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What's more said Hurley at a media conference to release the poll findings, "it's a grim and concerning reality that despite the fact incidents are happening almost daily, workers fear reprisal and incidents are under-reported". The majority of respondents said that in the last year, in the workplace they had experienced at least one incident of physical violence, but many said they had experienced nine or more occurrences.

59 per cent of the poll respondents are RPNs or PSWs. Of those respondents 73 per cent are women. 41 per cent of respondents provided other important support services at NBRHC. A high number, 81 per cent also indicated they witnessed incidents of physical and non-physical violence toward co-workers in the last year.

40 per cent of respondents had experienced sexual harassment or sexual assault either physical or non-physical in the last year. "These workers are largely women. This is violence against women that's being allowed to happen here. In what other workplace would sexual harassment and sexual violence, at this level be tolerated?" Asked Sharon Richer, OCHU north eastern

Ontario vice-president. The poll also points to a climate of intimidation in the workplace and an under-reporting of incidents. 51 per cent responded that they are afraid of reprisal if they speak up about an incident of violence. The poll shows that there are far-more incidents of violence experienced by respondents than are actually reported. "The findings show violence is pervasive in this workplace. It's an unsafe work environment where something is standing in the way of workers reporting incidents. There is a fear of reprisal if you report. There is also under-reporting, which is linked to reprisal. There is no doubt people are afraid to speak out," said Hurley. FOR FURTHER INFORMATION PLEASE CONTACT: Michael Hurley OCHU President 416-884-0770 Sharon Richer OCHU, Vice-President North Eastern Ontario 705-280-0911 Stella Yeadon CUPE Communications 416-559-9300 Source: Ontario Council of Hospital Unions (OCHU)

Several of the questions focus on how many incidents workers have reported and whether they are afraid of reprisal if they speak up at work about violent incidents. The poll also asked how many times in the last year staffhave experienced sexual harassment or assault either non-physical or physical. "The results of personal experience with violence are very disturbing and suggest a profoundly unsafe environment," says OCHU

president Michael Hurley. "But for us, the most unexpected and unsettling finding is the measure of sexual harassment or sexual assault. "The number of staffafraid of reprisal if they report violence in North Bay is also very concerning, if not unexpected, given the firing of a nurse who raised the issue in January."

In January, nurse Sue McIntyre was fired by the health centre after she spoke on a workplace violence panel. In her comments, McIntyre had zeroed in on the issue of reprisal against health care staffwho report. Others on the panel stressed that there are fewer staffto deal with more aggressive

patients. Ontario has the lowest hospital and long-term care staffing levels in the country. Delegates attending the conference asked the provincial health minister to take the following actions: Enact legislation, to protect health-care workers from violence Provide health care workers with the same rights to refuse unsafe work as other workers in the public sector Charge patients and family members under the Criminal Code who are violent with staff Fund and staffOntario hospitals and long-term care facilities to the Canadian average.

The report details vulnerabilities in the system and the costs of inaction: Emotional abuse, bullying, and even physical threats are often accepted as “normal” conditions of the health care workplace.  Production and cost pressures in health care have reduced intimate, personal caregiving to a series of demanding tasks performed under severe time constraints, detracting from what should be joyful and meaningful work. More full-time employee workdays are lost in health care each year (due to illness or injury) than in industries such as mining, machinery manufacturing, and construction.

In the letter to Timmings, lawyer Michael Polvere of Siskinds wrote, "While we encourage all honest and fair debate on the issues, defamatory and untrue statements made of and concerning our client, the LHSC, will not be tolerated and will be met with swift action. The LHSC intends to hold both RNAO and yourself personally responsible for the conduct of this meeting." At the 6:30 p.m. meeting at Wolf Performance Hall in the Central Library, Timmings will lead discussion on a nurses' association report that claims cash-strapped hospitals are cutting registered nurses and replacing them with less qualified and lower-paid staff to the detriment of patients. "These (changes) are detrimental to Ontarians, to nurses, and to the future of health and health care in Ontario," conclude authors of the report Mind the Safety Gap in Health System Transformation: Reclaiming the Role of the RN. No one should be muzzled from discussing key health issues and LHSC's efforts should be addressed by Ontario Health Minister Eric Hoskins, Grinspun said. Hoskins couldn't be reached for comment Thursday. Nor could officials at LHSC. Earlier this year, Glendining refused to comment publicly on Burkoski's firing but defended the hospital in internal memos that insisted that the nurses' association had told a one-sided story and that safety was always a priority.

