Sexual assaults, a life-altering concussion, shattered faces, fractured bones, and brain injury are some of the workplace violence injuries sustained by Ontario health care staff.

The study, "Assaulted and Unheard: Violence Against Healthcare Staff," was published in NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy.

The study was led by Canadian researchers Dr. Jim Brophy and Dr. Margaret Keith affiliated with the University of Windsor and the University of Stirling in the United Kingdom, and Michael Hurley, president of the Ontario Council of Hospital Unions (OCHU). It provides a clear picture of how workplace violence affected Ontario hospital staff physically, psychologically, interpersonally and financially.

Over a period of several months, the researchers visited every region of the province and completed 13 in-depth group interviews, each lasting 2 to 3 hours with 54 individuals representing a range of health care occupations and years of experience.

"We've learned that violence against health care staff is very widespread. We can't ignore this issue any longer. Just as we cannot ignore domestic assault or discrimination or harassment or sexual assault. And we are wrong to make excuses for violence, or silence those who suffer from it, because it has enormous repercussions for workers' own personal well-being as well as for the care they are able to provide for their patients," says Dr. Keith.

Many of the staff interviewed told the researchers they often work in pain caused by patients' aggression. Those working in emergency departments, psychiatric units, forensics units, and long-term care facilities said that they regularly go into work fearing they will be physically assaulted by those for whom they are providing direct medical and personal care.

Incidents of sexual harassment and assault are so commonplace, they are seldom formally reported. In fact, some health care staff felt they would suffer negative repercussions if they were to speak out about it.

The study concludes that there is a lack of institutional and legislative acknowledgement of the enormity of the problem of violence against health care staff and a corresponding lack of resources, such as adequate staffing, appropriate facilities. Preventative programs, like 'zero tolerance' policies and security measures and ensuring adequate staffing levels, a strategy recommended in much of the literature, was cited and emphasized in every group interview.

"There is a systemic under-reporting of violence in health care settings. So much so that the problem has been effectively concealed from public scrutiny. As a result, there is little public pressure to change the conditions that lead to violence. We know that ending violence against health care workers is not going to have a simple on-off light switch solution. It will require acceptance that there is a huge problem, focus on prevention and an in-depth look at the overall health of our health care system," says Dr. Brophy.

Those interviewed also identified the impacts of lingering psychological trauma and raised prevention strategies that included a wide range of post-incident supports, such as psychological counseling and financial supports, such as compensation, adequate time off work, and therapy.

Almost every participant in the study expressed fear that their employer might find out somehow that they had taken part in the study and that they might be disciplined.

"We heard that hospital staff care for patients in Ontario hospitals in a toxic environment of physical and sexual violence. They feel unsupported by their managers and are often blamed for the assaults they have suffered, which compounds their trauma. Health care staff felt unsafe talking about the issue of violence with the hospitals. Legislated protections would address the fear that study participants expressed about being reprimanded or losing their jobs for reporting or speaking up about the problem of violence," says Hurley.