Registed Nurses' Association of Ontario

Amend Bill 163 to Include Nurses

Amend Bill 163 to Include Nurses

The Registered Nurses’ Association of Ontario is dismayed with the exclusion of nurses in Bill 163. The American Psychiatric Association (APA) defines Post Traumatic Stress Disorder (PTSD) as the “exposure to actual or threatened death, serious injury or sexual violation” (APA, 2013, pg1).

The Diagnostic and Statistical Manual of Mental Disorders (DSM) sets three criteria regarding the event that could trigger PTSD:

  1. Directly witnesses the traumatic event;
  2. Witnesses the traumatic event in person;
  3. Experiences first-hand repeated or extreme exposure to aversive details of the traumatic event.

Nurses are exposed to violence and trauma across all settings that meet the DSM criteria. Nurses in emergency departments, intensive and neonatal intensive care units, long-term care homes and psychiatric settings experience physical violence oftentimes from patients who are cognitively or mentally impaired. Work-related violence is not limited to inpatient settings, in the community nurses work in neighbourhoods with high crime rates and in home care nurses enter patients’ private residences to provide care. Nurses also have roles during events that require immediate action at their organizations categorized by codes that could trigger the onset of PTSD: cardio-respiratory arrests, violent persons, missing patients, infant abductions, hostage situations, bomb threats, pandemics, and patients with life threatening blood loss. These situations place nurses in a position where they directly witness and experience firsthand exposure to a traumatic event.

It is both offensive and ludicrous to exclude nurses as first responders when they are regularly among the first to assist during emergency situations. How fast is our government forgetting the SARS crisis, or the Ebola scare? And, how little do political leaders know about what nursing work entails?

Premier, do you and Minister Flynn, for example know that in Toronto collaborative partnerships between hospitals and law enforcement have resulted in the implementation of Mobile Crisis Intervention Teams? These teams comprise of a mental health nurse and police officer who respond to calls involving persons experiencing a mental health crisis (Toronto Police Services, 2016). In a variety of inpatient and outpatient settings, nurses regularly respond to similar crises and other emergencies without the support of law enforcement. Thus, it is both inconceivable and unacceptable that nurses are disregarded in Bill 163.

In addition to directly witnessing trauma and experiences first-hand repeated exposure to aversive details of the traumatic events and loss, nurses also face a significant amount of violence in their workplaces. According to the Workplace Safety and Insurance Board (WSIB), in 2014 1,015 allowed lost time claims were made by nurse supervisors and registered nurses who suffered a workplace injury that resulted in time off from work, lost wages or a permanent disability (WSIB, 2014; WSIB, 2015). A national study of nurses in 2005 demonstrated that 30 per cent of nurses were physically assaulted in the past year while 44 per cent were victims of emotional abuse (Statistics Canada, 2005). While these statistics are jarring, experts believe most violence is not reported due to the perception within health care that violence is ‘part of the job’, complex reporting procedures, lack of time to report, lack of response when reported, and the belief that some patients are not accountable for violent acts (Canadian Centre for Occupational Health and Safety, 2016).

An investigation on violence against nurses by the Toronto Star and 16X9 (Global Television’s investigative program) identified over 4000 reported incidents of violence against Canadian nurses in their workplaces; well above the number reported by police officers and firefighters combined (Cribb, 2015). While RNAO demands zero tolerance for violence against nurses and nursing students, it is a pervasive problem (RNAO, 2008). This is why RNAO issued the Preventing and Managing Violence in the Workplace Best Practice Guideline (RNAO, 2009). It is therefore intolerable, that Bill 163 denies nurses the right to the presumptive legislation available to other first responders that links PTSD to conditions that arise out of their workplace.

Lastly, we are saddened and shocked to realize the gender bias of this legislation - a bias that you proclaim to be committed to tackle. Indeed, in reviewing the list of workers included in the legislation there is a clear bias towards male dominated professions. Nationally, 97.6 per cent of fire fighters are male (Government of Canada, 2015a), 80.1 per cent of police officers are male (Statistics Canada, 2012), 68 per cent of paramedics are male, and 64.2 of correctional service officers are male (Government of Canada, 2015b). Compared to nursing where 92.6 per cent of the registered nurse workforce is female (Canadian Institute for Health Information, 2015). RNAO has been vocal regarding the gender gap in the workforce and most recently submitted Closing the Gender Wage Gap to the Gender Wage Gap Strategy Steering Committee (RNAO 2016). One of RNAO’s recommendations to close the gender gap by 2025 is “mainstream equity compliance into government laws and policies” (RNAO, 2016, pg 9). Amending this bill is an opportunity to implement this recommendation and advance equitable policy.

Premier, RNAO urges you to immediately intervene by amending this Bill 163 to include nurses.

Warm Regards,

Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT.
Chief Executive Officer
Registered Nurses' Association of Ontario


Hon. Kevin Flynn, Minister of Labour
Patrick Brown – Leader, Progressive Conservatives (Official Opposition)
Andrea Horwath – Leader, New Democratic Party (Recognized Party)
Hon. Eric Hoskins – Minister of Health and Long Term Care
Ted Arnott – PC Critic, Labour
Cindy Forster – NDP Critic, Labour

See the letter with references below.

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