202. CCA Study Notes: Health Care Worker Safety, Abuse, Harassment, and Bullying

The Big Picture

Health care workers sometimes face harmful words, actions, unwanted sexual behaviour, or bullying while working. The person involved might be a client, a client’s family member, a co-worker, or another member of the health care team.

These situations should not simply be accepted as part of the job. You need to know how to protect your safety, respond professionally, report what happened, and record important details when required.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Abuse of Health Care Workers

Abuse means physical or mental harm that another person deliberately causes.

Health care workers, including support workers, sometimes experience physical or verbal abuse while working. The abuse might come from:

• clients
• clients’ family members
• other members of the health care team

Health care workers face a greater risk of client abuse in some situations. These include working with clients who:

• live with a mental health disorder
• have a condition that affects behaviour, such as schizophrenia or dementia
• have an addiction to drugs or alcohol
• have a history of abusive behaviour
• are being placed in restraints

Responsive Behaviour and Cognitive Impairment

Some clients have cognitive impairment and no longer have the ability to explain their feelings with words.

A client might become aggressive because the client is:

• cold
• uncomfortable
• ill

The aggressive action might be a responsive behaviour that shows how the client feels when the client cannot explain the feeling verbally.

Client abuse still requires a response. Staff should never ignore abuse or accept it as part of the job. Employers have policies for dealing with abusive clients.

What to Do When a Client Is Abusive

Safety comes first when dealing with an abusive client.

Keep Yourself in a Safer Position

• Stay calm.
• Stand up so the client is not in a dominant position.
• Keep about 2 m (6 ft) between you and the client so the client cannot easily hit or kick you.
• Position yourself close to a door in case you need to leave quickly.
• Know where call bells, alarms, closed-circuit monitors, and other security devices are located.
• Keep your hands free.
• Do not touch the client.

Communicate Calmly

Listen to the client and restate the client’s message in your own words.

Speak calmly. Do not:

• raise your voice
• argue
• scold
• interrupt

Stay polite and positive.

Avoid telling the client to “calm down” or saying the client has no reason to be angry. Instead, acknowledge the client’s frustration and explain that you will get your supervisor to intervene.

Watch Body Language

Watch for changes in the client’s body language.

Examples include:

• shaking
• clenching fists
• changes in posture

These behaviours might show that the client is preparing to hit or push.

If You Are Working in a Facility

If an abusive situation happens in a facility:

1. Tell the client that you will get a nurse to intervene.
2. Make sure the client is safe.
3. Quickly leave the room.
4. Tell the nurse or security officer what happened.

If you cannot leave and you think the client is about to lose control, use a call bell, alarm, or another security device.

If You Are Working in a Client’s Home

If you think you are in danger while working in a client’s home:

1. Leave the house.
2. Go to a safe place.
3. Immediately call your supervisor.

If you cannot leave the house and you feel threatened, call the police by dialing 9-1-1.

After an Abusive Encounter

Complete an incident report after an abusive encounter.

The employer’s policies also guide how staff should deal with abusive clients.

Examples of Abuse by a Cognitively Aware Client

A cognitively aware client might show abusive behaviour through:

• swearing or name calling
• racial or cultural slurs
• hitting, pushing, kicking, spitting, biting, or pinching
• other physical attacks
• inappropriate touching
• following a worker home
• finding a worker’s phone number and calling the worker at home

Sexually Aggressive Behaviour from Clients

Some clients flirt or make sexual advances or comments toward health care workers. Other behaviours include:

• exposing themselves
• masturbating in front of a health care worker
• touching a health care worker inappropriately

These behaviours might occur more often among clients who are cognitively impaired.

Changes in a client’s mental condition might reduce the social filtering that normally stops a person from acting on sexual urges in public.

Sexual behaviour from a client is usually not intended to be abusive. It still must be addressed. You must notify your supervisor when a client makes sexual advances toward you.

Other Reasons for Sexually Aggressive Behaviour

Some cognitively aware clients show aggressive or sexually aggressive behaviour without a mental or physical challenge causing it.

A client might touch a health care worker because of unmet needs related to:

• love and belonging
• self-esteem
• loneliness
• feeling unloved

These situations might embarrass or anger a support worker. The worker must still respond professionally.

