Code White: Aggression and violence on the front line of health care

Global Television recently aired a provocative feature on violence against nurses. It shines a light on the verbal and physical abuse healthcare workers can suffer on the job. Stephanie Ellis is in charge of the three medicine units at the Misericordia Community Hospital in Edmonton. She admits it is a serious issue.

“We would probably run into one situation a day on the units where someone is maybe not physically aggressive but is verbally aggressive,” says Stephanie Ellis, Program Manager, Medicine, Misericordia Community Hospital. “Our staff almost start to feel like it is an expected part of their job and they just need to deal with it. We are saying no, it is not; you do not need to be yelled at and sworn at."

One way Stephanie is arming her staff is with non-violent crisis intervention training. 

“It teaches them defusing techniques—to be in a situation and be able to defuse anxious hostile behaviour at the earliest stage. It is recognizing it to keep them safe and bring the patient or the family member down in their levels of anxiety or violence,” says Stephanie.

Stephanie says the vast majority of her staff are trained and it is a priority for new hires, especially recent graduates who are particularly vulnerable.

Other steps on the medicine units include improved communication between shifts. If an issue with a patient or family has been identified, there is a process in place to ensure the information is shared. Family expectations are discussed on admission and one family spokesperson is identified. More support is also being provided from leadership when there is an issue; they can intervene if necessary.  

Anytime a staff member feels in danger from either a verbal or physical threat, they are encouraged to call a Code White, the emergency response code for violence or aggression, and Protective Services responds immediately. Protective Services also plays a key role in the Emergency department; every day they are involved in managing and assisting with care.

The non-violent crisis intervention training is also offered to the Misericordia’s critical care and emergency departments. It is considered mandatory for all mental health staff, and Occupational Health and Safety is expanding the training across all Covenant Health facilities.


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