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Health Workers Are Facing Record Levels of Violence

Data obtained by The Tyee shows a dramatic increase in ‘Code Whites’ in BC’s two largest health regions.

Zak Vescera and Moira Wyton 31 Jan 2023TheTyee.ca

Zak Vescera is The Tyee’s labour reporter. Moira Wyton is The Tyee’s health reporter. Both reporting beats are made possible by the Local Journalism Initiative.

Health-care workers are facing a rising tide of violence in B.C.’s two largest health authorities.

The Fraser Health authority issued a record 2,370 “Code Whites” across 14 facilities in the 2021–22 fiscal year, more than triple the number of calls from 2014–15. The Code White call is used to alert staff to aggressive people in health-care settings without alarming patients.

That data — which The Tyee obtained through a freedom of information request — shows that 1,660 of the Code Whites declared in the last year were “physical,” indicating an assault or the threat of one. There were only 514 such Code Whites issued in 2014–15.

The number of Code Whites issued at Vancouver Coastal Health facilities rose 61 per cent between 2017 and 2022. That authority, which delivers health-care services in Vancouver, Richmond and part of the North Shore, issued 1,040 Code Whites in the 2017–18 fiscal year. Last year, it issued 1,689.

Total number of Code Whites in Fraser Health by year. The blue bars show the number of alerts due to threats of physical violence. Data via internal Fraser Health authority memo, graphic by Zak Vescera.

The two health authorities serve more than 60 per cent of B.C.’s population.

Unions say the figures reflect an epidemic of violence against their members, who increasingly endure scratches, punches and kicks while doing their jobs.

“Our members are facing violence in the workplace on a daily basis, and workplace injuries because of violence are contributing to worker burnout and making our staffing crisis even worse,” said Hospital Employees’ Union secretary-business manager Meena Brisard.

BC Nurses' Union president Aman Grewal said Code White calls are often answered by teams composed of health-care workers.

She said she responded to such calls when she was a site leader at Surrey Memorial Hospital and that nurses received “down to the mat-type” training to deal with aggressive or violent patients, family members or visitors.

“Do they have a weapon? Is there a threat of a weapon? Is there a risk for self-harm or harm to others? You have to do a very fast risk assessment and figure out how you’re going to respond, and then sometimes you have to call the police,” Grewal said.

She said it was an awkward and stressful job for nurses who enter the profession to heal patients, not restrain people.

“A nurse should not have to be going to work and then basically having the role of a security officer when there are so many other roles they have,” Grewal said.

Surrey Memorial Hospital, where Grewal worked, is an example of the rapid increase in violence facing health-care workers.

There were 573 violent “Code Whites” called last year, up from 167 in 2014–15.

That is about 1.6 violent calls per day, representing one-third of all violent calls in the Fraser Health region.

That proportion is not necessarily surprising: Surrey Memorial is the only emergency department and psychiatric ward serving 630,000 Surrey residents, about one-third of Fraser Health’s service population.

“These factors may contribute to this site having a higher number of Code White calls than other acute sites in our region,” according to Fraser Health spokesperson Dixon Tam.

Total number of Code Whites in Vancouver Coastal Health by year. The blue bars show the number of alerts due to threats of physical violence. Data via VGH, graphic by Zak Vescera.

The HEU’s Brisard said hospital and social services in Surrey, one of the province’s fastest-growing cities, haven’t kept up with population growth — leading to more patient and family frustration about long waits or missing resources. The City of Vancouver, for example, has four hospitals with emergency departments serving its more than 700,000 residents.

“Surrey is dealing with a lack of mental health support, housing insecurity and the poisoned drug crisis, which all fill into that hospital,” Brisard said. “Many people coming into our hospitals are having some of the worst days of their lives, and they may be dealing with trauma, pain, loss or with mental health challenges or addiction.”

Reducing violence against workers is about adequate staffing and people feeling as though they are getting good care, said Brisard, who lives in Surrey.

A long-promised new hospital in South Surrey, set to open in 2027, will add capacity for emergency and in-patient care, but won’t solve the problem, she said.

“We really need to get to the root cause for these issues and make sure that we have enough mental health resources in all of our communities, especially in Surrey,” she said.

