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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.

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)

Front-line health-care workers are doing their best to care for you and your loved ones. No one should have to endure physical or verbal abuse at their place of employment, regardless of the perceived shortcomings of the health-care system. People who believe they are waiting too long to see a specialist or in the emergency department should ask themselves whether there may not be someone sicker ahead of them in line. Instead of writing nasty comments to the Star about how long you had to wait in the emergency department for your last viral illness, perhaps readers should be writing to Dr. Eric Hoskins, the Ontario minister of health, regarding the Liberal government's plans to make it more difficult to see your family doctor in the coming years. Dr. Colin Blair Meyer-Macaulay, pediatrics, B.C. Children's Hospital, University of B.C.

However, we should avoid diagnosing this problem merely as a failure of law enforcement. Murders represent the tip of an iceberg of problems related to endemic violence in communities. Many Aboriginal women and girls, and indeed men and boys, live each day under the threat of interpersonal violence and its myriad consequences.

Initial statements from the three federal ministers tasked with leading the forthcoming inquiry — the ministers of Indigenous and Northern Affairs, Justice and Status of Women — suggest that its purpose is to achieve justice, to renew trust between indigenous communities and the Canadian government and law enforcement bodies, and to start a process of healing.

The inquiry surely must also endeavour to lay the groundwork for a clear plan to address the broader problem of interpersonal violence, which, in turn, is rooted in several key determinants. Addressing interpersonal violence is not merely an issue of justice; it is also a public health concern.

Factors associated with both the experience and perpetration of interpersonal violence are manifold. They include but are not limited to mental health issues, drug and alcohol misuse, unemployment, social isolation, low income and a history of experiencing disrupted parenting and physical discipline as a child. The Truth and Reconciliation Commission’s report has highlighted that many of these factors are widespread in the Aboriginal populations of Canada.4 Many of the same factors contribute to disparities between Aboriginal and non-Aboriginal peoples in areas such as education, socioeconomic circumstances and justice. T

here is also substantial overlap with identified determinants of poor health in Aboriginal communities both in Canada and elsewhere.5,6 These are the factors associated with higher rates of youth suicide, adverse birth outcomes and tuberculosis, and poorer child health. It’s clear that a common web — woven of a legacy of colonization and cultural genocide, and a cumulative history of societal neglect, discrimination and injustice — underlies both endemic interpersonal violence and health disparities in Canada’s indigenous populations. There is no conversation to be had about one without a conversation about the other — if the aim is healing — because the root causes are the same.

The World Health Organization (WHO) is currently engaged in developing a global plan of action to strengthen the role of health systems in addressing interpersonal violence, particularly that involving women and girls.7 A draft report by the WHO acknowledges interpersonal violence as a strongly health-related issue that nevertheless requires a multisectoral response tailored to the specific context. Evidence from Aboriginal community models in Canada gives hope for healing.

A recent report from the Canadian Council on Social Determinants of Health highlighted important strides that some Aboriginal communities have made to address the root causes of, and to mitigate, inequities through efforts to restore the people’s connection with indigenous culture.8 Increasing community control over social, political and physical environments has been linked to improvements in health and health determinants.

The public health sector in many parts of Canada has embraced the need for strong community involvement in restoring Aboriginal people to the health that is their right. In many community-led projects over the past few decades, the health care sector has worked with others to address common proximal and distal determinants of disparities.

We are presented with not just an opportunity for renewing trust between indigenous communities and the Government of Canada but also for extending the roles of public health and the health care sector in the facilitation of trust and healing. There is much that the health sector can contribute to the forthcoming inquiry. Health Canada should be involved from the start to ensure that public health is properly represented

North Bay nurse Sue McIntyre was fired by her hospital after she spoke on panel at a nursing conference about violence against health care staff. "While some health care employers want to deny that workplace violence is a growing problem, statistics show it's an enormous problem. We believe being open and frank about the root causes of violence against health staff and a proactive search for solutions is the best way to change the culture and to increase the safety of staff and the people we care for," says Richer. FOR FURTHER INFORMATION PLEASE CONTACT: Sharon Richer OCHU North Eastern Ontario Vice-President 705-280-0911 Stella Yeadon Canadian Union of Public Employees (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.

