Concerns about safety, unhealthy working environments and burn-out contributing to healthcare staffing shortages 

By Dr. Alika Lafontaine

For anyone who works in healthcare, it’s a familiar pattern:

Patients struggle to find access to care. Spikes in demand – the most recent driven by the tripledemic convergence of RSV, influenza and COVID-19 – overwhelms health system capacity. Both of these challenges amplify patient frustration, triggering an increasing number of them to verbally and/or physically abuse providers through insults, threats, and physical attacks. These unhealthy working environments are a primary driver of workplace burnout. They also contribute to the exodus of (desperately needed) providers.

Physicians and nurses have always suffered mistreatment at work. More than half of emergency department nurses experience physical or verbal abuse in any given week. In a survey of than 4,000 doctors and medical learners conducted by the Canadian Medical Association (CMA), 40 per cent said intimidation, harassment, bullying and/or micro-aggressions happen “often” or “frequently,” with women and racialized providers particularly at risk.

Typically, statistics like these have been greeted with a shrug. “It’s part of the job.” But the pandemic has escalated abuse in every health care setting. In my own practice as an anesthesiologist, I’ve been punched, kicked, scratched and spit on. I have been yelled at and threatened. During the pandemic this aggression has extended beyond the clinical environment, into my personal life. My situation is not unique. The prevalence and severity of abuse directed at health workers continues to expand and escalate.

Last January, new legislation finally came into effect to make intimidation and bullying of health workers a distinct criminal offence. The CMA was instrumental to the passage of Bill C-3, which has so far resulted in three charges in Ontario alone. Convictions can mean up to 10 years of prison time.

Strengthening protections for health professionals – best implemented before abuse happens, but also after the fact – is critical.

Some hospitals have constructed barriers at nursing stations. Video surveillance and “body-worn cameras” are in use at Kingston Health Sciences Centre. In the book Code White: Sounding the Alarm on Violence Against Health Care Workers, a source describes “a safe room where nurses could run to, lock the door, and we have a phone.”

The serious toll of workplace harassment on physician mental health also needs urgent attention: Respondents to our National Physician Health Survey who reported frequent experiences of harassment were twice as likely to score positive for depression than their peers, three times more likely to suffer from burnout and four times more likely to experience moderate or severe anxiety.

The CMA is building a national framework to foster better access, incentivization and accountability for doctors’ psychological and cultural wellbeing, as well as their physical safety.

All of this work must be accompanied, however, by pointed, immediate action to address the roots of aggression towards health professionals – the understaffing and under-resourcing of care.

Harassment of health workers is still focused at the level of individuals instead of the system. We need better ways to identify perpetrators and hold them to account across working environments. We need better shields and better support for the victims of abuse.

But we must also shift the current culture of physicians and other health professionals internalizing these messages, putting pressure on themselves to “just keep going.” We must shift the culture of silence when it comes to unreasonable and unsafe working environment for health workers.

In October, the government of British Columbia announced “a new security model across all health authorities,” including the hiring of 320 in-house protection services officers and 14 violence prevention leads. “Ensuring our health-care facilities are free of violence will not only help us recruit and retain health-care workers, but it will also improve patient care and continuity,” said Adrian Dix, Minister of Health.

A health system that is truly free of violence, though, is one where we also address worsening access and overwhelmed health systems. We cannot care for patients unless we care for our health workforce. These conversations are complex, but that also means small changes can have major impacts.

At the CMA, we’re committed to doing all we can to break the vicious pattern of staff shortages, staff abuse and staff exodus. Working with colleagues across the health sector, we’re pursuing an agenda of change to transform the system for the future – for providers and our patients.

Dr. Alika Lafontaine is the President of The Canadian Medical Association.