Healthcare workers experience more violence than any other job in New Zealand. A nurse writes about her experiences in ED wards around the country, and what needs to change.
I don’t work as an ED nurse to be assaulted. I go to work to help people. Unfortunately, the two currently seem inseparable. Violence and aggression towards healthcare workers is too common an occurrence in New Zealand. A 2011 report on violence in the New Zealand Workforce showed that healthcare workers experience more violence than any other profession, at a rate of 55.3 cases per 1000 employees. I’d be assaulted less often if I hung up my stethoscope and donned a police uniform. I’d also earn more. This statistic may be grossly minimised due to a lack of reporting and documentation of violence against healthcare workers.
The incidence of physical assault has been claimed as a frequent occurrence by many nurses and health care workers. This culture of tolerance and underreporting leads to an ignorance outside the profession of what goes on in our hospitals, rest-homes and wider communities. If we don’t report, we lack data and we can’t make safe plans and equip ourselves appropriately. As a registered nurse with five years of experience in both rural and urban emergency departments throughout New Zealand, I can attest to the fact that violence towards health care workers is common.
What it isn’t, and what it’ll never be, is ‘a normal part of the job’. To claim that it is minimises the harm of assault and results in normalisation of the behaviour.
This is a topical issue this week in New Zealand as we wake up to news that yet another nurse has been seriously wounded on the job, stabbed by a patient with a sharp broken object. Just over a week ago a nurse sustained serious burns after a patient threw scorching water over her. Earlier in the year, a nursing student was stabbed on her way to her car. Another nurse was violently beaten up after calling for police help. Another had their finger broken and torn apart. Another was beaten with an IV pole. Another bitten by a patient. The list goes on and on.
This is not localised to Aotearoa. Dr Zubin Damania (known as ZDoggMD on social media) published a series of commentaries under the hashtag #silencenomore, discussing the case of an anesthesiologist in the United States strangling a nurse in the workplace. He suggests that workplace stress and burnout may be contributing to a rise in violence among healthcare workers themselves.
I shouldn’t have to go to work fearing the people I’m there to help. It’s a near daily occurrence for someone to complain to me, to lose the plot, to yell, to say rude things, to attempt to physically hit, swing or spit at me. Their contact rate is terrible because I’m well practiced at dodging. Another norm is sexual violence. It’s unofficially tolerated in a hospital for sultry comments and sneaky hands to be laughed off or gently moved away. That doesn’t mean it’s okay. I can’t tell a patient to fuck off. I might if it happened on the bus to work, but once I’m in scrubs I lose that power.
A checkout attendant would be applauded for immediately calling the police if their customer called them a bitch and then tried to grab them. Security would escort someone out of a bank or law firm if they started touching themselves inappropriately or tried to touch an employee. These events aren’t uncommon in my world. They’re the norm. I walk away. I go tell my colleagues. We talk about how bad it is. He’s drunk, I say, justifying his behaviour. She’s upset, I say, justifying another verbal assault.
Eventually, I have to walk back in. I have to get these people undressed. Ask them questions. Find out what’s wrong, to try and help them. Pretend the assault didn’t happen. Perform an electrical tracing of the heart. Insert an intravenous line. Administer morphine. Ask more questions. Dodge more insults. I’m experienced enough to understand that some violence and aggression is a result of the patient’s condition. It might be drug or alcohol induced, or due to mental health issues or neurological diseases.
I know we can’t stop all violence, but we can properly equip ourselves so that when these situations occur we’re empowered to ask for immediate backup, a safe escape and equipment that can’t be weaponised.
I can’t believe the culture of violence we still have in New Zealand in 2018. I can’t help but think that it translates to a tendency to turn a blind eye towards violence in our hospitals, rest homes and our communities. How many times do I have to be hit, punched, kicked, spat at or sworn at before I should call the police on one of my patients? The answer to this question should be – once. If a mildly drunk person with a cut or bleeding arm spat at you and then kicked you in the supermarket, you’d call the police right? If a mildly drunk person with a cut or bleeding arm spat at me and kicked me at work, I should call the police. But, I don’t. I feel terrible about it.
Somehow, it must be my fault. Maybe I didn’t de-escalate the situation well enough, or I stood on the wrong side of the bed, or I didn’t smile the right way. Do these justifications sound familiar? It’s a behaviour that society teaches women at a young age to justify and validate why assault is somehow their own fault. I might tell a colleague about it. I might call security, but that might make their behaviour worse. I don’t want to cause more of a fuss. I don’t want to be seen as amplifying the situation. I take myself away from the situation usually, but at some stage, I have to go back into the room and care for the assailant/patient.
What part of our culture says that violence and assault towards a predominantly female profession is okay? Apparently, a huge part of it. Enough that earlier in the year, some emergency department staff and community care workers were supported to wear personal alarms in case of these situations. This has not been rolled out nationwide.
The incidence of workplace assault in New Zealand is highest towards healthcare workers. Not in the corrections setting or in the police workforce where people with violent tendencies congregate. This doesn’t mean I want to carry a gun or Taser at work. I don’t want to restrain everyone in the emergency department. I don’t want more violence. But we need to do something.
We need to talk about it. We need to, as a society, say that this isn’t okay and actually do something about it. We need to make it easy to report these assaults when they occur. We need to have more security presence, not just availability, in high-risk settings. We need to design our workplaces in a way that helps mitigate escalation of aggression and violence. We might all need personal alarms. We need our employers to stand up for us and say this isn’t going to be tolerated. All of these measures were recommended to reduce the risk of harm in a ‘good practice guideline’ in 2009, but I’ve seen few of them taken seriously.
Unfortunately for me, I’m a punching bag for the ‘crème de la crème’ of society at their worst. I’ve tried my best, but I’m not Teflon coated. Now don’t get me wrong, most of our customers are nice, lovely and grateful. But not all. We care for the people of Aotearoa, but it’s about time we started caring for ourselves.
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