Violence a problem

Unfortunately, that's how many hospitals operate. Inadequate staffing is a nationwide problem, and with the exception of California, not a single state sets a minimum standard for hospital-wide nurse-to-patient ratios. Dozens of studies have found that the more patients assigned to a nurse, the higher the patients' risk of death, infections, complications, falls, failure-to-rescue rates and readmission to the hospital -- and the longer their hospital stay. According to one study, for every 100 surgical patients who die in hospitals where nurses are assigned four patients, 131 would die if they were assigned eight.

In pediatrics, adding even one extra surgical patient to a nurse's ratio increases a child's likelihood of readmission to the hospital by nearly 50 percent. The Center for Health Outcomes and Policy Research found that if every hospital improved its nurses' working conditions to the levels of the top quarter of hospitals, more than 40,000 lives would be saved nationwide every year.

Nurses are well aware of the problem. In a survey of nurses in Massachusetts released this month, 25 percent said that understaffing was directly responsible for patient deaths, 50 percent blamed understaffing for harm or injury to patients and 85 percent said that patient care is suffering because of the high numbers of patients assigned to each nurse. (The Massachusetts Nurses Association, a labor union, sponsored the study; it was conducted by an independent research firm and the majority of respondents were not members of the association.)

And yet too often, nurses are punished for speaking out. According to the New York State Nurses Association, this month Jack D. Weiler Hospital of the Albert Einstein College of Medicine in New York threatened nurses with arrest, and even escorted seven nurses out of the building, because, during a breakfast to celebrate National Nurses Week, the nurses discussed staffing shortages. (A spokesman for the hospital disputed this characterization of the events.)

It's not unusual for hospitals to intimidate nurses who speak up about understaffing, said Deborah Burger, co-president of National Nurses United, a union. "It happens all the time, and nurses are harassed into taking what they know are not safe assignments," she said. "The pressure has gotten even greater to keep your mouth shut. Nurses have gotten blackballed for speaking up."

The landscape hasn't always been so alarming. But as the push for hospital profits has increased, important matters like personnel count, most notably nurses, have suffered. "The biggest change in the last five to 10 years is the unrelenting emphasis on boosting their profit margins at the expense of patient safety," said David Schildmeier, a spokesman for the Massachusetts Nurses Association. "Absolutely every decision is made on the basis of cost savings."

Experts said that many hospital administrators assume the studies don't apply to them and fault individuals, not the system, for negative outcomes. "They mistakenly believe their staffing is adequate," said Judy Smetzer, the vice president of the Institute for Safe Medication Practices, a consumer group. "It's a vicious cycle. When they're understaffed, nurses are required to cut corners to get the work done the best they can. Then when there's a bad outcome, hospitals fire the nurse for cutting corners."

Nursing advocates continue to push for change. In April, National Nurses United filed a grievance against the James A. Haley Veterans' Hospital in Tampa, which it said is 100 registered nurses short of the minimum staffing levels mandated by the Department of Veterans Affairs (the hospital said it intends to hire more nurses, but disputes the union's reading of the mandate).

Nurses are the key to improving American health care; research has proved repeatedly that nurse staffing is directly tied to patient outcomes. Nurses are unsung and underestimated heroes who are needlessly overstretched and overdue for the kind of recognition befitting champions. For their sake and ours, we must insist that hospitals treat them right. ☐

Menendez has claimed he and Melgen have been friends for years and that he did nothing illegal. Melgen also is charged in a separate indictment in Florida accusing him of multiple counts of Medicare fraud. Medicare is the government-funded program providing health care coverage to the elderly. A federal judge in Newark has set a trial date for October.

Many of the clinics in Canada have long since dropped Planned Parenthood from their names, and even the ones that proudly maintain the title aren't officially tied to the outfit in the United States. But still the stigma remains, and many are struggling. Some have cut services; some have closed, or fear they will have to. "It's getting quite desperate.

We're all feeling the bite," said Lauren Dobson-Hughes, president of Planned Parenthood Ottawa, which recently put out an urgent appeal to its supporters for funds. Planned Parenthood Ottawa, which provided counselling and sex education to 8,500 clients last year (not to mention distributing 72,000 free condoms) has seen its government support slashed by 10 per cent in each of the past few years. The United Way in Ottawa cut all its funding a few years ago. Other grant applications have gone unanswered, and donors are spooked by the very words "sexual health."

