Creating Partnerships Crucial to Tackling Workplace Violence Culture in Healthcare

Workplace violence against nurses continues to worsen here in Canada and around the world, threatening the workforce and impacting patient care. Headlines about long wait times, “hallway health,” burnout, turnover, and rising incidents of violence highlight a growing crisis. But while COVID-19 pressures and an aging population have certainly magnified long-standing strains, violence in nursing is not new.

According to the Canadian National Federation of Nurses Unions, ninety-two percent of nurses have been exposed to workplace violence, and violence-related lost-time claims are rising at triple the rate of police and correctional officers. One in four nurses report symptoms of post-traumatic stress.

It concerns me that there’s a segment of our workforce that goes to their jobs and has a good chance of being physically or emotionally hurt.

Soo Min Toh, a professor of organizational behaviour in UTM’s Department of Management, is looking for solutions. Her research focuses on inclusive workplaces and immigrant employment experiences, and she was noticing frequent reports of racism and inequity in medical settings. As Toh dug deeper, she found a lot of research documenting the stressors facing nurses, from undermining and bullying to incivility and physical violence. 

“It concerns me that there’s a segment of our workforce that goes to their jobs and has a good chance of being physically or emotionally hurt,” she says. Many of Toh’s colleagues — already working in healthcare or teaching future nurses — echoed her findings, prompting them to join forces.

Now, they’re building a Culture of Care network that brings together nurses, scholars, hospital administrators, and community partners to create theoretically grounded, actionable strategies that address the rising violence facing healthcare workers.

“For a project like this, you need to understand lived experiences and facilitate genuine co-design,” Toh explains. “That means engaging with nurses, hospital administrators, nursing associations, and unions — people with real experience and knowledge.” The issue is complex and deeply interconnected, she adds, which makes it essential that they bring multiple voices into the research.

There’s this idea of the ‘supernurse’ in the literature, where nurses are expected to have extraordinary abilities and a strong belief in self-sacrifice. Not being able to cope with whatever the work demands of you is then seen as weakness. 

Key partners so far include Trillium Health Partners, the Canadian Nurses Association, and the Family Services of Peel. 

Toh is particularly interested in how violence affects a nurse’s professional identity and long-term commitment to the field. “If we understand those early experiences, we can prevent the longer-term consequences of burnout and turnover,” she says. Their work includes examining the very culture of nursing, which, she points out, is a profession that is highly gendered and often expected to “power through” harm.

“There’s this idea of the ‘supernurse’ in the literature,” says Toh. “Where nurses are expected to have extraordinary abilities and a strong belief in self-sacrifice. Not being able to cope with whatever the work demands of you is then seen as weakness.” 

The team is also studying how hospitals can build “functional cultures,” environments that adapt to the specific challenges units face. The issue, Toh explains, is rarely a lack of solutions, but the difficulty of implementing them. “Changing long-standing behaviours is hard without a systematic understanding of people and processes, and cultural baggage can get in the way,” she says. 

France Gagnon, UTM’s Vice-Principal, Research and Innovation — also a registered nurse — delivered the opening remarks at the group’s inaugural meeting in February. 

“Nurses play a critical role in our society, and I care deeply about their wellbeing. Ensuring they’re safe and able to build long, rewarding careers is essential for all of us,” she says. “Preventing violence is about how organizations listen and respond to people — and this work invites us to centre dignity, safety, and professional identity as foundational conditions of care.”

To develop a clearer picture, the group’s research will draw on surveys, interviews, observations, and existing data from healthcare settings. They aim to understand the challenges people face, as well as opportunities for prevention.

Part of the work will focus on nursing students and how early placement experiences shape their confidence, identity, and decision to stay in the profession. Toh is collaborating with Laura Istanboulian, a nurse practitioner and an Assistant Professor in the Bloomberg Faculty of Nursing, to explore how findings may inform curriculum and training. 

Another line of inquiry involves collaborators at the University of Edinburgh, who are exploring whether AI tools — such as machine learning and large language models — might help detect risk factors for violence. Additionally, Toh will be connecting with colleagues in U of T’s Faculty of Information to expand the project’s interdisciplinary reach.

It’s a large, far-reaching project, with many collaborators and moving parts. Community-engaged research brings enormous value, Toh says, and creates incredible opportunities for both faculty and students. 

But it can also be demanding, requiring time, coordination, administrative support, communications expertise, as well as financial resources. As partnership-based research becomes more central across the University, faculty may also need help navigating funding application systems that were not built with community collaborators in mind. In addition to providing internal support, we need to ensure that organizations and community-based programs can find clear pathways for partnering with the university.

None of this work can be done in isolation. The university is at its best when it serves as a place where diverse partners can learn from one another and co-create solutions.

Gagnon underscores that responsibility. She wants UTM’s Research and Innovation Office to be a place faculty, community, and industry partners can find support as they work together.

“None of this work can be done in isolation,” she says. “Our role is to support partnerships that bring together lived experience, professional practice, and scholarly insight to address complex challenges. The university is at its best when it serves as a place where diverse partners can learn from one another and co-create solutions.”

Toh agrees. “As a university in Mississauga, we’re part of the community,” she says. “We are committed to partnering and contributing.”