For the majority of those employed in the Abbotsford Regional Hospital emergency room in 2015, working as a care aide or clerk nurse meant being regularly subjected to physical or verbal violence, according to an internal risk assessment report obtained by The News.
Of the ER staff who were surveyed for the report, three-quarters said they had been physically assaulted while working in the previous year.
All but one person reported being the subject of yelling, swearing, or threats within the last year, and more than half said they’d experienced such abuse more than 20 times over the last 12 months.
Around 70 per cent of staff participated in the survey, which is contained within a report on risk assessment completed in July of 2015 and obtained by The News through a Freedom of Information request.
The report followed an unprovoked assault in March of 2015 that left a nurse with a swollen eye and in need of stitches. Immediately following the incident, Fraser Health added another security guard.
Fraser Health says that it has implemented the majority of the 29 recommendations contained within the report, with the rest set to be addressed with the expansion to the ER announced earlier this month. One of those – the addition of a third security guard – was implemented immediately following the March assault.
A spokesperson said that as of July, full violence prevention training will be required to work in the ER and hands-on training scenarios are now being enacted monthly.
The report had recommended the hospital: install CCTV cameras at all access points; improve the design of the ER; implement reporting and security protocols; train all staff in violence prevention; and practise with security staff on a regular basis.
Those were made after the author found that staff’s general perception that violence in the ER was increasing through early 2015 was borne out by statistics.
Security responses increased 45 per cent in 2014/15 over the previous year, from 295 in 2013-14, to 429 in 2014-15. ARH had seen nearly as many incidents due to violence or aggression between 2008 and 2015 than did the much-larger Surrey Memorial Hospital.
Since the report was issued, the numbers have decreased again. Figures from last year were lower, with 316 security responses recorded, according to numbers provided last week by Fraser Health.
The report found many incidents were never reported by the staff affected, with some saying they didn’t know how to do so, while others said the process was too cumbersome.
Previous risk assessments had been conducted in 2008 and 2012. But while the 2015 report found most of the recommendations suggested previously had been addressed, several had not.
In 2008 and again in 2012, it was recommended that the hospital implement specific protocols and rules that staff could use to reduce violence. The author of the 2015 report wrote, “To date I could not find evidence that this has been done.”
Similarly, drills on “responding to aggressive behaviour and the physical safety techniques required” were recommended in 2008 and again in 2012. In 2015, the recommendation had not been met. While “table top exercises” had been conducted, no actual hands-on practice had taken place.
The 2012 report had also recommended monthly meetings to discuss “improving patient care and staff safety for mental health patients in the ER.” The 2015 report found that “this issue continues to be the major concern for staff.”
Staff told the report’s author that there were a range of barriers in ongoing efforts to improve education and training.
“The employees I spoke to were committed to doing a good job, loved their work and had a lot of empathy for the patients they worked with,” the report’s author wrote. “Most were also very concerned about the level of violence they experienced at work.”
The report continues: “There were some consistent themes that were repeated many times. The most common concern was the accommodation and treatment of mental health clients in the ER … Employees were also concerned about staffing levels, the personal panic alarm system, unauthorized access to the department and the communication of risk from patients.”
Last fall, Fraser Health announced that it would be creating a special area for mental health and substance use ER patients; and earlier this month, the province announced the ER would receive a $15 million expansion.
