Workplace violence makes nursing one of Canada’s most dangerous professions.

A man in his 20s, shirtless and tattooed, with blood pooling beneath his bottom lip, is lying on a bed in Toronto East General Hospital at 5 a.m. It took six police officers to restrain him.

When they left, his care was handed over to nurse Doriann Duncan-Johnson.

“He is agitated and violent, spitting at us, cursing and telling us to f— off,” said Duncan-Johnson, an emergency department nurse. This isn’t the first time these nurses have felt threatened caring for this man. He wears a blue band on his wrist, put on by the admitting nurse to signal that he has a violent history.

Related: Nurses speak out about violence on the job

The bands represent a unique “flagging” system in place at Toronto East General — and being studied across Canada — to help stop physical attacks on nurses.

“When you see somebody walking around with that arm band, you will think twice and be a little bit more cautious,” said Angie Panou, an RN. “You’re not going to get yourself caught in a situation where that person might be an aggressor. You are going to approach them differently.”

Between 2008 and 2013, there were more than 4,000 reported incidents of workplace violence against Canada’s registered nurses and licensed practical nurses that were serious enough to prevent them going to work, according to data analyzed from the Association of Workers’ Compensation Boards of Canada. That surpasses the number reported by police officers and firefighters put together.

In Ontario, nursing is one of the most violent professions, with more than 760 incidents reported between 2008 and 2013.

Since 2010, the province has issued only three charges against hospitals related to workplace violence, the investigation found. The vast majority of the aggressors never face punishment, largely because they are often vulnerable patients, some of whom are suffering from dementia and others who have other serious health problems.

Responsibility for nurse safety falls to hospital administrators, who often aren’t doing enough to protect their staff, say nurses, health policy researchers and politicians.

“I think there was that cultural part of this that we’re trying to overcome, that if you became a nurse you … would be asked to go into a violent situation and there was potential for you getting hurt and that was OK,” said Ontario Labour Minister Kevin Flynn. “Obviously, it’s completely unacceptable.”

Last year, the province launched a three-year inspection “blitz.” Inspectors are to visit every hospital with the goal of “bringing them into compliance,” Flynn said.

“The law clearly allows us to lay charges (against hospitals) and we will lay charges where it’s necessary. We’re very, very serious about this.

“There has to be a consequence to not doing the right thing or to be told to do the right thing and deciding that you’re not going to.”

Based on interviews with dozens of nurses across Canada, serious violence and abuse in the workplace are a troublingly common narrative.

“There was a case where a patient tried to stab me with a fork,” said Laura LeBlanc, a 28-year veteran RN and manager of medicine at Toronto East General. She suffered a back injury from the incident.

“I’ve had staff attacked, kicked in the head, slapped, punched, had their private body parts grabbed and patients attempting to strangle them.”

Toronto East General is considered a national leader in addressing violence against its health-care providers following a series of new measures in recent years. They include:

  • A “flagging” system that places blue wrist bands on patients with a history of violence at the hospital. Nurses receive a daily list of patients wearing the bands and huddle regularly to review the cases.
  • Personal communications devices worn by all nurses to give them swift access to emergency help.
  • The installation of more than 360 security cameras.
  • Offering training to nurses on self-defence, including how to get out of chokeholds and how to avoid being trapped in a room with a violent attacker.

Among the challenges in addressing violence against nurses is the professional code of silence surrounding the problem.

There is widespread agreement that workers’ compensation filings by nurses claiming injury from violent attacks on the job don’t come close to reflecting reality.

Violent acts have become so common that the vast majority are never reported by nurses to their superiors.

Dozens of nurses interviewed across the country said they haven’t reported violent acts because they fear retribution from superiors or because they did so in the past but nothing changed.

“It’s pointless,” one veteran nurse in Toronto said on condition of remaining anonymous for fear of repercussions.

“I was hit by one patient last year so hard I lost consciousness. My supervisor just told me it is part of my job and to suck it up.”

Henrietta Van hulle, a former nurse and now a workplace violence researcher, said it’s endemic in the profession to not report incidents.

“They’re scared of stigmatizing the patient. They don’t report because they don’t believe it will make any difference.”

Nurses who are victims of violence at work are just as unlikely to want to tell those stories publicly.

The Star/16×9 investigation interviewed dozens of nurses across the country with sometimes dramatic cases of violence.

Some said they blame themselves for the incidents. Others said they could never speak publicly or report the incidents to their employers for fear of being fired from the jobs they love.

“I would love to tell the world what’s happening inside our hospitals,” said one. “But it would be professional suicide for me. They’d fire me. Or they’d get back at me somehow. Speaking out just isn’t done in the health-care industry. Those who do are blacklisted.”

“I don’t want any nurse in the province of Ontario to be afraid to step forward,” Labour Minister Flynn said.

“If I thought for a minute that there (are) employers who are trying to provide some level of retribution for (nurses) coming (forward), that’s clearly illegal. We don’t tolerate that. We don’t stand for that.”

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