Three John Hunter Hospital security guards are on leave after suffering broken bones and a serious joint injury in assaults from the same patient.
The guards suffered a broken arm, broken thumb and dislocated thumb respectively last month, a Health Services Union (HSU) spokesperson said.
The security guard who broke their arm was attacked with a chair.
The incidents reflect a rise in assaults on staff at public hospitals, which have been linked to patients with dementia spending longer periods in hospital.
The violence is also linked to drug users addicted to substances such as methamphetamine, also known as ice.
"It's out of control," the HSU spokesperson said.
More than 1000 incidents - known as code blacks - were occurring at John Hunter each year, the spokesperson said.
These incidents are emergencies in which a patient, visitor or intruder is threatening harm or violence to themselves or others.
"They're not all violent, but they have the potential to be. Nursing staff don't call them if they're not scared," the HSU spokesperson said.
While there's an average of three incidents a day, in one case there were about 15 code blacks in a day. This involved the patient who injured the three security guards.
John Hunter Hospital general manager Julie Tait said the hospital was supporting the three injured security guards.
"As a large tertiary referral hospital, John Hunter cares for some of the most complex patients from our district and northern NSW," Ms Tait said.
Staff say incidents are underreported, especially those that involve threats of violence. Security can be understaffed and there's not always enough time to document everything in incident reports.
Underlining the threat to staff and patients at the John Hunter is the issue of weapons, of which numerous types have been confiscated at the hospital.
An improvised bladed weapon fell out of the bag of an offender who security guards were removing from the emergency department because of his threatening behaviour towards the public.
Other weapons found in separate incidents have included a meat cleaver and knives stashed in toilet cisterns.
Various sized knives and a homemade truncheon weighted with a bolt on the end have also been confiscated.
These incidents have coincided with a union push for security guards to be given greater powers in public hospitals statewide.
HSU NSW secretary Gerard Hayes said "for more than two decades, this problem has festered".
"We have seen a lot of talk and too little action," Mr Hayes said.
Last month, the Minns government established a taskforce to advise on ways to improve safety for staff, patients and visitors across the NSW public health system.
The NSW Health Safety Taskforce aims to improve hospital security systems and the capability of security guards.
Additionally, it aims to reduce the incidence and impact of occupational violence.
NSW Minister for Health Ryan Park announced the taskforce by saying "if you are acting aggressively towards others, you do not have a right to remain on hospital premises".
However, a key issue is the powers that security guards have in public hospitals to restrain violent patients. Some have suggested special constable powers are needed to contain the rise in assaults.
Mr Hayes said health districts can use powers under the Inclosed Lands Protection Act.
"This can empower security officers to move people on, search them if they have grounds to suspect they are carrying a weapon and, if necessary, restrain them," Mr Hayes said.
"These are commonsense reforms, but they do require implementation at a local level.
"I would urge John Hunter Hospital to get on with empowering security officers, so they can do their job and protect the public."
Security at John Hunter has increased from six to eight guards rostered on around the clock, as the new hospital building was completed. Staff believe this should be increased by at least two guards.
Additionally, affected hospital staff believe people at the top of NSW Health and local health districts who have responsibility for security should have a background in the sector.
"They need someone who thinks like a security guard. NSW Police don't put a politician in the role of commissioner," the HSU spokesperson said.
Ms Tait said John Hunter had "comprehensive security arrangements in place to help prevent, de-escalate and respond to incidents of violence and aggression."
She said staff develop "behaviour management plans for patients identified as presenting a higher risk of aggressive behaviour".
"Security staff also use powers available under the Inclosed Lands Protection Act where appropriate, including directing people to leave the facility when they are not seeking medical care," she said.
"The body-worn camera trial for NSW hospital security staff is also underway at John Hunter Hospital to improve safety."
