During a recent radio interview, Gayle Duteil, President of the BC Nurses Union, described the level of violence that her members are facing on the job. It is truly alarming, and violent incidents involving patients have risen steeply of late.
Worksafe BC confirms this, showing data that over 61% of the claims for violent injury of between 2006 and 2015 were in the Health Care and Social Services sector. Ms. Duteil went on to described what a “code white” is: when a patient needs to be restrained, the nurses plan how they will take him or her down (who will grab the left leg, who will grab the right, etc.) and of course many are injured in the process. That nurses are expected to do this, sometimes hundreds of times a year at busy hospitals, is shocking. At the end of the interview, Ms. Duteil put a call out to BC’s political parties, asking them what they would do to address this problem. I absolutely agree that this is a pressing issue, and should be addressed.
The reaction from the two main parties will be entirely predictable. The NDP will say that the Liberals have underfunded healthcare, and the Liberals will tell us our hospitals are performing well in general, and they’re working to address this specific problem (in some non-specific way). The way I see it, both parties are responsible for a healthcare system that seems not very adaptable to changing circumstances, be it rapid population growth, anti-biotic resistant bacteria, or unruly patients.
Why is that? Because healthcare in Canada is a centrally planned system. When there is an increase in demand for a particular service or product, the administrators at the top must quantify that demand somehow (perhaps on a survey of hospital and clinic intake records) and estimate how much of that product or service to provide to patients. However they are constrained at every turn. They are constrained by the budget they have. They are constrained by staffing levels, which are determined with unions, and further limited by provincial professional licensing schemes. They are restrained by the fixed capacity of facilities, hence patients on beds in hallways.
Let’s compare this situation to another product we require for survival: food. Can you imagine going to the supermarket to buy some bread and finding none on the shelves, being asked to sit and wait until the baker could bake some…and you end up waiting 4 hours? Of course not. If bread becomes scarce, prices increase, incentivising producers to make more, and distributors and retailers to get it to customers faster. The price mechanism works so well, that we scarcely notice its functioning. We take it for granted that we can find thousands or products on supermarket shelves any time of day or year, and even dozens of kinds of one type of product to suit our tastes.
Turning back to the specific issue of violence in the workplace, let’s do another thought experiment. Let’s say you were working as a shipping clerk at a distribution center. One day, an armed man bursts into your office, forces you to hand over the cash in the till. What would you do, other than reporting the incident to the police? Personally, I would expect my employer to provide better protections so that I wouldn’t have to go through the harrowing experience again. And if your employer didn’t provide any, you could quit and find a job with an employer who does. The employer has an interest in keeping staff and the cash in the till, and will very likely provide sufficient security measures.
What’s different about the nurses’ situation? First of all, it’s not as easy for nurses to find equivalent work with equivalent pay with another employer. Sure, they could go work in a private care home, but that doesn’t pay very well. They could look for work in another province, but that could take years to get licensed in that province and work up the seniority ladder in the union there. What about from the employer’s perspective? What factors must be considered in deciding whether to hire more security guards like the owner of the distribution center would? There could be many, including budget limitations, staff availability, agreements with unions, patients’ rights, and others I haven’t thought of. Weighing these many factors against each other to come to an optimal balance is near impossible for a small group of people to do, no matter how wise and experienced.
But that addresses only one side of the equation. Nurses have put up with such bad working conditions because the monopolized nature of our current healthcare system means they have few other employment options. But what if there was a privately owned clinic down the street, one that found a more effective way of dealing with violent patients? All other things being equal, that would probably be a more attractive place for nurses to work.
We realize that violence in the healthcare system isn’t an easy problem to deal with. Most of the patients who get out of hand are doing so because of dementia or other medical conditions, and dealing with them isn’t as simple as throwing them out of the building. We certainly don’t have all the answers, and realize that we need to learn more about the current healthcare system in order to provide solutions. But we need to grapple with this problem, recognizing that government bureaucracies are often resistant to change. So to answer Ms. Duteil’s question, what the BC Libertarian Party would do to offer BC nurses a safer working environment is to give them more choice of employers, and let those employers compete to offer the kind of safer workplace that will best attract qualified staff.