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?