What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Sunday, November 19, 2006

Abuse of Nurses and Staff

It would seem that our health care system in Canada (if Calgary is any indication) is getting weirder by the day! The Calgary Herald, Sunday, Nov. 19/06 edition headlines read “Abusive Patients Attack Nurses”. Now, as a family physician with more than forty years of practice experience, I can assure you that this is not new and is not a surprise. The article relates that documentation indicates a dramatic rise in both verbal and aggressive behavior toward healthcare providers, in particular, nurses. The article gives the example of a patient suffering from a drug overdose, being admitted to a cardiac unit for monitoring, becoming very aggressive and physically abusive to the nurses after two days. Here is a news flash! This is to be expected. People going into withdrawal frequently become agitated and abusive; that is the medical reality. The real question is “Was there an appropriate place, with the appropriate staff available, for appropriate transfer”? Why was the patient on a cardiac unit after two days? Did he really still need cardiac monitoring, or was there simply not an appropriate bed available? Many times in my practice patients for medical reasons are admitted to a medical bed for observation, and when the appropriate time came for transfer to a mental health bed, no bed was available. Consequently, a mental health patient ends up in a medical bed, being treated by a medical nurse (in this case, a cardiac bed and cardiac nurse), when they should be in a psychiatric facility treated by staff familiar with psychiatric and drug withdrawal problems.
This problem has been ongoing for many years and continues to get worse. Since the dramatic downturn in available hospital beds, patients get admitted (from the emergency departments) to the beds that are available, not necessarily to the department that is most appropriate. If there are beds available and the emergency department is jammed up, what is to be done? The staff use the beds available and the staff available, even though it may mean a medical patient ends up on a surgical unit, or even worse, a psychiatric patient ends up on a medical unit (the overdose scenario is typical).
I am sure, as the article implies, there is an increase in frustration on the part of patients who perceive that their needs are not being met, and this leads to increased acting out and abuse. When patients are suffering and in pain, it is not surprising that these patients become more difficult to manage. Nurses have always been, and are aware of this fact, and have dealt with it appropriately. Aggressive personalities often come to light when people are ill, or coming out of an anesthetic, but this isn’t a new phenomenon. Could our sense of entitlement as a patient be having an effect, or are there genuine deficiencies? Probably both are factors. But I think that the basic problem is not a “patient” behavior problem (not making excuses for abusive behavior!). Let us look at the actual statistics and what can be gleaned by the article.
Reported incidents have doubled at the Peter Lougheed Hospital in the last year. At the Foothills Hospital, complaints went from 25 in 2004, to 79 in 2005, to 112 already this year. Other hospitals have shown similar rises (It should be pointed out that an “incident” includes any situation where the nurse feels unsafe, or when the nurse feels the patient has been put at risk). Wendy Brigham, president of the Alberta Nurses Association local 121 at the Rockyview Hospital says “Nurses are getting really frustrated. They’re finally taking the time to document what’s going on”. This statement says it all, if we look at it closely.
Are they frustrated at the patient’s behavior (which they likely fully understand from a professional and intellectual perspective), or is it that their general stress and frustration level relative from a difficult work environment, has reached a point that their tolerance for bad behavior is now almost non-existent? As innovation and other changes have occurred over the past 15 years, nurses and other health care providers have simply put their heads down and worked harder and harder. Some of you may have read a previous blog where I mentioned that, during my recent visit to the recovery room of a local hospital, I was amazed at the intensity of care level, and the looks of stress on the faces of all the nurses. Perhaps the nurses have simply reached their level of endurance; perhaps more and more have simply reached that point of saying in writing “I can’t cope anymore with these conditions, something has to be done”. And it is about time. So they are now taking the time to report what has been going on. Perhaps the reporting is not so much a reflection of the “bad behavior” increase of patients, as much as the level of exhaustion of our nurses. We all tolerate untoward behavior better when we are rested and feel good in our jobs. Feeling you are doing a good job, getting “kudos” for the job you are doing, and having some control of your responsibilities in your day to day work place environment, goes a long way to putting up with your job “incidents”. But if at the end of every day you go home with the feeling that you didn’t have the time to deal with the responsibilities you’re given, deal with “patient at risk” situations, feel helpless from lack of resources and staff, and have the ongoing feeling that you are unappreciated, at some point, the frustration level must become unbearable.
The most incredible aspect of this situation has been the response of the Region. Their response to long waiting room times in out emergency departments is to hire an emergency room social worker. Their response, apparently, to the shortage of nurses and the increase of (reported) abusive incidence in our hospitals, is to hire 150 more security staff. Can security staff really take on nursing duties? Is this an “expanded role” of health care providers as suggested by the “premiers-to-be” of the Conservative Party of Alberta?
The article in the Herald states that the Calgary Region intends to aggressively hire the new graduates from our nursing schools. Great! But good luck! You not only have to hire them, you have to retain them. High stress levels in nurses work place is not going to help in the face of a world shortage of qualified nurses and aging demographics in the nursing profession and the population at large. Are we as nation going to start addressing the core problems, rather than the symptoms, or are we going to continue to simply insert more fingers in our Universal health care dyke, while the healthcare needs continue to rise?


