could play a role in creating that framework and best practices.
President, Paramedic Chiefs of Canada
I could briefly start off. My colleagues may disagree, but I'm sometimes accused of being sort of paralyzed by the need for evidence. There are some fantastic hypotheses brought forward, and we've answered them anecdotally. We need to stop doing that. We need actual research on what does actually.... Where's the prevalence? What are the right mitigating strategies? Who are the different target groups? Who's more susceptible? We need a little more evidence around that.
I don't think we should be stopping our interventions, just like we aren't in mental health. We need to move forward with some of those programs that we do understand around recognition of violence, de-escalation, tactical disengagement where appropriate, things like protecting both the patient and the workers through some form of support, as we discussed earlier—chemical restraints and things like that. We need to put some of that in place now, but we can't do that without proper evidence going forward. We need to do more research, and I think that's the role that this group could support.
President, Canadian Federation of Nurses Unions
Yes. We need data, and it's one of our recommendations, but we can't wait for it. I saw a 1,200% increase in violent incidents in the city of Winnipeg. Sorry, we can't wait. What the federal government can do is push forward the best practices. They do exist, as I mentioned, at the Michael Garron Hospital. Those are being transferred here to the Ottawa Hospital because of a champion, who is Dr. Kitts, the CEO. He saw what was happening, went there, and said that it's all about training, staffing and security. They need to work together, and they're changing the way they're doing it in Ottawa. We have other examples.
The federal government can transport those best practices and, yes, do the data analysis and the evidence.
Liberal
NDP
Don Davies NDP Vancouver Kingsway, BC
Well, I've been 11 years in Parliament as a New Democrat, and I've never been the most conservative person in the room before—
NDP
Don Davies NDP Vancouver Kingsway, BC
—so I'm trying to absorb this, but I clearly have misspoken.
I do want to clarify this. Certainly, I don't mean to suggest that a senior who is clearly living with dementia and hits out should be criminally charged. Of course I don't mean that. What I meant to say is that, with a police officer present in a place, their ability to intervene right away is what I think could be stepped up. I trust health care professionals to differentiate between those situations where there's accountability.
That leads to a question, and I wonder if you could help me. If you could venture a guess, what percentage of the violence that you see in the health care workplace is committed by those who are not legitimately responsible versus those you think may be?
Co-Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
I'm not a big fan of guessing, so I won't.
Co-Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
Actually I'm not. What I would say is this: I think there is a subset of the population that commits or perpetrates violence, or is involved with violence that probably falls into their world view.
Gang violence is regrettably an issue in Canada, and when gang violence ends up in the emergency department, you're a totally legitimate target for judicial undertakings. When you are the loved one of somebody in attendance in the emergency department and you strike out at that staff, you don't have the excuse of somebody who's delirious.
There is, of course, a subset of the population that would benefit from that approach.
NDP
President, Canadian Federation of Nurses Unions
No. It would really be guessing. There are horror stories on both sides, from patients and from family and friends—and co-workers too. We just need more data.
NDP
Don Davies NDP Vancouver Kingsway, BC
I was just going to say that. It would strike me that we really need that data, because violence committed by people who are not accountable is very difficult to prevent. It's going to happen. I think we'll need different strategies for how to mitigate that versus someone such as a family member who is allowing their frustration to get the better of them and they are striking or shoving a nurse or threatening someone out on the street.
In a hospital, is there any difference? Is the preponderance of violence happening in the emergency room or in wards? If so, are there particular wards in which it happens more? Is it more in extended care homes, or on the street? Do we have a general idea of where this violence is occurring?
Co-Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
Yes. There is a good body of literature that looks at violence. The three major parts in the hospital sector are the emergency department, the geriatric unit and the psych unit. It's those three.
President, Canadian Federation of Nurses Unions
Yes, and the new and upcoming one is home care.
NDP
Don Davies NDP Vancouver Kingsway, BC
Mr. Mellow, I will give the last word to you. I have only three minutes.
Your members are out on the street, so it's a very different workplace environment. What concrete suggestions would you like to see implemented to make sure those paramedics can enjoy a safer, healthier workplace?
President, Paramedic Chiefs of Canada
Again, we are out on the street, but not unlike the other workers who are in the homes. It's very similar.
Again, we need supports in that whole continuum of the issue to understand how to recognize, how to de-escalate and how to protect when necessary. We need the public to understand. We need to get that message out.
As I said in my opening statement, we need to support the employers to be able to provide the safety measures that are necessary, but we also need to reduce stigma and empower our workers to stand up for themselves and be able to report these incidents. We need a firm commitment from employers, and we need a firm commitment from the community to actually pursue the charges when it's appropriate.
We understand that probably the majority of incidents aren't egregious behaviour. The majority may be of some other medical issue. When we look at verbal abuse and intimidation, most of those are egregious and we need to get the message out that it's not acceptable, and support our workers and support our employers as well to stop it.
