Student nurses in Hong Kong reveal scale of violence and abuse while training, raising fears more will quit amid staff shortages in hospitals

Nursing student Chan Tsz-kwan can still recall the unpleasant experience of a patient swearing at him when he was trying to provide care. The man, who required tube feeding but was not allowed to eat before medical tests, got irritated when told by Chan he had to wait for those checks before being fed. “That patient used offensive language and asked if I intended to let him starve and not give him any milk,” said Chan, 21, recalling the experience from about two years ago when he was in his first year of studies. “I was quite upset afterwards,” he said. “But I understand it was pretty uncomfortable for him to have a feeding tube and he was hungry ... and he might not understand the procedures well.” Chan’s case might not be an unusual experience among nursing students. In a Polytechnic University study recently published in the BMJ Open, 37.3 per cent of the 1,017 nursing students surveyed in 2012 reported experiencing verbal abuse or physical violence when providing clinical care during their studies. The figure was described by the researchers as “moderately high”. “This is a situation that warrants our attention ... In the past, less attention has been placed on nursing students,” said the study’s first author Cheung Kin, an associate professor from the university’s school of nursing. Verbal abuse refers to words that humiliate or degrade a person, while physical violence includes behaviour such as kicking, slapping and pinching, according to international definitions. The study found there were further incidents of nursing students suffering verbal abuse during their clinical placements. A total of 311 of the students polled had such an experience, compared with 168 for those who had been on the receiving end of physical violence. Cecilia So Chui-kuen, president of the Hong Kong Nurses General Union, believed full-time nurses would experience even higher levels of abuse, as they tend to spend more time with patients than students would. Patients were described in the study as the main source of both verbal abuse and physical violence. “There are always urgent situations in a hospital and we would tend to be more tense in such situations ... Patients might then raise their voices and a nursing student could perceive it scolding them,” Cheung explained. Shirley Ching Siu-yin, a co-author of the study and an associate professor from the same nursing school, added patients might not intend to be offensive. “An elderly patient might feel confused after they have been admitted to a hospital, as they are not familiar with the environment,” Ching said. “If a worker needs to change their diapers or move them to another bed, and it is not understood by the elderly patient, they might pinch or grab onto the worker.” But the impact of abuse could last longer than expected. The study found a student had a “significantly higher” intention of leaving the nursing profession after experiencing either verbal or physical violence in a clinical setting. That meant the already serious nursing shortage problem in the city could intensify. Hard-pressed nurses demand action on staffing crisis Health care staff working in public hospitals complained that during the winter flu season, when more patients required hospital care, each nurse had to look after as many as 12 patients at a time. That was much higher than the international standard of one nurse for every six patients. In a strategic review of the city’s health care manpower planning, released by the Food and Health Bureau in 2017, it was estimated Hong Kong would be short of about 450 nurses in 2020, and the figure would increase to nearly 1,700 in 2030. But for nursing student Chan, who also had his clothes gripped by a man with dementia when changing the patient’s nappy, the experiences will not deter him from becoming a nurse. “Patients might be that emotional or agitated only because of their illnesses...I have learnt to be more careful when talking to or approaching patients,” he said. Annie Cheng Pui-sze, a tutor from Queen Elizabeth Hospital’s School of General Nursing, said students are offered training in communicating with patients. She said students could contact tutors for help with any abuse arising. The school would also approach the relevant wards to understand what had happened and seek solutions, she added. ‘I feel like I could work to death’: weary nurses share tales of toil A spokesman for the Hospital Authority said measures were in place to prevent workplace violence. They included skills training on control and restraint techniques. Hospitals have also installed curved mirrors at passageways, CCTV and alarm systems in emergency departments to protect staff and patients. Alex Lam Chi-yau, chairman of Hong Kong Patients’ Voices, said hospitals and the government should step up its education efforts in telling the public to respect health care professionals when receiving care.