Thank you, Madam Chair and members of the committee, for the invitation.
My name is Josette Roussel. I'm a registered nurse and the Program Lead for Nursing Practice and Policy at the Canadian Nurses Association. I'm joined today by my colleague, Ms. Isabelle St-Pierre, who is a registered nurse and an associate professor at the Université du Québec en Outaouais. Ms. St-Pierre also has her doctorate in nursing, with a focus on horizontal workplace violence.
The Canadian Nurses Association is the national and international professional voice of nursing care in Canada. It represents more than 135,000 nurses in 13 provinces and territories of Canada.
The CNA advances the practice and profession of nursing in order to improve health outcomes and to reinforce the public and non-profit health system in Canada.
Canada's health care system couldn't function without nurses. Nurses work in a variety of settings, including hospitals, nursing homes, rehabilitation centres, clinics, community agencies, correctional services, long-term care and home care settings.
Violence in health care is not a new problem. Violence can be overt, such as physical, verbal, financial and sexual behaviours, or it can be covert, such as neglect, rudeness or humiliation in front of others. Violence can occur between employees of an organization, such as between nurses or between employees and non-employees, for example, between patients and nurses.
In fact, violence is a widely recognized global issue, with one-third of nurses worldwide being victims of physical assault, two-thirds being exposed to non-physical violence at work, and 80% being victims of some form of workplace violence. Although these numbers show an alarming situation, it is much worse. Only 19% of nurses formally report workplace violence.
Statistics show that 60% of new nurses who experienced workplace violence will resign from their first place of work within six months of employment, and of these nurses, 50% will choose to leave the profession altogether. Nurses are the most at risk of being attacked in their workplace, second to police officers.
While all nurses are at risk of workplace violence, we know that nurses working in long-term care, emergency departments and psychiatric settings may be more at risk, as well as night-shift workers and novice nurses.
Perpetrators of workplace violence include patients, and patients' families or visitors. They can be doctors, managers, other nurses or other employees. The work environment is also known to contribute to workplace violence. Examples of organizational factors that contribute to the problem include excessive workloads; inadequate staffing; excessive use of overtime, both mandatory and voluntary; lack of managerial support when reporting instances of workplace violence, and a lack of perceived consequence when committing violent acts.
Some of the most reported workplace violence consequences include physical injuries, post-traumatic disorders, burnout, anger management issues and persistent fear and anxiety, to name a few. Statistics from the Workplace Safety and Insurance Board in Ontario show that in 2016 lost-time injuries due to workplace violence in the health care sector greatly outnumbered those in other sectors, with over 800 injuries compared to manufacturing at 138, construction at three and mining at zero.
The effects of workplace violence in the health care sector are significant, and their consequences are real. Violence negatively affects outcomes for patients, nurses and organizations.
CNA has four recommendations to make to the committee.
The first is that the federal government lead a pan-Canadian strategy to study why workplace violence continues to be an issue and why initiatives continue to have limited success. This study may include conducting consultations, round tables, and a public inquiry seeking feedback from politicians, senior leaders, health care professionals, patients and families. This federal government study would also lead to clear, more targeted definitions of violence to move toward a common language to allow comparison of data.
The second is that the federal government create a hub for promising practices and create information-sharing opportunities for organizations to discuss best practices and learn from incidents and near misses.
Third, we recommend that the federal government support funding to evaluate existing programs and successful strategies and conduct a longitudinal research program on workplace violence. These evaluations should focus on learning from incidents and near misses, on what health care professionals say is effective in their organizations and on ensuring that policies have the intended on-the-ground outcomes.
Finally, we recommend that the federal government collaborate with provincial and territorial health ministries and health care organizations to develop prevention strategies to take into account individuals' characteristics, interpersonal factors and organizational factors. Such strategies could include, for example, minimum system enhancement initiatives related to health human resources, communications and work environments.
Along with these recommendations, I would also like to point out that part of the problem is that definitions of what constitutes workplace violence vary. Many words are used interchangeably and there is no one standard typology that classifies episodes of workplace violence. CNA's full submission to the committee will further outline the complexity of varying definitions. However, there is a need for more standardized language to describe the problem. There's also an ongoing debate as to whether intent should be considered as part of the definition as well.
In closing, with an upward trend in the number of incidents of workplace violence in health care, CNA believes that workplace violence requires immediate federal government action, including support for the victims. By adopting the recommendations made here today, the standing committee can address the growing need for prevention, evaluation and intervention pertaining to workplace violence in the health care sector.
It will take a sustained, concerted effort and collaboration if we are to achieve what we all want: violence-free workplaces and the resulting improvement in outcomes for patients, nurses and organizations. As well, because different factors contribute to violence perpetrated by patients' families or health care professionals, it will require different and multi-faceted strategies to alleviate it. It is not a simple one-size-fits all approach or solution.
I would again like to thank the committee for providing CNA with the opportunity to share our perspective and recommendations. Let's all work together to create a better future for our health care sector workers and nurses.
We look forward to your questions. Thank you.