There is a disturbing trend in our society towards violence and it is clearly reflected in the growing number of incidents of physical, verbal, and emotional acts of violent, aggressive, assaultive and/or threatening behaviour being reported to police.

A recent report by the Ministry for Women's Equality (B.C.) notes that one in four women are the victims of domestic violence.  Sadly, this trend is reflected in the growing violence against health care providers, most of which are women.

Violent incidents by clients/patients and their family and friends toward health care providers have increased markedly.  The growing number of Workers' Compensation  Board's (WCB) wage loss claims for injuries due to acts of violence by patients/visitors/relatives had increased from 200 claims in 1981 to 502 claims in 1990.

The total number of reported incidents in all health care settings throughout British Columbia is also growing.  In a recent survey, 52% of acute care nurses, 45% of extended care nurses, and 43% of critical care nurses reported that they have been physically attacked by a patient.

In community care settings, incidents are also on the rise as community care providers care for more high risk clients.  Incidents involving aggressive language, slapping, biting, and kicking, while less frequently reported, are also part of the violence toward health care providers.

Let's look at the statistics a little deeper.  In 1992 there were about 1100 time-loss claims relating to "acts of force or violence" in the workplace.  Now this 1100 wasn't totally in healthcare but let's look at an overhead for the breakdown as to occupations.  Surprisingly, it seems that it is safer to be a police officer or a bouncer than it is to work in health care.

I was taught to be wary of statistics.  There is an old adage "Figures never lie, but liars can figure."  You can look at those 1100 cases of injury in two different ways.  One is that 1100 cases really isn't that high considering how many workers there are in B.C.  Or you can look at it as being the tip of the iceberg.  Firstly, not all workers are covered by WCB.  RCMP officers are provided with workers compensation by the Federal government; farm workers have only recently been given coverage; bank tellers and others who work in financial institutions have rarely been provided with WCB coverage.

Secondly, and more important, only a fraction of the violence in the workplace is reported to either the employer or to police, and then, only a fraction of those reported incidents will be sent to WCB as claims for time lost due to violence.

Violence in the workplace will not always be reported to the employer.  The worker may see the event as trivial, or accept some amount or degree of violence as part of the job description.  Alternatively, the worker may perceive that there will be no benefit or value in reporting the incident to the employer.  Some workers may feel that they might be blamed for the incident and that their job may be placed at risk if they report it.

Violence at work may also not be reported to the police.  Again, the incident may be seen as trivial.  It may be seen as part of the job.  Or it may be that the perpetrator of the violence would not likely be charged criminally, given his or her state of mind.  This is particularly true of violence from elderly, psychiatric or mentally handicapped clients.  The claims from these three populations form the majority of all force or violence claims in the province in the past decade.

In 1986, while I was working in a psychiatric hospital in Ontario, a patient purposely attacked me and assaulted me.  I called our local police department and tried to press charges.  They just laughed at me and told me it was part of my job just as it was part of their's.  They said they would press charges if I really wanted to but “why bother the guy was crazy anyway”.  I'll leave you to your own thoughts on that one.

Finally, workers are often reluctant to report violence to the Worker's Compensation Board.  Again, the incident may be viewed as trivial, or as part of the job risk.  As mentioned before, how many workers are cautious of reporting because of the idea that they may lose their jobs.  It seems to be the new reality that there are people lining up at the door for our job if we can't do it.  In addition, many workers may see the claims process, i.e. filling out the WCB forms as being too cumbersome.  They might just by-pass this system by phoning in sick, using up their short term sick leave.  You have to wonder how many employers encourage the worker to book off sick rather than make a claim.  This would keep their assessment premiums lower.

Rae Stonehouse RN 1996

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