Silence Isn't Safety, It's Strategy: Inside St. Joe's Fight Against Workplace Violence

I know this thing is on, and I know that you can hear me. Nursing and health care needs advocates and activism, so what are you waiting for? Let's do the damn thing. Hi, and welcome back to The Gritty Nurse, an unfiltered conversation about health care, nursing, and the intersection of health politics and policy. My name is Amy, and I am The Gritty Nurse. This podcast exam is taught topics in health care and discusses the changes that we need to see to have a more efficient, robust, and ethical health care system that is safe not only for the patients that we see, but also for those who work in the system as well. Sorry, no fluff here, just awesome fashion humans, and a lot of grit. If you're watching on YouTube or listening on Apple podcasts, Spotify, iHeartRadio, or any other podcast platform, please hit that subscribe button so you never miss out on any real stuff from The Gritty Nurse. We have all our stories of nurses or folks in health care that have been hit, kicked, spit on, sexually abused, assaulted, had names called, and for whatever reason in Canada, we're so polite, we just don't talk about it. But it's problematic, because if we don't have these conversations, we don't measure, we don't look at the stats, we can't actually fix a problem. So as much as we're speaking about it, I think that you know, hospital organizations should speak about it too, which brings me to a conversation, which recently I had been in an emergency department, and I was actually quite shocked to see that there were signs talking about workplace violence that occurs to nurses and health care providers, and that it is not okay. This is the first organization that I walked in that I've seen this, and I was quite taking it back. So you know, I think it's time, more than time, for us to have a conversation about workplace violence, and what can actually be done, because I'd say that most likely, it's not really enough. Today, we're tackling that issue that touches almost every single person working on the front lines of health care, workplace violence. But we're not going to just talk about the problem. We are talking about an executive leader who is taking steps to actually doing something about it. Today, my guess is CEO Mike Heenan, the president and CEO of St. Joseph's Health Care Hamilton. Mike brings over two decades of health care leadership to the table, including senior roles within the Ontario Ministry of Health and hospital systems across the province. Under his leadership, St. Joseph launched a raw, unfiltered public campaign, confronting the reality of violence against health care workers head on. And not only is he talking about it, he's here to tell us what he's going to do about it. Welcome, Mike, to the show. I'm so glad to have you here on the Greeniners Podcasts. Finally, we've met in our paths of crossed many different times. I'm so glad that you're finally going to come and speak to my listeners. Mike, you've held many different executive roles across hospital systems, and in the Ministry of Health, but you know, every CEO takes a different path to the top seat for folks that are listening today who might not know your background, who you are, what brought you to St. Joseph and how has your career been shaped up until now? Mike Heenan Yeah, thanks. It's an absolute pleasure to be with you today and your listeners. I think you're playing an important role in advancing the profession of nursing as well as clinical interactions, patient safety, patient experience, and worker safety. So thanks for having me today. I don't have a clinical background, so I'll just start with that. I actually started in political communications in the Ministry of Health, but I don't know 25 years ago, and I had an opportunity to become a project manager here at St. Joseph's Health Care Hamilton 25 years ago, and I've come full circle. So I've worked for the CEO Advancing Strategic Projects, I guess in 2003, and I quickly learned that, you know, you can contribute to healthcare in a variety of ways, and that can be through frontline clinical care, it can be as a clinical support service like partnering and painting and infrastructure, supply management, but I had an MBA and learned that some business processes could be brought to the sector. And so I got some stretch opportunities here to do strategic planning and look at things like quality and performance and measurement and really took off from there. And so my journey started here at St. I spent almost seven years here, and then I got great advice, which was because I wasn't a clinician, you should go out and do what you're doing twice, do it another organization, improve you can do it twice, and that you can learn different clinical cultures and different clinical delivery systems. And so, yeah, I've had a variety of roles in organizations in Ontario, probably for hospital settings in the Ministry of Health, and I think what I've learned through that journey is that it takes a whole, as the saying takes, it takes a village to raise a system and I'm proud to say hopefully that's what I've been able to learn, and hopefully that's what I'm adapting here at St. Joseph. So yeah, I've come full circle, and what brought me back to St. Joseph's Health Care Hamilton really, when I wanted to be a president and CEO, I thought, you know, what are the institutions that I would fit in with? And where do I agree with their culture and their history? And for me, a large academic health science center in an urban setting was attractive, like Hamilton, and it was founded by the Sisters of St. Joseph's. And so if you walk through the halls of my organization in any campus, you cannot miss our history. No. And so here were these eight women, wasn't men, was eight women who came to the shores of Lake Ontario, and they bought a house, and they started a hospital. That's so cool. And so we need to honor those ladies, one of them who has carried on, obviously it's been about 150 years, but there's actually a sister right now who's 97 and still volunteers in our organization. And so I think learning from them that anyone and everyone should be taken care of, and we'll talk about that theme today. So no