According to Planned Parenthood Ottawa, there has been a concerted effort by anti-choice advocates to badger agencies and donors who might otherwise provide financial support to clinics (even though they don't provide abortion services). As well, there is just a general leeriness around the subject of sex education - witness the vehement opposition to Ontario's new curriculum. Donors are risk averse in tough times. "For some donors, it's just easier to support something [such as] a cancer charity," said Ms. DobsonHughes. The result of dwindling funding is that the people at greatest risk suffer. One client, a pregnant sexual assault survivor in an abusive relationship, recently had to be turned away from the Ottawa clinic because there were no counsellors to see her.

This squeamishness may seem difficult to believe in 2015, but other sexual-health providers - the ones who give out free condoms, counsel nervous teens and pregnant women and offer screening tests for people who might not have a doctor - confirm that it's a dire time. In April, Health Initiatives for Youth Hamilton, the country's oldest birthcontrol clinic, had to shut its doors after it lost its local government funding. It had been running for 85 years.

In March of last year, it looked as if the doors of Victoria's Island Sexual Health Society would also shut when it faced a funding crisis. After a public appeal, it received a small boost from the province's health coffers. "The immediate threat is over, but we had to lay off staff and it's still a struggle," said Bobbi Turner, who's been the director of Island Sexual Health for 21 years.

Ms. Turner's clinic had 27,000 patient visits last year and provided sexual education for thousands of students. Like similar outfits, it offers education and pregnancy counselling and clinical services such as STI testing and cancer screening. One of the problems in Victoria, she said, is the lack of family doctors: "If we close, where are these people supposed to go?" Now the clinic is exploring "different revenue streams," including selling a line of sex toys. It's not exactly a viable alternative to stable, year-on-year funding, but desperate times calls for innovative measures.

In a tight-fisted world, it seems that women's health services - even with their long-term, quantifiable benefits - are the first and easiest things to cut. "Funding dollars are getting smaller and smaller," Ms. Turner said.

"It's the same old story. Prevention gets bumped to the bottom of the list, and it's not until we're about to close our doors that people take notice."

The numbers underscore the need for improvements to hospital staff safety measures, something the Ontario Nurses' Association (ONA) has long been calling for to better protect health-care providers. "Violence isn't part of this job. It shouldn't be part of this job," said Andy Summers, vice-president of health and safety with ONA. "Eventually, somebody will get killed."

Summers called the current situation of violence against nurses in Ontario "completely unacceptable." At UHN, which includes Toronto General Hospital and Toronto Western Hospital, there has been a consistent increase in reports of assault in the past three years. The number of reported violent incidents doubled in two years, jumping from 166 incidents in 2012 to 331 in 2014, according to data provided to the Star. In 2014, 11 workers who were injured were unable to return to work for their shift following the assault. Spokeswoman Gillian Howard said changes in reporting standards probably account for the rise. The changes include a Behaviour Safety Alert, implemented at UHN in 2014, which requires staff to put an alert on patient records if the patient has aggressive or violent behaviour. Howard also said increased reporting could be attributed to the fact that unions are encouraging staff to report every incident: "a very good thing," she said.

"We do not want any staff member at risk from a patient, but given the care we provide, the medications used, the fact that some patients have cognitive impairment as a result of injury or aging, the impairment of some patients when they arrive, and the risks associated with some of the treatments, it is not likely that we will see a year with no incidents," said Howard, adding that UHN employs approximately 13,000 staff and has over one million patient visits per year. But ONA lashed out at this explanation, saying employers are trying to downplay the issue.

Erna Bujna, occupational health and safety specialist with ONA, said some employers "absolutely" still discourage staff from reporting incidents, by telling workers that violence is just part of the job. ONA wants to see a violence strategy implemented at hospitals across the province. The strategy would include mandatory reporting of every violent incident reported to the Ministry of Labour - currently, employers are only required to report fatalities and critical incidents to the ministry - mandatory risk assessment of every patient, increased security and more health-care providers hired. They also want the Ministry to charge individual hospital CEOs when workers are not adequately protected from violence.

He added that legislation requires employers to assess the risks of workplace violence, create workplace violence and harassment policies, develop programs to implement those policies, and take every precaution reasonable to protect workers from workplace violence. ONA's call for an updated safety strategy comes on the heels of a decision by the Ministry of Labour to lay charges against Toronto's Centre for Addiction and Mental Health (CAMH) in December 2014. The charges - made under the Occupational Health and Safety Act and relating to failure to protect workers from workplace violence - stem from a violent incident in January 2014 in which a nurse was dragged, kicked and beaten beyond recognition, according to ONA.

