Nurses reluctant to flee risky situations, can’t count on support from bosses, U of M researcher discovers

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This article was published 30/12/2024 (251 days ago), so information in it may no longer be current.

Nurses are reluctant to leave patients, even when they’re feeling threatened, and can’t bank on getting much support from their supervisors in difficult situations.

Those are among the things three dozen nurses from Ontario to B.C. revealed to University of Manitoba instructor Jennifer Dunsford, a registered nurse doing research for her 303-page PhD dissertation.

The interview subjects — including 10 from Manitoba — had all dealt with risky and/or violent situations in the workplace.

“People lived through some pretty scary stuff, and then got up and went back to work the next day, which is mind-boggling to me,” Dunsford said Monday, adding she was contacted by 65 members of the profession and ended up with 36 who completed the interview process and consented to sharing their stories.

“There was no shortage of people who wanted to talk. There was very clearly a need for nurses to talk about this — about their experiences of violence in the workplace.”

The idea for the research came from her seven-plus years of experience as the Winnipeg Regional Health Authority’s director for ethics services. She often received calls from health-care providers asking for help in working through the decision-making process of a given situation.

“I was worried about finding people, because the situations are so traumatic that (she thought) people wouldn’t want to talk about it. But I think it was a bit therapeutic for a lot of them to talk about some of the situations that they were in,” said Dunsford.

“Sometimes people didn’t really even recognize that they’ve done anything remarkable by either staying in a situation or making a really difficult decision to leave.”

She said “very often” nurses felt they weren’t supported by employers and supervisors. Some participants said supervisors suggested they had provoked a situation.

‘“If you’d just gone in there in a different way, then maybe this wouldn’t have happened to you,’ and, ‘You know, it’s just part of the job, so move on.’ There isn’t time for debriefing an incident… you’ve got to pick yourself up, dust yourself off and go back to work,” she said.

“One of the recommendations is we need to be able to sit and talk and have critical-incident stress-management type of conversations.”

A Shared Health spokesperson said officials are looking forward to reviewing the study in the coming weeks.

“The safety and security of nurses and other health-care staff is of paramount importance, with a multi-faceted approach being taken to addressing the various challenges faced in this area,” the spokesperson said in an email.

Shared Health has hired 42 institutional safety officers for Health Sciences Centre with 21 more to come, increased security at key entrances, stepped up foot patrols and improved parkade safety, the spokesperson said, adding weapon-detection scanners will be set up at multiple entrances in the new year.

Dunsford said that for health-care providers, leaving a vulnerable person — even if there’s a risk of violence — feels like “failure.”

“I had one person who described having to leave somebody with a cognitive impairment in a soiled adult diaper in a wet bed because they just couldn’t get in there in a way that was safe,” she said.

“That doesn’t feel good. You think about, ‘If this was my mom, this was my child, how would I feel about somebody leaving them that way?’ It never felt good, even if they knew that staying in this situation was risky and could cause them injury.”

She said the nursing code of ethics specifically prohibits abandonment, and there’s all kinds of case law dealing with negligence. Some participants said they didn’t want to get sued, so they stayed in a situation longer than they otherwise might have because of concerns related to legal action.

The researcher heard from several nurses who said they were likely to tolerate more risk for a longer period from a patient with cognitive impairments or someone in a psychiatric crisis.

“They were much more quick to leave a situation if it was a family member or a bystander who could clearly control themselves but chose not to…. If it seems like you could control your temper but you choose not to, you get a lot less sympathy,” said Dunsford. “Very often those people aren’t in quite as acute a medical need, and if the nurse leaves temporarily or permanently… it feels like you can justify it in a different way.”

She also heard from nurses who experienced heightened risks while working alone in home care and overnight at remote northern nursing stations.

“If you’re in a hospital you can call a ‘code white,’ and within seconds you get a whole bunch of people there,” she said. “Just having somebody to help you — even just somebody standing there to be another presence might make somebody think twice about doing something silly.”

Some participants reported that having a team of uniformed security officers respond can turn a tense situation into a violent one.

“Having security on hand could exacerbate situations,” she said. “Nobody ever wanted to provide care by force, but sometimes that was something that was necessary in order to preserve the safety of the nurse or other people in the environment.”

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Institutional safety officers and weapons scanners at HSC are “mitigating factors,” said Dunsford, who recommended measures to reduce the number and impact of violent situations, including more training.

“There are evidence-informed ways of communicating and approaching people in a way that is not seen as threatening,” she said.

Some Manitoba long-term care facilities adopted a “gentle persuasive approaches” program, she said.

Adequate staffing to allow nurses and others time to address patient needs and access to help and escape routes when situations become unsafe would go a long way to reducing “moral distress” nurses face on the job, she said.

carol.sanders@freepress.mb.ca

Carol Sanders
Legislature reporter

Carol Sanders is a reporter at the Free Press legislature bureau. The former general assignment reporter and copy editor joined the paper in 1997. Read more about Carol.

Every piece of reporting Carol produces is reviewed by an editing team before it is posted online or published in print — part of the Free Press‘s tradition, since 1872, of producing reliable independent journalism. Read more about Free Press’s history and mandate, and learn how our newsroom operates.