matter who you are, what walk a life you come from, what God you believe in, who you love, what skin color you have, you're welcome here at St. Joseph, and that's a part of our history, and that's what attracted me to take this role. Wow. What a story and what a round, like roundabout kind of way to kind of be back at where you started. I think that's so amazing. I mean, we should have a whole episode talking about the sisters on like another broadcast because that's quite the story in itself, right? It is. I love talking about women and the power of women. So that's definitely something I'd love to circle back to, and the values piece, right? The fact that there are values that St. Joseph has that align with your personal values and the fact that, you know, it's so important to bring those to the forefront. Like you said, no matter where you come from, no matter what your background is that you will be cared for. And I think that brings us to the conversation we're going to have today because we need to talk about nurses and talk about nurses needing to be cared for because there was, and there is still quite a problem in relation to workplace violence, particularly with nurses. So one of the things that I read about you is that you've shared that every single morning before you start, you read workplace safety incident reports across your hospital. Is there any specific report or a story from a nurse or a particular breaking point in which you said, you know what, enough is enough? I think we need to do a major public campaign about workplace violence. Yeah. So let's start with the profession that I employ the most is nurses. Right. So I'm not saying that the other professions, whether you're a doctor or an allied health professional or a corporate support worker that you're not important, you're equally important. Of course. The reality is the most prevalent daily interactions that you'll have with as a patient is with a nurse. Right. And so I'll share the two nursing stories and then I'll share a story of a non nurse like a patient food worker. So I had read an article about this increasing evidence that was coming in. And so I was preparing to take this role. And I was just like, let's think about what's going to go on in these organizations. And I started reading about this. And so there was an article in the New York Times that said in the United States, this was happening. And there hadn't been a lot of Canadian attention to it. So I thought, well, I need to talk to my team about this. So I did. As soon as I came in, I said, I want to talk about worker safety. This is something that's happening. It can't just be happening self at the border. There's something happening worldwide. So can you send me all these incidents? And the first couple of days, sure, I'm seeing hitting, kicking, spitting, etc. But there were two in particular ones, one in dialysis. And I forget where the other one was. I think it was surgery. And that's an important note. One, it wasn't the emergency room and it wasn't mental health and addictions. So that proved to me that it happens everywhere. This does not happen just in emergency rooms to nurses. This does not happen only in mental health and addictions. This happens everywhere. I've seen incidents in surgery dialysis, complex continuing care, maternity. So this happens all the time and it happens everywhere. The one incident from dialysis was a nurse who wrote in her report, the patient lightly touched my breasts. So we're moving from kicking, spitting, yelling, derogatory slurs to actually touching. And I'm a rather candid guy. The word lightly also caught my attention. There's a grading scale that lightly versus, you know, in some significant pressure. Like, it actually showed to me that the person writing it had courage A to report. But B was a bit ashamed of it too. right like I'm gonna I'm gonna actually lower the temperature on it because I said it was lightly like I didn't know that there was a scale right that that was acceptable number one so that was one incident and then the second incidence what I tell often is is that I'm in Washington DC visiting a friend I've just left the African-American Museum of History and I open up my work phone and a black nurse is called the N word and it stopped me in my tracks here I am literally just leaving this amazing museum of what the history of African-American culture and everything from slavery to salt trade to the great things about Obama and the ascension of that and and bam it's 2023 and in my own organization someone continues to be discriminated against based on race right and so it was that moment that stopped us in our tracks and said there's definitely hitting kicking spitting and yelling but I've got now a racial issue and I've got a touching issue and and and that was important and then the third one was this is happening everywhere and so it's a medicine impatient unit the food service worker walks into the room with a tray knocks on the door it does exactly how they're trained knocks on the door high patient a on food services person I'm coming into severe meal remember what's left in the room the former meal tray right she opens up the door and the patient hits her with a meal tray and so this happens to nurses this happens to allied health professionals and this happens to our frontline dietary staff yeah and so it was those moments that said it's our obligation as an employer not to mention just human beings that that we have to do this work and it's important work and and we have to take a long-term view of this we're gonna dress it quickly and pay attention to it but here we are almost three years later and I think we've made some progress yeah you know I'm glad that you touched on the other forms of violence because I think that I think for the most part when people think about health care violence it's those various things like you mentioned like the hitting slapping and of course those things are completely inexcusable but the ones that we do share less of are you know the sexual touching the you know the inappropriate gestures or things that might be said to nurses as well and as well as this racial violence I myself endured racial violence and it's again it's it's one of those things that I think