Toronto police later charged the patient, who was found guilty of assault causing bodily harm, according to court documents. "We don't want staff ever to feel that aggression is the norm," said Rani Srivastava, chief of nursing and professional practice at CAMH, in response to the comments. "We are committed to a culture of safety and recovery and that means safety for staff and patients." Jean Dobson, a nurse at University Hospital in London, Ont., said she's been strangled with a stethoscope, stabbed with a metal fork and spat at by patients over the course of her 42-year career. "People think that they can hurt a nurse and that's OK," she said. "We have to smile and take it."

In one incident, Dobson had her nose broken when she was kicked in the face by a patient. She was forced off work for weeks and suffered from PTSD, she said. Dobson said she's seen the frequency of patient-on-nurse assaults and the severity of violence increase during her career. At Sunnybrook Hospital, reports of abuse against staff by patients and visitors jumped from 140 in 2012 to 320 in 2013. The hospital attributes the increase mainly to their move to electronic reporting, which makes it easier to record violent incidents, a spokesperson told the Star. According to a 2005 national study from Statistics Canada, 34 per cent of nurses surveyed reported being physically assaulted by a patient in the previous year, and 47 per cent reported experiencing emotional abuse. For those working in psychiatric and mental-health settings, 70 per cent of nurses reported experiencing emotional abuse.

But stress is not the sole explanation. As both the coroner and the ombudsman note in their reports, the medical classroom and workplace are brutal: Bullying and psychological harassment are commonplace in hospitals, and the stigma about mental illness is pervasive in the medical profession. In short, medical education is too often imbued with a macho attitude that learners have to be broken down and toughened up and that those who can't take it are weak and unworthy.

Perversely, many physicians take pride in this boot-camp mentality. When efforts were made to eliminate the insane 100-hour workweeks of residents, old-timers quietly (and sometimes not so quietly) dismissed the younger generation as wimps. Even Quebec Health Minister Dr. Gaetan Barrette, when asked about medical-school suicides, reacted dismissively, saying: "The pressure they are dealing with is a lot less than it was 15 years ago." In fact, what's different today is not that young people are weaker, it is that expectations are so much higher and isolation is so much greater, in spite of (or perhaps because of) so-called social media. Medical students and residents are also headed into a world of uncertainty, not one in which they are guaranteed a life of privilege.

There is also an open recognition of the problem; when residents and doctors killed themselves before, it was hushed up - now it is at least talked about. But while the system has become adept at collecting data on depression and suicide, it has done little concrete to offer help and invest in prevention. Emilie Marchand, like all her classmates, had stellar marks and, from the time she was in high school, dedicated herself heart and soul to the goal of becoming a doctor - in her case a specialist in internal medicine. When she was in medical school she was diagnosed with a personality disorder and, in residency, suffered from bouts of depression so severe that she had to be hospitalized. She also had a previous suicide attempt, using the same drug, hydromorphone. But Ms. Marchand continued her studies full bore and - her friends testified later - lived in mortal fear that her illness would be exposed and her career derailed.

Increasingly, research is showing that so-called superperformers (such as those attracted to medical school) are particularly vulnerable. Paradoxically, the very qualities that make someone a good doctor - empathy, caring, perfectionism - make them vulnerable to burnout, depression and suicide. The students attracted to medical school are among the best and brightest of their generation. They are smart, talented and driven. But many are also anxious, overwhelmed and lost - sick, not weak.

We cannot simply respond to the wounded healers with the age-old admonishment, Cura te ipsum (Physician, heal thyself). We must create an environment in which our future doctors can learn to heal, beginning with caring for themselves.

He said 555 employees participated in the most recent survey. "The health centre is committed to ensuring the safety of staff and patients and has numerous programs and processes in place in order to ensure a safe workplace and to deal with any safety issues, including workplace violence that might arise," Heinrich said.

"Further, the North Bay Regional Health Centre supports a blame-free culture of reporting of safety issues, including issues of workplace violence. As per the Occupational Health and Safety Act (OHSA) under no circumstances will any person who in good faith reports an incident of workplace violence /harassment or assists in its investigation be subject to any form of retribution or reprisal as a result of this action."