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Code White: Stats show violent incidents all too common at HSN

'There's a lot more work to do to prevent this from happening,' says hospital VP
Health Sciences North. (File)

The case of a patient who stabbed and injured a nurse at HSN with a screwdriver in October was brought to light in a story, but it's far from the first violent incident that's ever happened at the hospital.

According to Health Sciences North's Quality Improvement Plans, there were 303 workplace violence incidents — as defined by the Ministry of Health — reported between January and December of 2018. That's up from 109 incidents reported the previous year.

While health-care unions and Nickel Belt MPP France Gélinas claim health-care workers reporting violence fear reprisals from employers, Health Sciences North says it's actually encouraging more reporting.

It had a goal last year of increasing reporting of such incidents by 50 per cent, but as shown by the numbers above, reported incidents actually went up nearly threefold.

At the same time, it's focusing on decreasing the number of incidents where patients have been physically violent with staff members.

“We absolutely encourage our staff to speak up and to report all incidents of workplace violence to our managers,” said Mark Hartman, HSN's senior vice-president, patient experience and digital transformation.

“One of the reasons we've identified increasing reporting of incidents is we want that culture in the organization of people feeling comfortable to report things so that we can investigate and try and improve the situation.

“We have seen increases in the reporting of workplace violence situations, which is good in the sense that it allows us to respond and try to improve the situation. It still remains concerning how often it's happening, and really reinforces that there's a lot more work to do to prevent this from happening.”

The man who stabbed the nurse at HSN was actually involved in a previous incident the day before where he threatened staff with a wrench. The first incident was not reported to police until after the nurse's stabbing.

Hartman said HSN brings in the police “if the security and staff team don't feel like they can manage the situation.”

And he said the hospital does encourage staff to report workplace incidents to police “in any situation they feel it's necessary to do so, if they feel at risk.”

Hartman said the incidents leading up to the nurse's stabbing are currently under investigation by senior staff.

“I think that there's opportunity to clarify when it would be appropriate to report to police,” he said. “That's certainly part of the investigation we're doing in this particular case. That's something that we need to educate people on.”

Hospital investigations of violent incidents always start with understanding the facts and chronology of the situation, “and trying to understand what we can learn from that and do better in the future,” Hartman said.

He said senior managers respond to workplace violence incidents right away, and make sure the situation is under control, and get some initial information.

Then there are daily check-ins on the status of the investigation, “making sure we get those done in a timely manner.”

Hartman said all hospital staff, no matter their role, undergo workplace violence and prevention training.

“It includes reference to the Code White policy,” he said. “A Code White is one of our emergency response codes that staff can activate if they're in a situation where they feel there's threatening behaviour that's occurring.

“That policy entails things like the response from other staff to assist in that situation, the response from security, and encourages staff if needed, if a situation can't be managed, to contact Greater Sudbury Police.”

Workers in some areas of the hospital, such as the emergency department and psychiatric inpatient unit, wear safety alert buttons on their uniforms allowing them to call for help if they feel threatened.

They also undergo non-violent crisis intervention training.

If patients are acting in a way that is threatening or potentially threatening, this information is flagged on their electronic medical record, and a sign posted on the patient's door.

Many people who read the story about the nurse who was stabbed asked how the patient could have gotten his hands on a wrench and a screwdriver at HSN.

Hartman said patients' bags are searched in certain areas of the hospital, such as the inpatient psychiatry unit.

“We do have a policy in place around searching of the patient rooms if there's suspicion of concern,” he said. “There's guidelines around how we go about that.”

Hartman said the hospital is also starting to adopt a new violence prevention tool from the Registered Nurses' Association of Ontario called “Preventing Violence, Harassment and Bullying Against Health Workers.”

But all of this is happening as Health Sciences North works in a constant state of overcapacity, with patients sometimes housed in “unconventional” spaces such as TV lounges, linen storage areas and shower rooms.

“There's no doubt that being in a state of overcapacity is really what we're working within,” Hartman said. “The environment doesn't help us in managing the situation.

“Alleviating some of those issues won't solve all of those problems, but it would certainly be an environment that would be easier to provide a safe environment for our staff and our patients.

“We know HSN was built too small, and we really need to continue to work on expanding to alleviate some of those pressures.”