Workplace Violence in Canadian Healthcare: Why Bill 168 Changed Everything

For years, aggression toward nurses and hospital staff was quietly treated as part of the job. Bill 168 ended that. Since 2010, managing workplace violence in hospital security across Ontario has been a legal obligation, not a courtesy — the Occupational Health and Safety Act (OHSA) now requires healthcare employers to assess the risk of violence, build a program to control it, and give workers a way to summon help fast. This guide explains what changed, why healthcare carries some of the highest violence rates of any sector, and where a competent security operation fits into your legal duties. For the wider picture, see our healthcare security services.

Why healthcare is a violence hotspot

The scale is not a matter of opinion. A cross-country survey by the Canadian Federation of Nurses Unions found that 61% of nurses reported abuse, harassment, or assault in the year before being surveyed — and the same parliamentary review noted a 2019 poll in which 53% of health-care workers said they did not report incidents at all. The problem is both widespread and undercounted.

The drivers are structural: emergency departments running at capacity, patients in pain or crisis, intoxication, cognitive impairment, long waits, and staff working alone. None of these disappear on their own, which is exactly why the law shifted from “manage it individually” to “prevent it systematically.”

What Bill 168 actually requires

Bill 168 amended the OHSA to make violence and harassment a formal health-and-safety duty. In practice, a compliant Ontario healthcare employer must:

• Have a written workplace violence policy and a harassment policy, reviewed at least annually.
• Maintain a program that puts the policy into practice — including how risks are controlled and how incidents are reported and investigated.
• Assess the risk of violence arising from the nature of the workplace and the type of work (a busy ED carries different risk than an administrative office).
• Provide measures to summon immediate assistance — the practical basis for duress alarms, radios, and a security response.
• Warn workers about a person with a history of violent behaviour they may encounter, where reasonably necessary.

A later reform, Bill 132 (2016), strengthened the harassment side further. And for the small number of federally regulated health workplaces, the Canada Labour Code Part II and its violence-prevention regulations impose parallel duties. The common thread across all of them: prevention must be designed, documented, and resourced.

Where security fits into your legal duties

Security doesn’t discharge your OHSA obligations for you — accountability stays with the employer — but a well-run security program is often how several of those duties get delivered on the ground.

• “Immediate assistance” becomes real when trained officers respond to a duress call in seconds, not minutes.
• Risk assessments get sharper when security incident data feeds into them, showing where and when aggression actually clusters.
• Response is consistent because officers work to defined procedures rather than improvising, and coordinate with clinical staff during a behavioural emergency.
• The environment gets safer by design — controlled access, visible presence at flashpoints, and monitoring tools such as security camera systems that support both prevention and evidence.
• Investigations are credible because officers document incidents factually and consistently, which matters if a case is ever reviewed by an inspector, an insurer, or the courts.

This is also where healthcare security overlaps with adjacent skills. The emergency department is where most violence concentrates, and mental health crisis response is where de-escalation training earns its keep.

Want your security coverage mapped against your OHSA obligations? Book a consultation and we’ll review your sites.

Turning compliance into an actual reduction in incidents

Meeting the letter of Bill 168 is the floor. Reducing incidents is the goal — and that comes from a few disciplined habits:

• Report everything. Underreporting hides the risk; a strong incident-reporting workflow makes the pattern visible so you can act on it.
• De-escalate first. Officers trained in recognized techniques prevent far more harm than they ever manage through force.
• Review the data quarterly. Feed security and staff reports back into your risk assessment so controls evolve with the threat.
• Coordinate roles. Clinical staff, security, and management should each know exactly what they own during an incident.

Handled this way, security stops being a line item and becomes the mechanism that keeps your workplace violence obligations current. When you’re ready to evaluate providers formally, the safety questions belong in your healthcare security RFP, and the privacy side is covered in our PHIPA guide.

Frequently Asked Questions

Q1. What is Bill 168 in simple terms?
Ans. It’s the 2009 amendment that added workplace violence and harassment duties to Ontario’s Occupational Health and Safety Act, in force since 2010. It made prevention a legal requirement rather than an optional practice.

Q2. Does Bill 168 apply to hospitals specifically?
Ans. Yes. Ontario hospitals and other health-care employers must assess violence risk and implement control measures under the OHSA, and healthcare is among the highest-risk sectors it covers.

Q3. Is hiring security enough to comply with Bill 168?
Ans. No. The employer keeps the legal accountability; security is one of the ways you deliver duties like summoning immediate assistance and controlling risk, not a way to transfer them.

Q4. What counts as workplace violence under the OHSA?
Ans. It includes the exercise of physical force, an attempt or threat to exercise force, and statements a worker could reasonably interpret as a threat. Verbal abuse alone may fall under harassment rather than violence.

Q5. What does “measures to summon immediate assistance” mean in practice?
Ans. It’s the requirement behind duress alarms, panic buttons, radios, and a defined security response. Workers must have a reliable way to call for help quickly.

Q6. How often must our violence and harassment policies be reviewed?
Ans. At least once a year. Many facilities review sooner after a serious incident or a change in operations.

Q7. Do we have to warn staff about a violent patient?
Ans. Where a worker may encounter a person with a history of violent behaviour and there’s a risk of harm, the employer must provide the information reasonably necessary to protect them — while respecting privacy limits.

Q8. Which areas of a hospital see the most violence?
Ans. Emergency departments, mental health and behavioural units, and long-term care settings consistently report the highest rates, which is why security presence is usually concentrated there.

Q9. Are federally regulated health workplaces covered by Bill 168?
Ans. No — they fall under the Canada Labour Code Part II and its violence-prevention regulations instead. The duties are parallel, but the governing law differs.

Q10. How do we prove we’re meeting our obligations?
Ans. Keep current written policies, a documented program, dated risk assessments, incident records, and training logs. If an inspector or investigator asks, that paper trail is your evidence.