National Nurses United

were failing to do so, even though a review of OSHA injury and ill- ness logs showed numerous incidents of workplace violence. Nurses countered by voting unanimously to authorize a strike. The vote alone won additional staffing and security rounding. Finally, NNU has filed a petition with federal OSHA based on the California legislation and pending implementation regulations. This would protect private sector nurses across the United States as well as many in the public sector. States that have their own OSHA plan would have six months from the time that a federal standard is adopted to adopt a comparable or stronger standard. Many GNU member groups are likewise winning new victories and making progress in the fight against workplace violence. RNs in the most industrialized countries with public and centralized, gov- ernment-run health services appear to have made the greatest gains, likely because there is a publicly accountable body and leaders to advocate for reforms; nurses in lesser-industrialized countries that cannot even rely upon the rule of law are definitely struggling. This January in New South Wales, a patient high on crystal meth in the emergency department at Nepean Hospital, one of Sydney's largest facilities, managed to hold a female doctor hostage with a pair of scissors at her throat, then get possession of the gun of the police officer who responded. He then shot both the officer and the hospi- tal's security guard in their legs before he was finally apprehended. NSW Health convened a "Security Roundtable" with all stakeholders, including NSWNMA and the other three health workers unions. Together, the roundtable developed a 12-point plan for emergency departments and got the minister of health to quickly approve it. In addition to the new reporting system mentioned previously, the plan includes many commonsense goals to prevent and manage workplace violence, including providing an intensive program of multidisciplinary training to ED staff, conducting a detailed security audit of all 20 EDs in New South Wales, properly training and inte- grating hospital security staff into any plan, and developing policies in coordination with police about what happens after they drop off violent and aggressive patients at hospitals and what should be the protocol for bringing firearms into the facility. The audits found huge security breaches and inconsistent implementation of safety proce- dures throughout the hospitals: doors to what should-have-been secure wards were propped open; in the same ED where the shooting occurred, the knife used to cut a staff member's birthday cake was left out in the open; nurses in some units were wearing antiquated per- sonal alarms, while nurses elsewhere in the same hospital were all wearing modern ones, and nurses in yet another unit were not wear- ing alarms at all—even though an entire box of new ones were sitting on a desk at the nurses' station. "A deputy secretary at the health ministry said that hospital security was 'consistently crap,'" said Kiejda. "That was her technical term." But, as always, the devil is in the details, said Kiejda. At the group's last meeting in September, the government's recommendations resulting from the audit were "pretty fluffy, no teeth." She pointed out that the health serv- ice had allocated only $5 million toward implementing changes to make health facilities safer for workers, which everyone knows is not nearly enough. As NSWN- MA has done for years, Kiejda says that nurses will take to the streets and stage public protests in order to win funding for reforms. In Canada, nurses have long been raising awareness of and advo- cating for greater regulatory and legislative protections against workplace violence. Nurses in the Canadian Federation of Nurses Unions (CFNU) came out with their first position statement against violence in 1989 and launched an awareness campaign. "Back then, in 1989, we thought a campaign was a poster," said Linda Silas, pres- ident of the Canadian Federation of Nurses Unions. "In the 1990s, all you saw was zero tolerance, posters everywhere. You think you've dealt with it. Then the campaign died out and nobody talked about it." Of course, the problem had never gone away. Today, the member unions of CFNU in Canada's various provinces are among the most active and successful in winning pro- tections against workplace violence. The Manitoba Nurses Union, the Ontario Nurses' Association, the New Brunswick Nurses Union, and the Nova Scotia Nurses' Union all have active anti-workplace violence campaigns. The Manitoba Nurses Union in 2011 surveyed its members and found incredibly high rates of violence. The union organized RNs to win major changes to workplace safety rules and, last year, won passage of groundbreaking legislation to make post- traumatic stress disorder (PTSD) a presumptively eligible occupa- tional disease as of Jan. 1 for registered nurses, as it is for all other first responders. The Ontario, Nova Scotia, and British Columbia nurses are in the process of trying to win similar legislation. In Ireland, Hughes of the Irish Nurses and Midwives Organiza- tion reports that earlier this year, through union negotiations with the health service under existing laws, INMO won recognition of each of the country's 26 hospital emergency departments as a work- place unto itself, with its own RN health and safety representative who enjoys legal rights to be a spokesperson and advocate for employees and time set aside to do the job. Currently, INMO is in the process of training all the safety reps and hopes to radically change the culture among nurses of prioritizing their own health and safety. "Nurses are the least conscious of their own health and safety. They think of their own patients first, always," said Hughes. "But we are trying to get them to think differently and saying, 'If it's 18 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G M AY | J U N E 2 0 1 6 "A deputy secretary at the health ministry said that hospital security was 'consistently crap.' That was her technical term." —Judith Kiejda, assistant general secretary of Australia's New South Wales Nurses and Midwives Association

• Cover