when I think about Canada and again going back to you know you were reading a newspaper in the States and saying oh well like you just don't talk about it here I think there's that kind of good Canadian like oh you know we're so polite I think there's this perception that we don't have those things here and it's just like okay well racism has no borders violence has no borders it's just we don't talk about them as much and I think that is something that we need to work towards where we have the courage to have these conversations because again when I worked in quality improvement we wanted to hear these things so we can actually do something about it because we know that it's happening but not reporting on it doesn't mean that you're that also means that you're not acting on it so I'm glad that you mentioned those other forms of violence because they do happen very often within nursing and with other professions as you mentioned as well so you started a very public campaign I got to witness it myself I had I took my mom to the ED and I was I was I was actually pretty shocked to see these things because you don't typically see the type of imagery the type of wording and so these you know these public exhibits dispitting you know real violence at the staff face and really sharing publicly that this is something that's unacceptable and something that happens and occurs on a daily basis it's actually quite a bold move for a health care system tell me a little bit more about it sure I think building off of your common you have to act and so the campaign that you're talking about is it's not okay in a cafeteria and it's not or a cafe and it's not okay in a hospital but that was just released so we had to build to that right right so the first one we did was start to encourage reporting and so at least on the racism ones and the sexual touching events I would email the staff immediately so I just don't read them I email the staff yeah thank you for having the courage to report here are the resources that are available to you I've copied in your team as well as whether it could be the EDI team or the safety team the HR support team psychological team we're here to help you and and thank you for reporting and that started to gain traction all of a sudden someone's listening to the CEO and the chief nurse are writing me right and they're saying we're behind you and and here's the supports that's the first thing the second thing is is that we started to document this in patients charts so you're gonna call my nurse the n-word that's going in the chart as it should right like it's not in a separate file it's in the clinical chart right and it's not like as you know Amy that that in some organizations you know you're labeled a potential violence risk and we called a purple file right well we just don't say you're a purple file we tell you why you're a purple file and it's in your health record so you know when staff started to see that that was happening they're like there's action here right and so go to your Canadian values sure I've seen I've literally seen in the United States something that says if you're gonna act this way we're kicking you out right we have different legal laws we different cultures we have different norms so I have to take care of you right but I also don't have to put up with this so how do I manage it and find that that nice spot between those two and so have we asked families to leave yes we've actually put trespass orders on families because it's actually the family who's reacting and not patient and so you can't just run a campaign without actually showing some action to begin with right because what happened was is the staff came to us from the joint occupational health and safety which Ona as an example would sit on and said you know you have all these signs around this building that says you don't tolerate violence but the fact of the matter is as you do yep right you do and so the sign doesn't back up what you're trying to change and so while we were starting not to tolerate it they still were proving the points across our sector those signs are everywhere right and so we changed that actually do it won't be ignored right and so won't be ignored means we're gonna address it we're gonna send security up if we need to we're gonna put it in the chart we're gonna like manage these things and then we're gonna say everyone has to do no harm this is a two-way street so the first communication strategy was move away from toleration because it has no traction it's lost its meaning to front line staff I agree but every front line staff whether you're a nurse or a doctor or an ally of professional has signed a note that says I will do no harm well guess what patient and family and client you too should do no harm yep so and by the way the literature is very clear if we both don't do harm and we treat each other with respect your outcomes are gonna be better hydrogen so that was the first step and then the second step is exactly what you've just described which was launched in the last couple of months which is it's not okay in a cafe and it's not okay in an emergency room it's not okay on the road it's not okay here and we're also telling the story because one we've done a lot of work behind it here at St. Joe's we're very proud of so our reporting is up almost 40% and our and our harm so lost time injuries is is down equally about 35% we've also reduced lost time injuries and so because we've also started to train people if you think there's a risk you go in with two of you can I staff every bed with two nurses no I can't do that but if I have a high-risk patient and you don't feel comfortable going into that room unless it's life and limb don't go into that room right right and so go in together right we've also started to change our infrastructure so one of the other incidents that I am recalling now you me is like and it was our fault right so the nurses train it's a mental health patient fair enough says a patient we're going to go into clinic room a nurse goes into the room first right there's only one door yeah that's a trap there's no window yeah and the patient grabs her rear end yeah right so now we're starting to think about we we can't necessarily have a door on every room