James T. Brophy & Margaret M. Keith Break the Silence on the Hidden Crisis of Assaults on Health Care Workers

In health care settings, it's easy to assume the most vulnerable people are, at all times, the patients. But there is another element of vulnerability that is rarely discussed, despite its reaching a critical crisis point, and that is the issue of violence committed against health care workers, many of whom are women of colour. 

In Code White: Sounding the Alarm on Violence against Health Care Workers (Between the Lines Books), researchers James T. Brophy and Margaret M. Keith delve into this incredibly complex and troubling element of the health care landscape. 

Named for the hospital code that refers to an emergency response for an assault on a worker, Code White is shocking, but not a surprise to anyone who has spent time in health care settings. From being verbally degraded and spit on to brutal beatings, Brophy and Keith share stories collected from over 100 nurses, personal support workers, aides, porters, cleaners, and administrative workers.

Their experiences show a systemic issue that has gone long unaddressed. In their writing, Brophy and Keith strive to do more than just bear witness to these workers and their trauma, but to put forward potential solutions to an urgent human rights issue. 

We're proud to welcome Margaret and James to Open Book to discuss Code White. In our conversation, they tell us about how employer reprisal has caused workers to fear speaking out about their mistreatment and assaults, why they hope the book leaves readers angry, and how they processed the responsibility of listening to and recording such sensitive and difficult material. 

Open Book:

Tell us about your new book and how it came to be. What made you passionate about the subject matter you're exploring?

James T. Brophy:

We were outraged, while attending a health and safety conference in 2016 sponsored by the Ontario Council of Hospital Unions (OCHU/CUPE), to hear delegate after delegate speak about the physical and verbal abuse, they face every day at work. Although Margaret and I have been working in the field of occupational health for decades, we were unaware of how widespread and largely unaddressed this problem really is. It was not until we started our research by interviewing health care workers that we understood why we did not know.  The health care workers were being silenced by their employers. They feared reprisals if they spoke publicly about the problem. We wrote this book so that their voices, their concerns, could be heard and the public would finally learn about the crisis the people who care for all of us are facing.

Margaret M. Keith:

Although I had been involved for many years in advocacy work around the issue of violence against women, somehow, I was unaware that the health care workforce, which is made up predominantly of women, was experiencing a hidden epidemic of abuse. Despite the fact that I had personally witnessed several incidents of verbal and physical violence in the hospital setting, it wasn’t until I began hearing directly from health care workers, nurses and PSWs in particular, that the penny dropped for me. I then realized this is yet another egregious manifestation of violence against women.

Open Book:

Is there a question that is central to your book? And if so, is it the same question you were thinking about when you started writing or did it change during the writing process?

JTB:

The question we started with is why violence is so pervasive in our health care system. We were also forced to ask why this violence is so ubiquitous and yet essentially ignored. We hope that the reader will feel the injustice we experienced talking with health care workers about violence in their workplaces. We hope that the reader will be horrified and angry as we were. We hope that the public will understand that abuse is a symptom of a deep systemic crisis in our health care system that is being eroded by underfunding, understaffing, and a failure to respect and listen to the concerns of health care workers. And finally, we hope that our society will draw a clear line that violence and abuse is not to be tolerated at work or anywhere.

Open Book:

What was your research process like for this book? Did you encounter anything unexpected while you were researching?

MMK:

I think Jim and I were both unprepared for the emotional toll the research would take on us. Almost every health care worker we talked to described having sustained injuries or having witnessed co-workers being injured. They told us, many tearfully, about the bruises, cuts, strains, scrapes, scratches, punctures, bites, torn ligaments, fractured bones, broken teeth, shattered faces, concussions, and even brain injuries they or their colleagues suffered. Some said they are regularly slapped, punched, and hit with objects. And they are subjected to verbal abuse: threats, insults, racial insults, and sexual harassment and assault. I found myself being triggered and in tears by some of the stories, especially those graphically describing sexual assaults. We were further disturbed to hear that health care workers feel they are expected to quietly put up with aggression from patients and residents. And they are left feeling degraded and traumatized. Many victims – working in hospitals and long-term care feel they are blamed for the assaults against them. This sounds uncomfortably like the way women have been made to feel by society when they have been victimized by violence—an injustice that is now being widely challenged. To add further to the harm that is done by the violence itself many staff find themselves without adequate post-incident supports leaving them to suffer emotionally, physically, and financially. The entire research process and its findings were a revelation to us.

Open Book:

What do you love about writing nonfiction? What are some of the strengths of the genre, in your opinion?

MMK:

In a previous chapter of our lives, we produced videos and a community tv program on a variety of occupational and environmental health issues. I loved doing the research, conducting interviews, and then weaving the stories together – all the time hoping they would contribute to increased awareness and the beginnings of change. I have always been more comfortable being on the operator side of the camera or microphone. Writing a nonfiction book is very much like video production – it is a creative endeavour, a little like putting together, piece by piece, a colourful quilt or tapestry. Besides the profound satisfaction I feel in having crafted a carefully researched argument for healing our broken health care system, I feel deeply honoured to have been trusted to facilitate the sharing of health care workers’ stories and ideas.  

Open Book:

What do you need in order to write – in terms of space, food, rituals, writing instruments?

MMK:

I find it difficult to write in the midst of clutter, noise, or other disturbances. Household distractions are especially difficult for me to ignore – the unwashed dishes, the squeaky door that needs to be oiled, the smelly dog that needs a bath. In pre-Covid times, Jim and I often went on trips to the woods in our camper to write or to quiet coffee shops or sometimes to the library. Since the pandemic began, we have been pretty much confined to quarters and I have had to struggle with myself to ignore the domestic demands that incessantly call out to me. I am thankful not to be working alone. Jim’s enthusiasm, optimism, and loving support keep me motivated and grounded.

Open Book:

What do you do if you're feeling discouraged during the writing process? Do you have a method of coping with the difficult points in your projects?

JTB:

When I am feeling discouraged or blocked, I will re-read previous sections to try to get back on track. I will start putting down whatever thoughts come to mind and then develop them further, polishing and augmenting as I go. I have been blessed to have a caring and skilled partner who, when I am feeling lost or disheartened, patiently reviews my work, makes suggestions, and sends me back to keep writing.

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James T. Brophy is a career activist, researcher, and advocate focussing on occupational and environmental health. He received his doctorate from the University of Stirling on occupational risks for breast cancer. He is a former executive director of the Occupational Health Clinics for Ontario Workers (OCHOW) in Windsor and then Sarnia, where he and his partner, Margaret Keith, helped to document one of the largest cohorts of asbestos diseased workers in Canadian history. In recent years, he collaborated on research exploring violence against health care workers and on the lived experience of inadequately protected health care staff working during the pandemic. He lives in Emeryville, Ontario.

Margaret M. Keith is an occupational and environmental health advocate and researcher, focussing particularly on women and work. She earned a PhD from the University of Stirling. Margaret served as Executive Director of the Windsor Occupational Health Information Service before joining the Occupational Health Clinics for Ontario Workers in Sarnia. She and her partner, Jim Brophy, assisted the First Nation’s community of Aamjiwnaang near Sarnia in exploring health problems related to environmental pollution from the adjacent petrochemical industry. Margaret was co-author of an internationally recognized research article documenting a skewed sex birth ratio uncovered after examining Aamjiwnaang birth records. She lives in Emeryville, Ontario.