Last year B.C. Health Minister Adrian Dix announced the government would hire more than 300 security guards to better protect staff at a select list of 26 high-risk acute care sites.

Brisard welcomed the move, and Grewal said those workers could be in position as early as spring.

Fraser Health’s Tam said in a statement Monday that security staff will be added at eight of the region’s facilities, including Surrey Memorial.

The statement said they will add to efforts to prevent violence against health-care workers, including risk assessments at each site, violence prevention and de-escalation training for all staff, specialized training for staff in key units, hospital and regional committees on workplace safety and public campaigns to promote kindness and patience towards health-care workers, Tam said. “The health and safety of Fraser Health staff, medical staff and patients is our priority and any form of violence or harassment is not tolerated.”

The Tyee has previously reported on how violence against health workers is widespread and under-examined, and many workers pointed to the rising prevalence of Code Whites in hospitals as proof.

But with the exception of Vancouver Coastal Health and Fraser Health, none of B.C.’s regional health authorities voluntarily told The Tyee how many Code Whites their hospitals had issued, and it appears many do not track that data. The Provincial Health Services Authority, which runs specialized care sites like BC Children’s Hospital, also did not respond to The Tyee’s data request.

The Tyee filed a freedom of information request to Northern Health, for example, after that authority did not respond to a request for comment.

In a response, the authority’s information office noted they recorded 141 “unsafe behaviour events” last year involving a patient or visitor that were recorded as Code Whites. That’s up from 127 in 2017 and 125 in 2021.

But that figure likely doesn’t capture all Code Whites in Northern Health, the information officer said in the response, because the data collection relies on staff reporting the incident and the field to mark “Code White” is optional.

In early December, The Tyee twice requested data from Fraser Health on Code Whites.

The Tyee did not get a response until Monday, after it had already informed Fraser Health it had obtained the Code White data through a Freedom of Information request.

Tam apologized and attributed the almost two-month delay to bureaucracy.

“In your case, the info was being co-ordinated provincially and the various health authority and Ministry of Health processes took too long,” wrote Tam.

The HEU asked health authorities to start tracking and reporting Code White and other workplace risk data to the union as part of its latest collective agreement, which was ratified last year.

Grewal of the nurses’ union questioned why that data was not proactively released by all health authorities.

“There has to be a recognition that this is an issue,” she said.

There have been signs violence against health workers has been on the rise for years.

Previous Tyee reporting showed about 4,500 nurses told WorkSafeBC, the province’s worker compensation board, that they had to miss work because of violence in the workplace from 2010 to 2021.

In 2021, WorkSafeBC accepted 1,069 time-loss claims due to injury caused by violence or force in the workplace from workers in the health and social service sector.

Acts of force and violence are also the second-leading cause of time loss at work among HEU members, Brisard said, with over-exertion the leading cause.

“Violent incidents in health care aren’t new. What is new is the types of incidents we’re seeing more frequently,” said Victoria Schmid, the CEO of SWITCH BC. The organization is an occupational health and safety organization for health-care workers in B.C. that is jointly funded by government and unions.

Observers note the problem has grown worse since the start of the COVID-19 pandemic as workers have been under immense pressure and stretched thin.

In its response, Vancouver Coastal Health acknowledged the problem had “intensified” since the pandemic and required “a closer look at violence prevention efforts.”

Fraser Health’s Tam said while there is no definitive explanation for the increase, “additional stressors brought on by the COVID-19 pandemic may have influenced people’s behaviour when seeking health services.”

But the data from the Fraser Health authority indicate the number of Code Whites had already been increasing significantly before COVID-19.

“People are increasingly agitated and they’re taking their anger out on health-care workers and security professionals. This increase can be attributed to post-pandemic rage and a general decline in respectful public behaviour, but also to the increased need for earlier intervention and more robust mental health care,” SWITCH BC’s Schmid said in a statement.

Grewal said the problem can’t be addressed without a clear, public picture of its scope through regular and proactive reporting of this data by health authorities.

“It makes you wonder, ‘Why? Why are they not putting it forward?’”  [Tyee]

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