but maybe when we know there's a high-risk situation on a clinic we're going to build two or three clinic rooms with a window with two doors right yeah and start thinking about these things and I think we needed to tell what we're doing just not that it's a problem otherwise it's just management speak right and so your listeners are going to sit there and go it's just management speak you know hopefully and you can talk to my frontline staff they're going to say reporting is up because he allows us to do so he's dealing with this through an EDI lens he's looking at supports for his staff if I'm a part-time worker I'm still going to help you because you were injured on the job I'm not going to say you don't have the benefits right we're we're starting to put these in because we would like to say it's not just about the campaign it's about what's behind the campaign right and so that that's why we've done it and and I think it's important it's you know people come to work every day for a 12-hour shift in their families eyes that's a 14-hour shift takes them an hour you have to work and I already get home my number one job is to get them home yeah and I think that's how nurses feel like I got the end of the day, we do want to go in and do a good job. But we also want to get home to our families. And I think that there's this perception out there. And I've seen it. I've seen it on social media. I've heard other people make these types of comments. Well, what did you expect? It's a part of the job that is definitely not a part of the job. And I'm glad that, you know, St. Joe is taking this one step further because again, the accountability pieces there and also doing something because I'd say that for the most part, I think a lot of nurses like this is lip service, right? Like what exactly are the measures that are put in place? How are we measuring? And how are we seeing that something is being changed? And it sounds like, you know, that type of work is being put in at St. Joe's. What's the reception been like from nurses and staff? Yeah, I think it's been positive. But listen, sometimes they only tell the boss the good news. Yeah, I was going to say, let's talk about the push back to any discomfort around. I think, I think the response, if you look at our reporting, you know, five, just just three years ago, there were 979. I got the update in front of me now, 979 reports. It's up to 14, 14 this year. You know, like, that's a 40 plus percent. So if even just by the number one thing I could measure is, hey, this guy wants us to report for Cal, their chief nurse wants us to report, that's a positive sign. No, no, number one. Present trust. Number two, we have them design this with us. And so when we did the do no harm, and we did the, it's not okay campaigns, those were St. Joe staff. This was not some AI generated campaign. We didn't hire a public relations firm to do this and find actors. This is our frontline staff saying, we're on site, we're going to do this. Right. And they've not been shy at saying, hey, listen, this is a concern here and we tackle it. And so it's hard. Sometimes some of the stories we hear are difficult to hear. So I think, I think pushback would be and look, I respect on this position on this, what I'm about to say, we need more nurses, we need, we need some technology to help us as well. And so we'll listen to that for sure. But I think between reporting supports addressing EDI as well and not backing away from that, you know, I've met, look, I'm a white man, I've met with 25 black staff and they've said, this is the first time the leadership team at least in the last 10 years has met with us on safety of our staff who are black. So, you know, but again, I don't live in that world, right? I don't have that lived experience, but I think there's progress to be made here. And are we perfect? No, we're not perfect. I have seen some incidents that we continue to tolerate. Or staff want to say, it's okay, that's, you know, that happens. Well, it doesn't have to happen. And so, yeah, I think there'll be some who will criticize, there's still a little bit of, well, there's still a patient who does X, Y, or Z, I can't solve every problem overnight. I'm not trying to be not accountable for that, but I'm all ears and happy to listen to Frontline Staff on how to do this. And as we redesign our buildings in particular, Frontline Staff input into design will be, will be critical. Yeah, no, I think that's whenever something is being built. Again, I like in black communities, we say nothing about us without us, right? So, it's just kind or even really in any community, you could say that because I think it's so important that the people who are living this be a part of the design and it won't work otherwise if they aren't a part of the design and don't feel that they have the space to truly, you know, share themselves and be, to share their thoughts and opinions. And it sounds like you're creating that type of environment at St. Joe's where, you know, you might have to hear those uncomfortable stories, but it's being action done. Something is actually being done about that. I kind of want to circle back to some of the pushback. Is there any other types of, you know, for example, I remember posting about it and hearing some nurses, you know, and other organizations just being like, well, why did it take so long that people are starting to have this conversation? Like with this reality on display, has there been any other hospital organizations that are that say, you know, that might be even using this as an example? There's been some good work in the sector. I think, so I really don't know how, if I'm not answering your question, please call it out. In 2015, the Ontario Hospital Association put a big summit together around on this and they had a good framework actually at the time. But what we've added, and we've used their pillars, but what we've added to that is research and education. And so we're also researching our work. Physicians in particular, and I know I'm on the granny nurse's podcast, but physicians in particular don't report, right? And if you're an experienced nurse, sometimes you don't report, right? Because you don't know what you're training people. You need to be the