St. Joe's still has work to do to reduce violence against nurses: report

St. Joseph's Healthcare Hamilton has made strides this year in addressing the problem of patient violence against nurses. But it still needs improvement. That includes more activities for patients with mental health issues, and watching the caseloads of psychiatrists.

President says it's still a mystery why so many St. Joe's nurses were hurt in quick succession

Nurses gather outside the inpatient entrance, a secure area set further inside the hospital building. A new report says St. Joseph's Healthcare Hamilton still has some work to do to reduce violence against nurses. (John Rieti/CBC)

Several months and an external peer review later, St. Joseph's Healthcare Hamilton (SJHH) says it's still no closer to knowing why there was a rash of violence against its nurses early this year.

Why that sequence of events occurred, I don't think we have an answer to that.- David Higgins, St. Joseph's Healthcare Hamilton

SJHH released a third-party review Thursday looking into violence against nurses from patients with mental health issues. There were more than six incidents in a month in late December and early January.

The peer review had a lot of helpful suggestions, many of which the corporation is already doing, said president David Higgins. But the reason for that rash of violence at that time period remains a mystery.

"Why that sequence of events occurred, I don't think we have an answer to that," Higgins said.

The number of incidents can depend on which patients are in treatment. It's not unusual for hospitals to have a string of violent incidents.

Otherwise, he said, "We can't identify a specific area why that sequence of incidents happened so rapidly."

The review said SJHH has already made significant strides since the nurses were injured.

But the organization still has work to do, including better training, more activities for patients with mental health issues and forming a task group to look at the caseloads of psychiatrists.

Staff are trying their best under very, very difficult circumstances.- Linda Haslam-Stroud, Ontario Nurses' Association

In February, SJHH nurses told CBC Hamilton that least nine had been injured. 

"I'll be honest, I'm afraid," one nurse said in the wake of one of the incidents.

Thursday's report includes six categories of recommendations, many of which St. Joe's says it's already doing.

St. Joe's hospital in downtown Hamilton.
St. Joseph's commissioned the external peer review in the spring after a number of nurses were injured by patients. (Terry Asma/CBC)

The recommendations include better training, more tuition support for mental health nurses to upgrade their skills and refreshers on how to handle mechanical restraints.

The report also encouraged the agency to do more work to make sure it hires nurses who can handle patients with mental health issues.

It recommended more activities for patients with mental health issues on days, evenings and weekends. Another recommendation: better communication with staff who need to know when such an incident has happened.

Higgins said SJHH will continue implementing the report's suggestions. 

"That's going to be ambitious," he said. "It's a little scary, but it's also the right thing to do."

Higgins also said the incidents in January were frightening for hospital staff.

"The staff take my breath away with the commitment to care and how they come back," he said. "It just blows me over their commitment to the patients and wanting to ensure they're cared for."

Linda Haslam-Stroud is a St. Joe's nurse and president of the Ontario Nurses' Association. She said the report is a good start, but doesn't address occupational health and safety issues.

She also said St. Joe's has to hire more nurses if it wants to achieve some of the goals laid out in the report.

"Staff are trying their best under very, very difficult circumstances," she said. 

"The report is great to a certain extent but it certainly is not comprehensive enough."

The reviewers were:

  • Ian Dawe, associate professor of psychiatry at the University of Toronto, program chief and medical director of mental health at Trillium Health Partners in Mississauga.
  • Barbara Mildon, chief nursing executive and vice president at the Ontario Shores Centre for Mental Health Sciences in Whitby.
  • Ann Pottinger, registered nurse with a masters degree in nursing from the University of Toronto. She is currently director of quality, patient safety and risk at the Centre for Addiction and Mental Health.