Violence against workers in health-care settings like hospitals, nursing homes and psychiatric environments is an under-reported, ubiquitous and persistent problem, says an article published Wednesday in the New England Journal of Medicine.

What's worse, the article says, it's a problem that's been tolerated and largely ignored.

What were "once considered to be safe havens are now confronting steadily increasing rates of crime, including violent crimes such as assault, rape and homicide," says the review article.

'No nurse should expect to go to work and be assaulted, and be beaten up.' - Gayle Duteil, president of the B.C. Nurses' Union

For the review, titled Workplace Violence against Health Care Workers in the United States, Dr. James Phillips from Beth Israel Deaconess Medical Center in Boston looked at previous studies looking into workplace violence and interventions to reduce violence.  

In one study, 46 per cent of nurses reported workplace violence during their five most recent shifts, and one-third said they were physically assaulted.

Nursing professionals in Canada say nurses on this side of the border face the same dangers on the job.

"This study is of no surprise to us," says the president of the B.C. Nurses' Union. Gayle Duteil says there needs to be a cultural shift in how nurses are viewed.

Nurses are repeatedly told that violence comes with the job, she says.

"It is not part of the job," she says. "No nurse should expect to go to work and be assaulted and be beaten up."

The head of the Canadian Federation of Nurses Unions says punching, biting and scratching are "typical physical violence," but now there's also "a lot of the bullying and harassment," Linda Silas adds.

According to the Association of Workers' Compensation Boards of Canada, there were more than 4,000 reported incidents of workplace violence against Canadian nurses between 2008 and 2013.

'He broke my nose'

Jean Dobson has been a nurse for 44 years, and has experienced first-hand what it's like to be attacked by some of her patients. There was the time at University Hospital in London, Ont., when a male patient punched her so hard, she blacked out.

"He broke my nose," she said in an interview with CBC News. "He kicked me in the face with his left foot. My nose was no longer in the middle of my face. I ended having to have it surgically set."

Another time, during a night shift at London's St. Joseph's hospital, a female patient grabbed the stethoscope hanging around Dobson's neck "and started squeezing," says Dobson.

'Changes who you are'

Cranbrook, B.C., nurse Nancy Silzer used to work in the psychiatric unit at the East Kootenay Regional Hospital, but was transferred from that unit because of incidents with extremely violent patients. She suffered neck injuries when one patient twisted her neck. Silzer now works in the surgical unit, but suffers from post-traumatic stress disorder.

"It changes who you are," she says. "I don't like the dark. I don't like sudden noises or sudden movements."

When she's not nursing, Silzer is a representative on the nurses union's regional occupational health and safety committee.

Some nurses don't mind talking about on-the-job violence, but many others won't talk about their experiences because they fear they might lose their jobs for speaking out.

According to the Ontario Council of Hospital Unions, a nurse in North Bay, Ont., was dismissed from her job earlier this year because of comments she made at a union meeting about violence in the workplace.

Nurses are also reluctant to lay assault charges because often the patient has mental health issues, dementia or has problems with substance abuse.

Nurse attacked

The B.C. Nurses' Union says an Abbotsford ER nurse suffered serious trauma and injuries from an assault, for which a man pleaded guilty earlier this month. (BCNU)

The B.C. Nurses' Union says nurses are encouraged to press assault charges, and the union says it will assist them in the process of legal challenges.  

Earlier this month, an Abbotsford, B.C., man pleaded guilty to assaulting a nurse at the hospital there.

More and more, provincial governments and union groups are working to make the workplace in hospitals safer.

Emergency "code whites" in hospitals are now routinely used, under which security guards assist nursing staff with physical takedowns of problem patients.

In Ontario, nursing staff can log on to computers and flag potentially dangerous patients or visitors.

The Registered Nurses' Association of Ontario has come up with a set of guidelines for violence-free environments.

Hospitals in that province can be charged for not providing a safe environment for their staff.

And last summer, the British Columbia Nurses' Union joined the Health Ministry in announcing a $1.56-million violence-reduction plan on Aug. 6. Four high-risk hospitals will receive key safety upgrades, including security systems, personal alarms, better training in violence de-escalation training, and code white drills.

In a news release issued last August, Ontario said it will develop an implementation plan to:

  • Make hospitals safer.
  • Reduce workplace violence in hospitals and the broader health-care sector.
  • Change attitudes toward workplace violence and improve workplace safety culture regarding violence.