Fetterly said there could be violent blows and spitting from patients but also the threat of violence from visitors to a facility. "This kind of abuse has to stop and we'll be going to the provincial government to put some demands on to make some changes," she said.

"We have had nurses stabbed, beaten up, punched in the head, fallen to the floor, cracked their head on the floor, kicked, punched," Tracey Newton, a nurse at Providence Care and a chief steward with the Ontario Public Service Employees Union Local 431, said at the time. "Quite often, on a daily basis, nurses are subjected to violent assaults. We still have five nurses offwork with head injuries." Clayborne said the stories are the same where she works in Hamilton. "We've had quite a few incidents that have been brought to the public," she said.

Recently, according to the council, nurses have been attacked in Hamilton, North Bay, Cornwall and Kingston. Last November, about a dozen staff members from the Providence Care Mental Health Services site on King Street West held an information picket at the hospital entrance to bring public attention to what they say are dangerous conditions inside the building caused by having too few staffto deal with too many high-risk patients.

According to a news release from the union, its recommendations to the province include: increasing funding and staffing at least to the Canadian average in hospitals and long-term care facilities; beefing up legislation to protect healthcare workers from violence, giving health-care workers the same right to refuse unsafe work as other workers in the public sector; laying criminal charges against patients and family members who commit violence on health-care workers; and also improving security at these facilities.

In December, the hospital reported five attacks on staffby patients over a 10-day period. "We've had two nurses who were attacked: one left unconscious and suffered a severe concussion from a violent patient and another girl who had hot coffee thrown in her face on the forensic unit." Fetterly said about 85 per cent of RPNs in Ontario are women. Clayborne said St. Joseph's has five forensic units housing patients, some of whom have committed serious crimes and have mental health issues as well. "Short staffing led to those assaults," she said.

Clayborne said the patients know when the nurses are understaffed and take advantage of that. She said the nurses have to see patients without the benefit of security officers nearby. "The hospital has contracted out the security at our facility," she said. "The security guards make approximately $11.50 an hour and their job is to just show up and be there as a support, they're not supposed to put their hands on the patients." Nurses are trained in non-violent crisis intervention, Clayborne said, but when being attacked by a stronger and heavier person, the training doesn't help very much. Nurses wear panic alarms, but the alarms don't work all the time, Clayborne said.

"In violent situations, we press our alarms, nothing happens and nobody comes to help you," she said. When the alarms do work, there's a one-to three-minute delay before the call goes out. "That makes a big difference when you're being beaten before somebody comes to help you," After a violent incident, the RPNs often suffer from post-traumatic stress disorder, fear and anxiety before returning to work, and sometimes the incident also takes a psychological toll on the nurses' family members. Fetterly agreed that the issue should be considered a crisis.

Because of the funding and the funding freezes, we're working with less and less staffand the bed occupancy is at an all-time high," she said. Fetterly believes people will ultimately leave the profession. "Why should you go to work every day and be exposed to someone beating on you, intimidating you or spitting in your face. I didn't sign up for that. I signed up to give quality patient care." - With a file from Michael Lea ian.macalpine@sunmedia.ca Twitter.com @IanMacAlpine

Ian Macalpine, The Whig-Standard / Ontario Council of Hospital Unions officials Helen Fetterly, left, and Linda Clayborne attended a two-day conference on the safety of registered practical nurses in Ontario's mental health facilities.

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."

Mark Hancock CUPE national president

TORONTO – Physical abuse, sexual abuse, emotional abuse and murder — family violence is a pervasive but often hidden reality within Canadian society, says the country’s top doctor, who calls the scope of the problem “staggering.”

In 2014, the latest year for which statistics are available, almost 58,000 girls and women were victims of family violence, said Taylor, Canada’s chief public health officer.

Every four days, one woman in Canada was killed by a family member; every six days, a woman was killed by an intimate partner; while a man was murdered by a partner every 23 days.

A forum on workplace violence is planned for March 21 at 7 p.m.

After the Kingston conference, nurses appealed to the health minister to take the following actions: Legislation, to protect health care workers from violence; Providing health care with the same rights to refuse unsafe work as other workers in the public sector; Charge patients and family members who are violent with staff under the criminal code; Fund and staff Ontario hospitals and long-term care facilities to the Canadian average.