calm, cool, collective one and you're training someone. And so we've also noticed that. Like sometimes you would expect a 20 year nurse to report, well, let's talk about a 20 year nurse, first of all. So one, she probably grew up in a culture where reporting wasn't encouraged. Right. Right. Two, there wasn't a sudden change in society in the last year that we've had in in across the globe economically in the pushback unfairly against EDI. She probably didn't understand EDI at the time, depending on the nature of her background. And yet she's responsible for training the next generation of nurses. And I don't want to tell a negative about a job I love to the next generation of nurses, right? And so I think if you were to talk to university presidents and faculties of, you know, nursing, do you actually cover personal work or safety in your curriculum? I think it really answers to that. To know your answer, right? And so I think some of the pushback, you can't blame people for pushing back. There's been, you know, then the pandemic happens. They're held as heroes. But and then all of a sudden it changes, right? Right. Like it changes. And so and it changes for a variety's, economic, social, political issues, whatever. But it changes. And then all of a sudden this one, somebody says, hold on here, like, you know how many double shifts I did in pandemic? Do you know how many I did there? Like, do you know I trained as a nurse online? Like, do you know how to do that? Like, do you know I had to go into a long-term care home, which was like, you know, infectious disease big problems? And then when I get back in here, I'm being kicked on, I'm being spit on, I'm being yelled at, I'm so like, so, you know, there's pushback just on like, are you even aware this is happening at the front line? Right. And then the second one is, are these actually tangible changes that you're making? So I think those are fair pushback. Do I have a lot of pushback now in my organization? Look, go talk to a front line staff. I'm completely comfortable because you know what my answer would be? Great. Let me talk to that front line staff person. Okay. That'll be my answer. All right. Right. And let's go figure out how you challenged me to talk to some things. You know, and look, and if we've missed, we've missed. And I think that's the future of leadership in this area needs to say, hey, we got it wrong there. Yep. Right. And so you were in quality improvement, you said. So the best thing for quality improvement is to say we got it wrong. But we don't hear that a lot, right? That's the thing. That this is why I feel like you're in a, you're an anomaly in the system. You're a part of the matrix because we don't hear that. Like, healthcare just is one of those areas where we just don't hear the fact that we got it wrong. Yeah. Well, I can tell you here, because my staff have the courage to come up and say, those signs of doing on tolerates as this organization's tolerates, you tolerate this. So, you know, did we try? We tried. Sure, we tried. But it doesn't mean the outcome of that attempt was impactful. And so what's impactful? The other thing about quality that we started to do, we're not good at it yet. We just started this is when we have an adverse event clinically with a patient, well, you've been on the front line, you've been a director, a nurse manager, etc. What's the first thing the quality department do? They call you and they say, we're going to review this case. Right. That sounds a shiver through the organization, right? It certainly does. Yep. Right. And we're going to talk to Dr. A who's the MRP. We're going to talk to the nurse manager. We're going to put you in a room and we're going to do a quality of care case review. Yeah. Right? Yep. And if you don't manage that from a just culture properly, that could go sideways, right? And so what we've, and we've only done three of them, we've started to review these incidents like that. So, nurse A reports an incident. And we say, I think that needs a review. And we look at the infrastructure. We look at what was the staffing on the unit that day? What was the patient? Who was the patient? Did we tolerate something from the patient? Was it the family? Right? And what can we do there? We've just started it. Like, I think we've done two and we have to get better at documenting it and building a framework, like the quality of care reviews. But I think that's also saying there's data and then there's like stories. Right. Right? And so, you know, that's how we learn these, these, these type of things. And so, look, you're asking the guy who's the president to say, what are the negatives? I think no one's going to get anything perfect. We have readmission rates. We have return to ED in seven days. We have a variety of things that move on clinically. And we're going to have some gaps when we try any management initiative like this. And so, I want us to gather someone wants to say, talk to Amy and he's missed this. I'll be all ears. And I'll do it in a respectful way. All right. Sounds good. No, I'm like, I'm, I'm actually encouraged to hear this conversation because I would say that there are very few leaders that I've spoken to that is open to saying that, you know, what we've got it wrong. And this is how we're going to go around to try to change it. Right? So for me, that's kind of a win. Like, I would want to work for an organization that has that transparency and has that accountability model where they're saying, okay, you know, we're not going to get it right 100% of the time. Because again, I think that just shows the human because humans make mistakes. And again, with my quality mind is just like, okay, so we're making mistakes. How do we improve and make sure that we don't do this again? And it doesn't mean that the situation won't happen. And it's just like we might find a different way and a different approach to kind of figure this all out and that we're trying to do it together because that's the other piece. Like no one has it all figured out. And if anybody, if any hospital out there says they have it all figured out, then we know they're lying. So at the end of the day, I think it sounds to me like you're going down the right track. So I'm going to bring it back to some