Friday April 18, 2014

Union angered by attack on nurse

BCNU says more staff needed at Hillside Centre to deal with violent patients

A violent psychiatric patient attacked the lone nurse on the unit after being told he’d have to wait a few minutes for toast Saturday afternoon.

Two unions representing the Hillside Psychiatric Centre workers are now calling on Interior Health to make working conditions safer for staff, with the count of violence against employees reaching 64 so far this year.

Interior Health defended the staffing levels and said they are adequate for the number of patients at the psychiatric facility.

The patient hit the nurse in the face, knocking her to the ground, then jumped on and pinned her. It took eight staff to pull him off. Two police officers had to drag him out in handcuffs and he was still able to assault one of them en route to the detachment, the unions said.

The nurse, who has worked at Hillside for less than two years, is showing signs of post-traumatic stress. This is the second time she’s been attacked by a patient in the past few months, said B.C. Nurses’ Union regional chairwoman Tracy Quewezance.

“This could have been fatal. My heart goes out to this nurse because she’s traumatized,” she said. The nurse has facial swelling and soft-tissue injuries, but the psychological price is even higher, she said.

“You don’t expect to go to work to get beat up.”

Quewezance said the baseline requirement is for three nurses per each ‘pod’ of patients. In this case, there were two nurses to deal with eight neurological patients and one went on her break.

All eight patients were ‘purple dotted,’ an indicator they can be violent.

Two staff is not adequate but requests for more have been repeatedly denied, she said. When other staff left their posts to rescue the nurse, two patients in one of the abandoned pods started fighting.

Sandy da Silva, IHA regional director for tertiary mental health services, said the authority and WorkSafeBC are both investigating.

“With any incident, this one in particular, we are conducting a full investigation to determine what if anything we can learn going forward, also recognizing the impact of such incidents on our staff. We have already provided critical stress debriefing and counselling for the staff members on shift at this time,” she said.

She disputed the union’s claims of understaffing. She said the ratio Hillside uses is one nurse per four patients — lower than other facilities that go by one nurse per six patients.

“On the night in question the centre was fully staffed,” she said.

“We have a one to four ratio to take into account we have a clientele with higher acuity as a general baseline.”

The unions determine baseline not on number of patients, but simply at three nurses per unit, while management looks at acuity and volume of patients, she said.

She has been told the nurse who was attacked is already back at work.

Quewezance said the nurse’s attacker came up two weeks ago from a forensic facility in Vancouver where staffing levels are higher. He is a big man who has attacked two patients and, just a few days before, hit another nurse.

“We are questioning why he was brought here,” she said.

Later that same night, RCMP called Hillside to see if they could return the patient as they couldn’t deal with him in cells. They were told no, and he wasn’t returned until Sunday.

“Hillside has been a very violent facility. . . . This has hit a critical point,” said Dan Murphy, president of the Union of Psychiatric Nurses.

“We don’t scapegoat the patients. It’s the facility. It’s the management.”

Workers get one day of code-white training to deal with violent patients, but Murphy said that’s like giving someone a black belt after one day of teaching.

Staffing levels are so low, psychiatric nurses don’t have any time to treat patients, he said. All they can do is get them up, feed them, medicate them, and put them to bed.

“It’s more like a glorified group home,” Murphy said. “The care is not good.”

Da Silva wouldn’t comment on the patient’s history, but did insist Hillside isn’t a forensic facility — it focuses on diagnosis, stabilization and psycho-social rehabilitation.

Her office is in Hillside and she feels safe walking the halls and meeting with patients.

As for the code white calls, they indicate staff are taking action earlier when patients seem to be getting agitated, she said.

“It’s early identification of potential violent incident or a change in behaviour of the clients. So the statistics we’re seeing is that staff are using the system earlier when there is a concern of escalating of patient behaviour. But more importantly, we’re seeing a decrease in hands-on incidents.”

Murphy said Hillside’s duress system broke two and a half years ago and hasn’t been fixed. The system pinpoints where in the building a worker is if he or she sets off an alarm.

But da Silva said that was wrong. The system is seven years old and, in her six years at Hillside, it has gone down three times that she knows of. There is also a backup system. A new system is being looked at.

Megan Johnston at WorkSafeBC said Hillside Psychiatric Centre was issued an order to do a violence risk assessment in September. It hasn’t been completed, but it can take time.

“It’s an audit of the risks. It can be a complex process of completing that,” she said.

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