Anonymous Anonymous said...

Al, Your blog gives me hope that at least a few Albertans are beginning to see the long term cost of the Alberta war on health care costs.

What many Albertans do not know is that when health care workers finally fall victim to work overload, role overload and finally chronic stress it is WCB Policy to deny any disability claims due to workload related issues.

These Heros of health care are dumped into the downward spiral of poverty as a reward for their years of saving lives.

Makes you proud to be Albertan doesn't it.

24/1/07 7:23 AM  
Blogger Al said...

The competition for the remaining providers is starting in earnest now as evidenced by recent headlines pertaining to the competition for nurses. The "innovators" admit that we are short thousands of bedside nurses but at the same time herald nurse practitioners, nurse physician extenders, nurse counselors, nurse triage persons, etc, as the solution to physician shortages. I am convinced that no meaningful change will occur until we hit bottom. Unfortunately that will occur like a tsunami of health care needs as the "baby boomers" hit their seventies, existing workers reach the age of retirement, and the present and future generations avoid the health care field. It may well be "the perfect storm".

24/1/07 9:44 AM  
Anonymous Burnt Out Health Care Worker said...

Hi Al,

It's nice to see someone getting a handle on the real issues in health care. Understaffing leads to increased wait times, medical errors causing patient deaths, and attrition of 'burnt-out' health care workers.

The failure of the workers compensation system to compensate for depression caused by chronic stress due to excessive workload, allows provinces to understaff their hospitals without going through any workplace safety inspections.

This is a conflict of interest on the part of the Alberta government (and all provincial governments) because they run both the hospitals AND the WCB. By allowing WCB legislation or policy that denies compensation for "workload" related chronic stress, they can freely understaff their health regions without repercussion.

I am an ex-health care worker from Alberta who went through this whole process. I lost everything I had ever worked for simply because I worked too hard for the David Thompson Health Region. My story is listed on the website of the Canadian Injured Workers Society at

The CIWS addresses the failure of the workers compensation system across Canada.

There are stories on that site about how the failure of WCBs across Canada contributes to increasing wait times in Canadian hospitals.

I don't think understaffing of hospitals will be addressed until provinces are forced to deal with the REAL costs. Compensation of burnt out health care workers is one of the costs they are avoiding.

Once there is a financial cost to employers (provincial hospitals included), for understaffing their workplaces, then we may begin to see some changes toward adequate staffing levels.

Thanks for a great blog site!
Jane Edgett

24/1/07 9:48 AM  
Anonymous Burnt Out Health Care Worker said...

Here's the link to my story again. It was too long in the last post.

24/1/07 9:56 AM  
Anonymous Burnt Out Health Care Worker said...

OK, I'll try that again.

24/1/07 9:57 AM  
Anonymous Burnt Out Health Care Worker said...

Oh, well. Just go to

and click on

"Stress and Death in Alberta Due to Understaffing of Provincial Workplaces"

at the right side of the page.

24/1/07 10:03 AM  
Blogger Al said...

Seem to be having a problem with possting. Read your story----fairly typical. You cared to much in a situation in which you had little control but still felt responsible. The sysrem is weeding itself of "caring people" through attrition (retirement, burn-out, etc) and selective recruitment. We live in a throw-away society and we were warned that health care in Canada would be adopting a big business approach (cost before care). Those remaining as providers will have to develope immunity to caring or not survive (note abotying in Calgary emergency department waiting rooms). And sensitivity training won't help.

24/1/07 10:54 AM  

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