of, back to some of these questions in relation to safer workplaces. So you mentioned that this is a two way street nursing bullying. It's an ugly word, but it happens. So patient to nurse to patient happens as well. What are the responses like in relation to these forms of workplace violence, whether it's you know, like nurse to nurse a physician to nurse? How is that being handled at St. Joseph? Yeah, it's a fair comment. So first of all, I haven't heard the phrasing of nurse bullying. So thank you for the introduction to that. It's not represented to me. Like I can only speak to what's been presented to me. So I think that's fair. Like do we have nurses who are bullied? Yeah. It'd be interesting what you've tweaked me to is it'd be interesting to now start to classify our data along those lines too, right? Rather than just physical, it's actually bullying, right? So let me thank you for that piece of conversation and we'll take that back and see what we can do with it. Do we have some staff to staff concerns? Yeah, we all do. Sometimes there's, you know, he did arguments and things happen and we manage those like anyone else. Like no one comes to work thinking I'm going to at least I hope they don't. You know, I'm going to put someone in a psychological or physical harm's way. And I think, you know, we would have all this standard work around that in terms of occupational health and safety, public policy, legislation and regulation. But it's not been a focus of this type of work. This really has been, hey, first of all, you're in front of the patient or the client, you know, some worlds that is the customer. And so we need to get that right. And I think if we get that right and we're all supporting merit, we should decrease our internal because you now have two nurses who say we're going to go on this together and those two nurses become partners, right? Or the nursing and the dietary staff become partners because I have actually seen a nurse with the dietary one. It was a good example with the tray. The person who stepped in and said, this is not right, was a nurse. Good. And that's how it should be. Right. Who stepped in and said, hold on here a second, this is, you know, this is an important employee. You may not think they're important. They're just delivering food. But you know how important your nutrition is to your recovery, right? That's a nurse who tells that story, right? That's a nurse who steps in and says that. And I think that's what we're finding now is even our reporting is going up. But even in the reporting, sometimes you're seeing someone else report it than the victim. And so I'm seeing more collegialiality amongst our own staff. So what I have to go and look at me and get the data on nurse to nurse, nurse to doctor, et cetera. Yeah, I have to do that. Do I think it's an issue here at St. Joe's? No, I don't. At least not as significant as, you know, the public to that. So yeah, I don't think so. You know, and I'll just go back to your other question if I might. I need to promote that we're not the only ones doing good work here. A lot of work being done in British Columbia on this, a lot of work, provincial government set its direction. UHN has done a bit of work on this stuff in terms of their emergency rooms. They've done some research on it that's been published, which is great. A trillium's doing some work in this area as well. So again, I think, you know, for us though, we're a downtown urban hospital with a variety of patient complexity here, and we think there's a chance to elevate the story and impact the national conversation. But we're not the only ones doing this. Well, it's okay to give yourself a pal in the back. Yeah, that's our system's Catholics. Don't tell those. You don't brag. That's hilarious. So we talked. You just touched on national, so which is great because that's kind of where I was going with the next part of the conversation. I think you've actually been quite vocal about advocating for federal legislation changes. And again, I'm a huge proponent of also things have to be done at the hospital. But also, you know, if it comes to a point where it is deemed as assault, there should be changes. So I know there's Bill S233. How is this fight being, you know, taken beyond those hospital walls to address those root causes in the community? What does that look like maybe a year from now? And you know, what metrics will you, like we'll tell you that this effort has actually worked? We were in Ottawa at the beginning of June meeting with a variety of members of parliament, including the Justice Minister's parliamentary assistant. We met with the opposition critic for justice. And that's a good thing, right? We're talking about healthcare from a justice perspective. Absolutely. Right? This is not the minister of health only, right? This was an opposition member of parliament who proposed the original bill, C321. We are one of the only countries in the world that doesn't have what's known as an aggravation factor to be considered insensing. Don't you think that's weird? But it does. Yeah. Well, again, I think that goes to our culture, right? Like you looked at, like less than three minutes ago, I said, we're not the only ones. We're humble. Sometimes we were so proud of our healthcare system. We don't want to talk about the challenges within it. And so we become humble. So the fact that we're, you know, just doing this is not surprising, right? Well, here we are and give that opposition member credit. He's from BC, he's not inside government and he puts this private members bill together. And he gets unanimous consent for this. But it dies on the order table because of the elections and these things happen, there's bills that die on the order table. It's unfortunate they couldn't expedite it, right? But because of this. But here we are. So what the law would do to describe to your staff is if there's an assault on a healthcare worker and someone is found guilty of that and they go to sensing, it would allow the judge to consider that aggravation factor that it was done on a healthcare worker. And so again, I'm not a lawyer and I don't know the criminal code that well. But in essence, let's say someone was going to get three years for that. Well, the an aggravation