Marathon Talks Underway to End Israel-wide Nurses Strike Over Workplace Violence

Health authorities believe the strike and the violence against medical staff are the result of the growing burden on the system

Medical staff at Safed's Ziv Medical Center hold signs that read "Enough with violence" during a nationwide nurses' strike, on Tuesday.
Courtesy of Ziv Medical Center

Marathon negotiations are underway to end the nationwide nurses strike that began on Monday morning, and affected all but emergency and essential services. The National Association of Nurses in Israel said it called the strike in response to “the government’s unwillingness to deal with the serious violence in the health system” directed at medical staff.

The talks were renewed on Tuesday between representatives of the nurses association and representatives of the health and finance ministries. It initially appeared that the sides were close to an agreement, and that the strike would end on Tuesday.

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At the heart of the negotiations are two main issues: significantly reducing the violence against medical staff, in particular, nurses, and enhancing their sense of safety at work.

The nurses are demanding additional positions for nurses in the public health system to reduce the load on the medical staff, which would also reduce the amount of violence directed at them. The agreement is expected to meet this demand. In addition, the agreement will include a commitment, with a specific timetable, to implement the recommendations of the Health Ministry committee on eradicating violence from the healthcare system.

The recommendations include dozens of steps and actions – on both a system-wide level and at individual medical institutions. They include a national program to eradicate violence, expanding the authority of security guards in medical institutions, deploying police officers, advancing legislation to harshen the punishment for such violent crimes, along with training for staff on handling such incidents.

The nurses union said early Tuesday evening that they were making progress in the meeting on all the issues, including the heavy workload on nurses and punishment of perpetrators of violence against medical staff.

The strike, and the problems of violence that led the nurses to strike, is considered by healthcare authorities to be the result of the growing burden on the public health system and a shortage of personnel and infrastructure. Health system officials feel that the solutions under discussion, such as adding more security guards, are only a partial solution and a large part of the violent incidents are the direct, or indirect, result of the overloading of the health system.

Nurses say that at least some of the harsh violent incidents directed at them cannot easily be explained by just a lack of budgets. In hospitals, compared to other places that provide service to the public, there is a sense shared by ordinary people that “it is legitimate to speak disrespectfully to medical staff, out of a view that they will listen only if I raise my voice,” a nurse from the emergency room at Rambam Medical Center in Haifa told Haaretz.

In December 2017, a Health Ministry committee submitted its report with recommendations on how to end violence against medical staff and employees in the health system. The committee, headed by Prof. Shlomo Mor Yosef, was appointed following the murder of a nurse, Tova Kararo, by a patient at at Clalit Health Services clinic in Holon in March 2017.

Every year, some 3,500 cases of violence against medical staff are reported, according to the committee. Twenty percent of the cases include physical violence and the rest involve verbal violence. Only 11 percent of the cases were reported to the police, and not all of them result in charges and convictions.

The report stated that despite a number of actions taken over the years, including plans to prevent such violence, attacks on medical staff are increasing both in number and in severity.

The Brookdale Institute and the Clalit Health Services published research in the past that drew similar conclusions that 75 percent of the medical staff in clinics had reported suffering from violence.

Five months ago, Bar Siman Tov issued a directive on preventing violence and handling such incidents, and ordered the implementation of the committee’s recommendations.

The recommendations include a long list of actions, including establishing a supervisory committee on the problem of violence, implementing a national program to prevent such violence as part of the ministry’s ongoing work and creating a national computerized system for reporting and collecting data on such incidents and for investigating them. Other recommendations include an ongoing national media campaign, the development of training materials to respond to violence, the deployment of more police at medical institutions and the expansion of authority of security guards. In addition, legislation is to be advanced to increase the punishment of perpetrators of violent attacks on medical staff.

The latest strike was called after a patient stabbed and injured a nurse at Shmuel Harofeh geriatric hospital in Be’er Yaakov.