COMMON BELIEFS “a national epidemic” “an occupational health problem of significant proportions” “something intrinsic in the nature of the work itself which results in high risks “the numbers are a gross underestimate of the actual numbers of incidents”
SURVEY RESULTS u Four in 10 report being harassed or assaulted by patients/relatives in past 12 months u Higher than average in learning disability, long term care, mental health u 67% experienced verbal abuse at some time in career. 95% for A&E u IRNs less likely to report verbal abuse u Overall only 31% reported
SURVEY RESULTS u 27% experienced physical assault at some time in career – nearly half of these in last year. u In 91% of cases there was no outcome from any intervention taken by individual or employer u 80% agreed with statement “I am confident that my manager would support me if I were physically assaulted at work”
ACTION TAKEN FOLLOWING ASSAULT Reported to more senior member of staff Reported to police Made claim to CICA
EMPLOYER RESPONSE TO ASSAULT Offered counselling/debriefing Involved police Care discontinued
FACTORS ASSOCIATED WITH WELLBEING u Working hours: part time –better scores u Shifts/control over working pattern – poorer scores u Inappropriately graded – poorer scores u Not consulted about work life balance – poorer scores u Exposed to bullying and harassment – poorer scores (particularly frequent bullying) u Exposed to assault – poorer scores u Intention to leave – poorer scores u Satisfied with job- better scores
REASON FOR SURVEY u March 2005: John Reid “NHS staff who work on their own in the community will have their very own guardian angel in the form of a high- tech protection device” “I am determined to do everything within my power to stop NHS staff suffering from violence and abuse” “Up to 100,000 staff work alone in the NHS every day and thanks to this device they will have the knowledge that help is only a button away.”
LONE WORKER SURVEY u 3010 members across UK; 996 completed u 85% spent more than a quarter of their time working alone u 53% work outside “office” hours. u Two thirds stated that employer did not know whereabouts or only “sometimes” u 78.8% said employer had details of car u 82.4% said employer had policy but 17% not provided with it
LONE WORKER SURVEY u 38% rarely or never carried out risk assessment u 72% never rarely or only sometimes received all the information needed about the visit u Over three quarters felt very or quite safe at work but one third sometimes felt unsafe while working alone
LONE WORKER SURVEY u 52% said they thought the risk of violence/abuse had increased over last two years u Mobile phone most common safety equipment – often employee’s own. u 3.5% had Identicom u Nearly one fifth had not received conflict management training. Almost half had not received any training in last two years.
VerbalPhysical Number of incidents Number of incidents reported 883 (44.6% of total verbal incidents) 83 (86.5% of total physical incidents) Number of incidents reported to police 30 (1.6% of total verbal incidents) 12 (12.5% of total physical incidents) Number of racial incidents 49 (2.6% of total verbal incidents) 27 (28.1% of total physical incidents) Number of sexual incidents 128 (6.8% of total verbal incidents) NUMBER OF INCIDENTS
“Attending a remote farmhouse, rural location recently, I was threatened verbally by a patient's husband that 'he would be behind the door with a gun if he was ever in a bad mood'...This experience has greatly affected my feelings for my career as a district nurse,” district nurse, North East England. “I was assaulted and subjected to high levels of aggression and threats to kill us on a home visit with a social worker in 2000, where there were child protection concerns and serious enduring mental illness in the mother. The social worker sustained a serious injury and we were both traumatised for months and ever since,” health visitor, Merseyside.
WHAT THE RCN WANTS u FIVE POINT PLAN ; –Prevention: technology –Risk assessment –Policy –Training –Support from employer
UPDATE u Physical assaults : –58695 (decrease of 1690) – one for every 23 staff –41,345 in mental health (decrease of 1752) –11,100 in acute and foundation trusts (increase of 342)
THE GOOD NEWS u Physical incident reporting u Local Security Management Specialists – a force for change u Legal Protection Unit u Memorandum of Understanding u Training u Guidance u Legislation
CHALLENGES TO ADDRESS u Organisational culture/learning/capability u Environment u Training u Research u Staffing levels u Risk assessment u Sanctions u Compensation
WHAT ELSE COULD/SHOULD RCN DO? u Legislation: nuisance and disturbance proposals/new offence? u Make existing legislation work? How? u CICA change – action/lobbying ? u Improve reporting? u Better support after incidents? u Lone worker – provide technology? u Training –effective? u Better risk assessment?