A Portrait of a System in Crisis

It was just after 8 p.m. on a spring evening at Port Moody’s Eagle Ridge Hospital when BCNU member Victoria Treacy, a registered nurse in the emergency department, heard yelling. It wasn’t unusual, but something about the tone made her pause what she was doing to go check.

A few seconds later, she found a patient in a hospital gown, holding a machete above his head, screaming threats and moving towards her and her colleagues aggressively. In a moment of chaos, her co-workers ran to barricade themselves in a room. Treacy backed away to call the police as the man screamed and threatened staff. The hospital initiated a code white, indicating an aggressive patient, and then within seconds, a code silver, indicating a patient with a weapon. Treacy and her team started evacuating several terrified patients to safety.

Officers eventually arrested the man in the parking lot.

“We get threats, but never in my career did I think my life would actually be in jeopardy,” says Treacy. “My co-workers and I were just far enough away from a swinging machete. We are not trained or equipped for this.”

A Broader Look at Violence Across BC

Treacy’s story, as shocking as it is, isn’t isolated.

Across the province, nurses are dealing with escalating levels of violence that wouldn’t be accepted in any other workplace. Last November, a patient attacked a student nurse with a knife at Vancouver General Hospital (VGH). In March, a nurse at Eagle Ridge Hospital was violently assaulted. That same month, officers arrested a patient at Langley Memorial after he threatened staff with a knife, and at VGH, a patient strangled a nurse unconscious.  

“We’re hearing more about patients bringing in weapons like handguns and knives, nurses being exposed to non-prescribed substances and experiencing verbal and physical abuse on a daily basis,” says BCNU President Adriane Gear. “This is no longer rare or unpredictable – it’s a daily reality for nurses in every part of the system. And frankly, it’s completely unacceptable.”

From rural health centres across the province to urban emergency departments and other health-care settings, the level of violence has been making headlines at an alarming rate.

“It’s about rebuilding an entire culture of safety, transparency and accountability – one where nurses are protected, respected and empowered.” 

- BCNU Executive Councillor for Occupational Health and Safety and Mental Health Aida Herrera

Meanwhile, health authorities continue to drop the ball when it comes to dealing with the crisis, often failing to provide adequate support following a violent incident, or listen to the concerns of frontline staff to develop strategies to prevent incidents from occurring.

In fact, over the past decade, WorkSafeBC has issued a number of significant fines to health employers across the province for failing to provide safe, hazard-free workplaces – a clear indication that systemic safety issues are being repeatedly ignored.

(For more information about the fines WorkSafeBC has issued, see sidebar)

A BCNU member survey commissioned last spring offered a shocking snapshot of just how often nurses are exposed to occupational health and safety hazards at work. It found that 81 percent of nurses experience verbal and/or emotional abuse at least once a month, with 39 percent reporting exposure to weapons. Nearly half reported working short-staffed every day, and more than a third said they are seriously considering leaving the profession or are already making plans to do so. 

While the roots of the problem are complex, they are also deeply connected.

Chronic understaffing has pushed health-care workers to the brink. Nurses are doing more with less, caring for too many patients in overcrowded, chaotic environments. That workload, combined with mental health and substance use crises worsened by the shortage of primary care doctors and supports, has created a dangerous tinderbox in emergency departments.

While the province has created specialized relational security officer (RSO) positions 1 designed to de-escalate aggressive patients, the staffing level is often inconsistent, with some hospitals in rural settings still waiting to see any trained RSOs at all. As for risk assessments, the incident at Eagle Ridge Hospital has shown that the system is frequently failing to flag patients with a history of violence.

And worst of all, violence continues to happen.

“There seems to be a veil over top of hospitals,” says Treacy. “If you walked into a local shopping mall waving a machete, there would have been an enormous response in an instant. But because it happened in a hospital, it’s now deemed acceptable?”

When violence happens on the job, nurses are often left to pick up the pieces – physically, emotionally and professionally. Despite having systems in place for reporting incidents and safety hazards, many nurses aren’t using them. And it’s not because they don’t care.

Reporting can be confusing, time-consuming and emotionally draining. After a traumatic event, nurses are required to fill out paperwork and make phone calls to document what took place. They sometimes feel that reporting is ineffective – that the employer doesn’t follow up and nothing changes. Some aren’t even sure how or when to report, especially when incidents involve exposure to substances, verbal threats or near misses.

Treacy believes the post-incident support she was offered after her experience was limited.

“CISM (critical incident stress management) wasn’t notified until the day after it happened, which I believe is a major failure of the employer,” she says. “When I did end up going to the debrief, I had to revisit the worksite, which I found quite triggering and traumatic.”

Improving the reporting process is a priority for BCNU. The union is advocating for simpler, more streamlined systems, clearer education and visible follow-up to rebuild trust in the process. BCNU’s Simon Fraser regional council member Roy Hansen says the work will help protect members.

“Documenting these incidents is critical and creates a paper trail that can’t be ignored,” he says. “Reporting informs the union about incidents right away and helps us identify the resources and prevention efforts that are needed to ensure members get support in a timely manner.”

BCNU’s Solutions 

BCNU has outlined a framework for actions and approaches employers need to take to prevent violence in health-care workplaces. The framework includes implementing minimum nurse-to-patient ratios, which are proven to allow time for safe, patient-centred care, and hiring more RSOs who are trained in trauma-informed care and embedded with care teams. Other proposals include strengthening the risk assessment process and ensuring all members can access mandatory violence-prevention training. BCNU also wants employers to better communicate when patients have a violent history as they move between facilities.

In addition to a comprehensive framework, Gear says the next step is to put the employer on notice. 

“It is time that senior leadership within each health authority is held accountable and implements these solutions with urgency and integrity,” she says. “If the employer doesn’t respect a safe and healthy culture, then nothing is going to change.”

“If the employer doesn’t respect a safe and healthy culture, then nothing is going to change.”

- BCNU President Adriane Gear

The Advocacy Continues

The incident at Eagle Ridge Hospital should have been a turning point.

And yet, little has changed.

“If someone came into your office and threw a chair at you or tried to stab you with a pen, you wouldn’t go back to work and finish your shift without expecting something is done about it,” says Hansen. “Unfortunately, many nurses do. And that tells you how broken the system is.”  

Treacy agrees.

“I left my shift immediately because I knew I couldn’t care for anyone after that,” she says. “But other staff stayed and finished their shifts that night.”

BCNU will continue to push health authorities, senior management and the provincial government to meet their legal obligations and act on the clear, practical solutions already on the table. Members should also keep in mind that their union is ready to support members in guarding their rights when it comes to working in unsafe conditions. These include the right to know about hazards in the workplace, the right to participate in health and safety activities and the right to refuse unsafe work. By law, employers cannot penalize workers for raising health and safety concerns.

Aida Herrera is BCNU’s Executive Councillor for Occupational Health and Safety. She says health authorities need to undergo systemic change if they are to reduce violence in health-care settings.

“It’s not just about fixing broken panic buttons or simplifying reporting forms. It’s about rebuilding an entire culture of safety, transparency and accountability – one where nurses are protected, respected and empowered to speak up without fear or futility,” she says.

“Let this be the moment we stop treating violence in health care as just another occupational hazard – and start treating it like the emergency it is. We will keep advocating. We will keep demanding answers. And we will not stop until nurses are safe – in every hallway, every room, every shift, in every corner of BC.”

UPDATE (Summer 2025)