The Facts
Nurse encounters abusive patients at work and suffers psychological injury
A case in 2023 concerned a woman who worked as a nurse and made a claim for compensation for PTSD.
The woman worked in the emergency department of a hospital in northern NSW from 2011 to 31 January 2019.
Staff in the emergency department were regularly subject to abuse by patients.
Around 2015, the nurse had a particularly upsetting encounter with a patient, LF, who was verbally abusive, yelled profanities at her and threw a blood pressure monitor across the room.
On 31 January 2019, when the nurse arrived for her shift, she saw LF’s name on the patient handover sheet. She began crying uncontrollably and suffered a panic attack for the first time.
She left work that day and has been unable to work since.
The nurse was diagnosed as suffering from post-traumatic stress disorder (PTSD).
Nurse seeks workers compensation for permanent impairment
The nurse brought proceedings in the Personal Injury Commission of NSW, seeking payment of permanent impairment compensation for PTSD, a psychological injury.
The question before the commission was whether the nurse had developed PTSD over time due the nature and conditions of her work.
Expert commentary on the court's decision
Commission rules in favour of nurse
In Schouten v State of New South Wales (Northern NSW Local Health District) [2023] NSWPIC 565, the Personal Injury Commission found in favour of my client, the nurse Juliette Schouten.
The commission accepted that Ms Schouten’s PTSD had developed over time due to the nature and conditions of her work from 2011 to 31 January 2019.
Two categories of injury under Workers Compensation Act
Under the NSW Workers Compensation Act 1987 there are two main categories of injury.
The first category is a “personal injury”, often referred to as a “frank injury”. This is a one-off incident or accident characterised by a sudden change, for example a printer who injures their hand by getting it caught in the printing press.
The second category is a “disease injury” or “disease of gradual process”, which means that the injury develops over time, for example an executive assistant who develops repetitive strain injury after repeated use of a computer keyboard.
Depending on the facts, PTSD may fall into either category.
Our client’s claim before the commission asserted that the PTSD was a “disease injury”.
Standard of causation for disease injury higher than for personal injury
Establishing causation for a disease injury is more difficult than for a personal injury.
This is because under section 4(a) and 4(b)(i) of the Act, an injury is defined as a “personal injury arising out of or in the course of employment” or as a “disease injury… that is contracted by a worker in the course of employment but only if the employment was the main contributing factor to contracting the disease”.
Causation turns on employee’s perception
In summarising the principles to be applied to determining causation, the commission noted that employers must take employees as they find them. The law does not require that an employee’s perception of events is one that passes a test based on an objective measure of reasonableness.
This is referred to as an “egg-shell psyche” principle.
Regarding Ms Schouten’s perception, the commission said that:
Commission rejects employer’s arguments
The commission rejected the argument of the employer, Northern NSW Local Health District, that there was no contemporaneous evidence of psychiatric symptomatology as a result of the alleged traumatic events.
The commission said: “To the contrary, I accept that the treating medical evidence did demonstrate a clear causal relationship between the diagnosis of post-traumatic stress disorder and the nature and conditions of the applicant’s work prior to the events of 31 January 2019.”
The commission also rejected Northern NSW Local Health District’s argument that Ms Schouten’s PTSD was only causally related to the two specific incidents involving LF in 2015 and on 31 January 2019.
The commission dismissed the opinion of Northern NSW Local Health District’s independent expert that Ms Schouten had a pre-existing non-work-related psychological condition.
Importance of reporting and documenting incidents
This case highlights the complexity of psychological injuries in the workplace, especially in high-stress professions like nursing.
Ongoing exposure to stressful or traumatic events at work can build up over time and potentially lead to compensable psychological injuries.
As an employee, it is crucial to report stressful incidents at work and to seek medical help for any symptoms. This creates a paper trail that can support future claims if needed.
Employers in high-stress fields should implement robust systems to support staff mental health and to manage potentially traumatic incidents. Regular check-ins and debriefings could help identify problems before they escalate.