factor might make that four or five. They'll decide inside the criminal code, right? Because it's a healthcare worker again, we are one of the only jurisdictions in the world that does not have this, right? In the United States, they have to do it by state, they have state justice systems. But there are places like Australia that aggravation factor is up to 14 years in prison. Sounds great. It sounds about right. Hoping a nurse, right, a doctor, an allied health professional, a porter, right? And so this bill would do that, right? It's past second reading, which is good news. Unanimously, it's going to committee in the fall, we're hopeful to present there as a, you know, as an organization, just not an association. Someone who can actually tell the operational story from an operational lens, right? But it's not through yet. Just because it's through second reading doesn't mean it's through the entire area. There are some who believe that a current bill, I think it's C5, I can't remember the number, which has to do with bail reform would cover that. That's bail reform. And so we would like it clearly spelled out that it's an aggravation factor tied to being a health care worker, right? And so we're hopeful that that given we've had unanimous consent to date, that that would happen. That's really, really important. How that gets measured, that's another question altogether, right? So we're already seeing some folks who are convicted of multiple crimes getting back on the street, you know, look, there were three Scottish guys who came to this country and they assaulted a restaurant worker about three and a half years. We're not talking about guns and gangs and underground, our justice system needs to say this poor Indian, you know, he's from India, he immigrates to this country, he runs a restaurant. Three guys from Scotland come in, don't pay their bill and they kill them and they get three and a half years. So imagine a nurse looking at that and saying, I dedicate myself to community service. I'm from India, my parents came here, they educated me, you know, I went to this great university, I decided to give back to my community in this way. Sure, I get paid, sure, but that doesn't mean that that's, now I get assaulted and someone gets three months for that, yeah, that's wild. So you know, will it, will it solve the world's problems? No, it won't solve every problem. Well, I still have someone come in here and call that black nurse the end word. God, I hope not. But I can't solve every problem, but I think these incremental steps are important signals to nurses that you play a fundamental role in our society, yeah, and it helps the doctor deliver a baby, a nurse, who's going to take care of you in a hospice as you pass away a nurse, like that's what happened. Sure, do we have OTs and PTs and they play fundamental roles in therapies. But the fact of the matter is, is there actually not even a doctor necessarily at a hospice at the end of life? Right. When you're going to die, but the nurse is going to be there. And so we have to put these systems in place and we have to have laws at signal. This is a great profession to get into and we have to have the courage to have that conversation and hopefully that's what we're doing here at St. Joe's. I hope so. It sounds like, like I said, it sounds to me like you're on the right track. And I think that, you know, when I think about tying all of these pieces together, like there has to be actions within, well, one, we didn't talk about community, but again, there has to be stuff that's done in the community. There has to be things done internally within the hospital walls or has to be some type of legislation. And there has to be, you know, accountability behind all of these things. And I think that I really want nurses to also think, because sometimes this also happens where we feel that, you know, the only system that we operate in is within the hospital system. And they don't even think about, you know, human rights, tribunals, or other things outside that can help support them. And I think that, you know, understanding that there are bills and legislations, these are things that nurses also should be mindful of to get their own to get behind. So they can also bring that momentum forward to bring about these changes. It's, it's crazy to me to think about like, you know, police, firefighters, other organized, other, you know, jobs that have, you know, risk danger associated. And for whatever reason, when we look at nursing, and I don't want to just say it's because it's a female dominant, I think it's a part of it that the same protections aren't in place. I know people think twice before they decide to attack a police officer. And I think that I would love them to think twice before they assault a nurse. I don't know if you've seen this, but it's gone quite viral on social media. I don't know how much you are on social media of a nurse who's trained in a Brazilian Jiu-Jitsu sport that I took up as well. That actually was a, that a patient attacked them. And again, using these types of techniques was able to subdue the patient safely and bring them down to the ground again. I don't think the owner should ever be on the nurse to have to do this. But it was definitely something I took up to keep myself safe. Because again, at the end of the day, I want to go home. So the nurses and health care workers listening right now might who are burnt out, who are hyper-vigilent, I feel like violence might be a part of the job. What is your direct message to them about their safety and their future at St. Joe's last words to you? Yeah, let me, let me add a couple of things that I could. I've talked today primarily from a hospital perspective, but we have nurses in long-term care homes. We have nurses in primary care clinics. We have nurses in home care. I've seen a sexual assault in a home, not seen in obviously. I've seen a report of it. Right. PSW goes in to a home. I don't know where that home is. One, two, three main streets somewhere in Ontario. She goes in alone and she's, her hand is grabbed and the man puts it on his reproductive parts in his home. There's a lack of reporting in long-term care because the keyword in our legislation is home. That's their