Christchurch Hospital emergency department staff are still being punched, spat on, sworn at and sexually harassed by patients, despite efforts to stem violence and aggression in the workplace.
Recorded rates of abuse have remained relatively static over the course of a seven-year study, but Canterbury and Otago University researchers suspect the problem is under-reported by doctors and nurses.
Dr Laura Joyce, who co-authored the report, said she was often abused by patients while working in the hospital's ED, which is one of the busiest in Australasia.
"Violence and aggression would happen on an almost daily basis in the ED at the moment. I would regularly be sworn at, shouted at," she said.
"I'm really worried with Covid that violence and aggression is increasingly dramatically. There's a lot of stress in the health system, our patients are waiting longer and so they're understandably getting really frustrated."
Patients have been taking that frustration out on the very people they have asked for help, with a barrage of verbal abuse, violence and sexual harassment.
Another of the report's authors, Canterbury University's Sandy Richardson, said staff were constantly threatened.
"They may well be subject to racial comments, they may be subject to sexual innuendo ... threats about what might happen to them at the end of the shift - common things - I'm going to follow you home, I'll find out where you live."
The study, published in the New Zealand Medical Journal, involved annual May audits of violence and aggression reported by staff from 2014 to 2020.
Most episodes involved verbal abuse from patients shouting and swearing, but staff also reported being punched and groped, often on night and weekend shifts.
The number of May audit reports ranged from 107 in 2014 to 86 in 2020 - figures much higher than in other months.
Joyce, who is also an Otago University academic, said that suggested standard reporting systems did not accurately reflect the prevalence of workplace violence.
"I suspect that our under-reporting is getting worse and that's why our numbers have stayed static."
Christchurch Hospital staff have also been subject to sexual and racial threats, the report's authors say. Photo / Supplied
Violence against hospital staff nationwide problem
The problem is nationwide - emergency medicine specialist Dr John Bonning ordered an intoxicated, injured man out of Waikato Hospital's emergency department on Monday night because of his behaviour.
"They were so rude and aggressive and racial disparaging of our staff - I asked him to leave and come back when he was going to be more appropriately behaved," he said.
"The nurse was visibly upset about being abused when she was trying her utmost at 1 o'clock in the morning to help this person. It's just so, so unnecessary."
Bonning also believes violence and aggression in hospital EDs is significantly under-reported, with angry people often lashing out because of wait time blow-outs.
Another doctor told the researchers about treating an intoxicated patient who had stood to urinate in an ambulance and vandalised a hospital room.
"Punched ED staff. Police called and arrested patient. Patient restrained, spat in my face and tried to punch me several times. Dug fingernails into my hand. Very verbally abusive," the doctor said.
A nurse told of a patient repeatedly "suggesting I get into bed, take my clothes off, suggestions of what he would like to do", while a hospital aide reported a "very intoxicated patient grabbing me inappropriately and fixating on me. Attempted to kiss me twice".
Along with longer wait times, Richardson said alcohol and drug use and an emerging category of demanding "all about me" patients were part of the problem.
She plans to do more research on the impact of the coronavirus pandemic on hospital violence and aggression.
"The idea that because of Covid you can't have a support person in a number of hospitals has been a source of widely raised anxiety, agitation and aggression, including physical aggression," she said.
Staff burn-out, anxiety, depression due to exposure to workplace violence
Exposure to occupational violence can lead to burn-out, and anxiety and depression, as well as absenteeism, high staff turnover and legal consequences for employers who fail to provide a safe workplace.
Joyce warns more worn-out doctors and nurses will quit without better staffing, training and more efficient reporting methods.
"Many of our profession are becoming burnt-out, many of our profession are leaving and going to other positions that don't have that front-line interaction with patients who are becoming increasingly distressed and agitated."
Christchurch Hospital's ED clinical director Mark Gilbert said the district health board had worked hard to improve safety for patients and staff.
"This includes continuing to work on improving de-escalation techniques, emergency response plans and risk information sharing.
"We have also worked hard on the design of the physical environment of our new ED to support safety and have updated our security technologies in this area."
Gilbert said staff assaults were treated seriously and they were well-supported by colleagues and management.
"Although no level of violence is acceptable in any workplace, the ED can be a challenging environment."