How to Respond to Unwanted Sexual Behaviour

If a client touches you or behaves sexually toward you:

• Ask the client not to touch you and tell the client where you were touched.
• Tell the client that you will not do what the client wants.
• Tell the client that the behaviour makes you uncomfortable.
• Politely ask the client not to behave that way.
• Leave the room or house if you think your safety is at risk.
• Call your supervisor when safety is at risk.
• Tell your supervisor what happened.

Your supervisor can help decide whether further action is necessary.

If you feel uncomfortable being with the client, you have the right to ask for assignment to another client.

Sexual Harassment in the Workplace

Sexual harassment is a form of sexual abuse. It includes sexual conduct, comments, gestures, threats, or suggestions in the workplace.

The behaviour might come from:

• clients
• clients’ family members
• co-workers

If another person’s behaviour offends you or makes you uncomfortable while you are at work, the behaviour is harassment.

Sexual harassment is not limited to women. It can also affect men and people of all genders.

When a Co-Worker’s Behaviour Is Unwelcome

If a co-worker makes comments that make you uncomfortable, firmly but politely tell the person that the conduct is unwelcome and unacceptable.

Do not assume the co-worker already knows that you object to the behaviour.

Be assertive, but do not be rude. Many people stop the behaviour once they understand that it is unacceptable.

Keep a Record

Try to have a reliable witness present when you object to the behaviour.

Always record important details, including:

• when the incident happened
• where it happened
• what was said

Keep this documentation in a safe place. The record gives you information to refer to if the behaviour happens again.

If the harassment continues, tell your supervisor.

Employers in Canada are legally required to prevent sexual harassment at work. Employers also have policies for dealing with sexual aggression and harassment.

Workplace Bullying

Workplace bullying involves acts or verbal comments that mentally hurt or isolate a person in the workplace.

Bullying sometimes appears obvious. Other times, it appears in subtle ways.

Examples include:

• a co-worker repeatedly making fun of your hijab
• a manager regularly making inappropriate comments about your physical appearance
• a co-worker threatening your safety after a heated discussion
• a supervisor rubbing your shoulders despite repeated objections

Look for the Pattern

When identifying bullying or harassment, consider:

• the type of incidents
• the number of incidents
• how often they occur
• especially the overall pattern

Health care workers who feel bullied might also compromise client safety.

Employers have a duty to protect workers from workplace risks involving both physical and mental health.

Effects on the Person Being Bullied

A person targeted by bullying might experience:

• anger
• frustration or helplessness
• increased vulnerability
• loss of confidence
• loss of sleep or appetite
• stomach pain or headaches
• panic or anxiety, especially about going to work
• family tension and stress
• difficulty concentrating
• low morale and productivity

Effects on the Workplace

Bullying can affect the entire workplace.

Possible effects include:

• increased absenteeism ⓘ
• increased staff turnover ⓘ
• increased stress
• increased costs for employee assistance programs and recruitment
• increased risk of accidents and incidents
• decreased motivation
• decreased staff morale
• decreased quality of client care

What to Do About Workplace Bullying or Harassment

If you feel bullied, discriminated against, victimized, or harassed, firmly tell the person that the behaviour is unacceptable and ask the person to stop.

You can ask a supervisor or union member to be with you when you speak to the person.

Keep Factual Records

Keep a factual journal of daily events.

Record:

• the date
• the time
• what happened
• how the event affected you
• names of witnesses

Keep copies of material received from the person, including:

• letters
• memos
• emails
• faxes

Report the Harassment

Report the harassment to the person identified in your workplace policy.

Depending on the workplace, this person might be:

• your supervisor
• a delegated manager
• a union steward ⓘ

If your concerns are minimized, move to the next level of management.

Do Not Retaliate

Avoid: Do not retaliate ⓘ against the person.

Retaliation might make you appear to be the person causing the problem. It can also create confusion for the people responsible for evaluating and responding to the situation.

Common Mix-Ups

Wrong Idea	Better Idea
Client abuse is simply part of health care work.	Client abuse should never be ignored or accepted as part of the job.
Sexual behaviour must be intended as abuse before you respond.	Sexual behaviour might not be intended as abuse, but it still must be addressed.
A co-worker will know that a sexual comment bothered you.	Firmly and politely tell the co-worker that the behaviour is unwelcome and unacceptable.
One detail alone always shows workplace bullying.	The number, frequency, and especially the pattern of incidents help reveal bullying or harassment.