home. Right. Well, we don't put up with domestic violence. Right. So why do we put up with violence for nurses and allied health professionals in a long-term care home? Should it. So one, I've talked, I will, you know, say to the nurses who are listening or not from hospitals today, you matter to. Right. And you need solutions that are unique to your environments. And so as an example, working with the technology company right now for that PSW and that nurse that does home care. Because they're out in the field and they don't have a call button. They don't have a code white button. Right. So we need to pay attention to that. And I have a large home care division. And thankfully, I have a lady of color who is a leader in this organization who convinced a front line person of color and of a certain religious background to please report. Otherwise, I would have had no idea. That's what happened. Yeah. That that happened. And we're going to go fix it. So one, part of my last words is this is not hospital-based. Right. Like 61% of nurses. This is Canadian data. At some point in their career will be assaulted, no matter where they are. Right. And that's what we know because that's reportable data. But to your point, who think it's a part of the job, this is not a part of your job. So I'm the presidency of an academic health science center. I run a home care division. I run three long-term care homes. I run a hospice and I run a hospital setting with a mental health and addictions focus. This is not a part of the job. This is not a part of a job of a construction worker to not be trained on how to use a ladder or window washers that are not going to be safely equipped to do their job. And so if you're not safely equipped to do your job, you need to speak up. And if that's through someone like me, great. If that's someone through an owner representative or a union representative, great. But we just need to speak up. And then I need to know how to protect you. So one, I might have a solution. But again, I'm not in that unit. Right. And so we need your input too, which says, yeah, you might design your training like this, but I don't deal with that patient population. I deal with this patient population. And so what are the tools, equipment, and training that you need to do that? And I think the one thing that drives me, my mind gets stops all the time, is when I walk into a unit and a nurse says to me, I can't find a blood pressure cup. I can't find tape. Where's the bladder skater? So I'll also say every leader who goes under a unit should ask one very, two very simple questions. One, do you feel safe at work? And two, do you have the tools equipment and training to do your job? And so it does not have to be a part of the job. And if someone says it's to be a part of your job, like St. Joe's.ca has lots of openings. And we'd love to have you. And where's the, where is it, five years? So, but look, if I were to talk to any other CEO in this province, you know, and I've listed two other organizations today, I'll list a third. You were to talk to Kevin Smith, the president of UHN, you were to talk to Barb Collins at Harbor River. You were to talk to, you know, Carly Farrow at Trillium. They would want to know too. And as would, you know, a Roy Butler at St. Joe's landed in Karen Davies at St. Thomas, you know, the list can go on and on. And I don't mean to only not name a few. But there are leaders out there that want this changed. And I happen to be one who's a little more forward right now about it. But if there's a nurse out there that says, hey, I'm not comfortable here. You know, if anyone says it's a part of the job, they'll leave it this way. They're actually asking for patient care to be compromised. Yeah. Right? There's the construction worker who goes on to site today. It says, I don't feel safe today. You think they're building that home properly? No. Yeah. So the same thing has been said here, Dr. Chris Rebat, you know, Christina Bowman, you know, they've said, I go in and I'm nervous. I'm not going to be thinking right. Am I really doing that independent double check on a high risk med? Am I really checking the wound? Am I really cleaning that wound right? Have I ordered the right PT? Like, so if anyone thinks it's a part of the job, they think negative patient outcomes is appropriate. Yeah. And that's not right. And then I would say that the other pieces to ensure that, you know, as an organization, the onus is on you to ensure that they feel trusted to share those stories and those moments with them. Because again, I think when I think about my colleagues who have suffered these types of, you know, instances of violence, Shane comes with it too, which is, which is a wild thing to even think that, you know, some of this might be their own fault. And sometimes they actually hear that type of language. So again, building that culture of openness, transparency and accountability will make that nurse wherever they are, whatever, whether it's a hospital community, long-term care, feel that it's okay to say, you know what? I deserve much more. And here's why I'm going to share why this happened. So we can make change together. And I encourage my nurses and other folks who are listening from the allied health world that it is definitely not a part of your job. And that we should be all speeding up together to make change. But again, Mike, I would say that the word, maybe the theme actually is courage here, that you have within your organization to kind of take that first leap to say, you know what? Violence is not acceptable here. And here we're going to talk about it quite openly. So I thank you and I applaud you for doing that as well. And all the work that you're doing at St. Joe's. I'm ready. Here's my resume. Yeah, yeah, send it in. That's so funny. But yes, like you said, there's job openings, guys. Thank you so much, Mike, for coming on the green nurse podcast to share what's happening with your organization. Of course, you could let other CEOs feel free to come speak to me. I'm happy to have conversations right across Canada. But yes, thank you so much for coming on. Thank you. You're doing an important work. As is all your listeners. Thank you so much. 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