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Dealing with violence in the workplace

Awareness of assaults on NHS staff has been on the agenda for some years now, but despite several high-profile media and poster campaigns the number of cases is continuing to rise.

Figures produced annually by NHS Protect, the body responsible for dealing with crime in the National Health Service, show that the total number of assaults on staff has gone up over the last few years. The most-recent figures are for 2014-15, when there were 67,864 recorded assaults on staff. In contrast, there were fewer than 60,000 assaults during the period 2011-12.

Who is it happening to?

There are no specific figures for attacks on nurses, but the statistics were broken down into acute, ambulance, mental health, primary care and special care.

There were more than 19,000 assaults on acute care staff in 2014-15 – and that figure was dwarfed by in excess of 45,000 attacks on NHS staff working in mental health. There were fewer than 2,000 assaults against either ambulance or primary care staff – with none recorded in special facilities.

Kim Sunley, senior employment relations advisor at the Royal College of Nursing (RCN), confirmed that the overall pattern held true for nurses.

‘No area of nursing is untouched by violence, however year-on-year we are seeing high levels in mental health environments,’ she explained. ‘We are also particularly concerned about those nurses who work alone as they are at greater risk of sustaining an injury from a physical assault.’

Who is carrying out the assaults?

While it’s the boozed-up accident and emergency patients who get in the news for attacking NHS staff trying to help them, that’s only part of the story.

As hinted above, by far the biggest portion of assaults happen in mental health facilities – and a significant number of these are from elderly patients.

Kim says: ‘Statistics from NHS Protect have shown high levels of incidents from patients over 75 – this is likely to be due to reduced capacity through medical conditions such as dementia.

‘Strategies for dealing with this would be different than an assault from someone with capacity. You wouldn’t prosecute or sanction the individual – however you would still need to follow up such incidents and review care/risk assessments.’

Kim also believes that pressure on resources in the NHS can play a role in making staff more vulnerable. ‘Staff shortages or a poor skill mix and inappropriate environments may also exacerbate these types of incidents. They can also have a demoralising impact on staff,’ she adds.

So what should you do?

The RCN has published guidance for members facing or fearing physical abuse – and the first thing you should do is make sure the incident gets reported.

‘Report incidents via your organisation’s incident reporting procedures,’ advises Kim. ‘Even if it is verbal abuse – which can be an early warning sign of worse.’

She also advises nurses to attend any training available on how to protect themselves, as well as making use of equipment provided for their protection, such as lone worker devices or static alarms. If making home visits, nurses are advised to carry out a dynamic risk assessment. And any concerns about the risk of violence should be reported to the RCN safety representative.

Kim adds: ‘We offer counselling support for our members and legal support with a personal injury case, so we would advise all members to contact RCN Direct helpline.’

Keep yourself safe

‘If a nurse feels in serious or imminent danger (particularly when working alone), then he or she should withdraw to a place of safety,’ advises Kim.

‘For example, if they are doing a home visit and feel unsafe – use a strategy to leave such as “I just need to pop out to pick up some notes I’ve left in the car”.

‘The Nursing and Midwifery Council code states that they should take account of their own personal safety as well as those they care for.’

If you’re given a personal safety alarm such as Identicom or mobile phone based alarm, check that you have a signal and battery life. The RCN strongly recommends that all members use safety equipment provided by their employers including lone worker alarms. As an employee, you have a responsibility to use all equipment that is provided for your safety, so long as you have been fully trained on how to use it.

Working in a buddy system may also be advisable.

Is enough being done?

According to Kim, there are ‘pockets of good practice,’ in the NHS. ‘For example, some organisations are investing in training and lone-working equipment, but this is not widespread.

‘Guy’s and St Thomas’ NHS Foundation Trust is a good example of a trust taking this seriously, but financial restraints and staffing shortages are also exacerbating the situation generally.

‘The NHS (and our members) are also reliant on the police and CPS responding appropriately to incidents of physical abuse and again, intelligence suggests this is patchy.’

Violence is also an issue in the private sector, but the extent is difficult to measure as no national data is kept. Kim says: ‘Again there are pockets of good practice which the NHS could learn from, but also particular challenges in relation to an appropriate organisational response to patients who are persistently violent and are paying for their care.’

The effects of violence

There is obviously both physical and psychological harm caused by assaults on NHS staff, but Kim contends that the damage runs deeper in some instances.

She says: ‘Working in an environment where violence is poorly managed or where you feel vulnerable will impact on morale. People may vote with their feet and move elsewhere or even leave nursing.’

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