Posted By jackw.
The recent figures from nurses of up to 35% being subject to some form of violent/aggressive behaviour, whilst not surprising is non the less worrying. particularly the increasing trend for this to be from a carer or family member and not the patient. Lone working policy, violent warning marker systems etc. aren't working. What else can we do to protect this vulnerable group of workers?.

Should we insist that patients come into hospital, docs surgeries or other "safe" properties. Can we insist on this given other legislation that dictates people must receive a service at home if required. Should we be saying staff will only go out if family cares friends etc vacant the house whilst staff are carrying out treatments?

What to do indeed?

Posted By Tabs
35% have experienced what though? And how often?

If I am a nurse of twenty-five years experience and had one carer poke me in the chest because they were frustrated or hurt 10 years ago, do I become part of the 35%?

To have anyone exposed to physical violence is very wrong, but I don't think we are being given enough information about frequency or severity - and how both of these compare to the shop assistant, cinema usher, or bus driver.

If it is a big and serious problem, perhaps the answer lies in authority?

A district nurse of the 50's would have had the whole of the police force, magistrates, and senior businessmen of the area behind them - and anyone causing them harm would be in no doubt that they would be dealt with very harshly. Almost ostracised.

What happens now? small fine and community service, and almost complete anonymity because non of your neighbours know your name even if they saw it in the papers.

Teachers have nervous breakdowns because teenagers have more authority then they do. Teachers fear the consequences of being labeled bullies or molestors because a single accusation will be believed.

Great Britain needs to give authority back to the traditional levels of society - not the lowest.

Posted By Keith Rossington
Hi Jack

A lot can be done to prevent - most of which has already been mentioned. I don't know if you work in the NHS but if so, Conflict Resolution Training does help. Also contact your local Sec management Specialist. Our is excellent and he's done a lot around making sure we have a Violence & Abuse policy and that we follow it. This ranges from the initial 'we don't expect our staff to be spoken to in that way' to taking out contracts that we give treatment but your part of the contract is not to abuse staff, NHS AsBOs and ultimately withholding treatment (we haven't had to do that yet because the ther methods have worked). Gladly help if poss.

Posted By jackw.
Hi guys. I have a background in housing and social work with a large LA...around 4000 employees combined with both departments ...I have knowledge and experience of most of what has been presented here. But like many people find this is often inadequate and just doesn't work... but i agree a combination of the control factors mentioned will help. The problem with doubling up and employing security staff is cost. Compounded in the latter by the fact that a householder can refuse entry to this type of employee.

I suppose I really posed the question on the back of the recent survey of nurses who work in the community as an open one for general discussion.

Cheers.

Posted By Paul Duell
If you haven't done so already, check the website of the Suzy Lamplugh Trust - their advice is based on not getting into a bad situation in the first place, and it's what we use as the basis of the advice we give our people.

We also do the conflict management training, personal attack alarms etc (I'm not in the healthcare sector), but the basis of the advice we give is:
1) Don't go into what may be a bad situation alone.
2) In ANY situation keep your exits clear.
3) If a situation looks like turning bad, leave.
4) Only if steps 1 - 3 have failed to keep you out of trouble, should you apply conflict management techniques.

Hope this helps - I'll be following this thread closely for any advice anyone else has!

Posted By AHS
Medical/Nursing staff can be very rude/arrogant and there is a culture of us and them developing in the NHS.

This needs to be addressed along with punitive actions taken against unruly members of public.

Posted By Christopher
Brigham

Jack mentioned the subject of violent/aggressive behaviour towards staff. AHS has only identified a potential reason for such a behaviour. Those of us with expertise of the health service, violence, agression and conflict resolution are fully aware that it is often the arrogance of staff that contribute towards the problems. This should be covered in the Lone Policy of any organisation, and even if people find it upsetting the recognition that it may be their attitude/behaviour that is contributing to the problem needs to be addressed.

If we had the courage to take about sensitive subjects openly, then possibly the statistics wouldn't be so high.

Posted By Brigham
So how do you assess and identify an arrogant employee and how do you cover it in a lone working policy?

Posted By Christopher
John

If we are too sensitive to consider the potential factors which might cause friction, then sadly there will be members of staff and members of teh public who will bear the blunt of this ommission. Every member of the health care team forms part of the marketing of the NHS. Sadly if one member of staff brings a bad attitude it can result in members of families being brought in ready to support their relatives. Health care staff are not taught how to recognise a reasonable challenge and how to address it. This is a weakness in their training. As a very experienced person in both the delivery and the receipt of health care, I am very aware of staff who do an amazing job, and those you wonder whether they are fit to work within a caring profession. This is only one part of what should constitute a robust training programme. Communications are a key factor in health and safety - are staff attitudes not a form of communication?

Posted By jackw.
Hi, lots of interesting and some controversial stuff esp re staff attitudes. I agree that staff attitude can sometimes be "unhelpful" That, I hope, can be addressed by training and supervision. One thing that struck a cord with me was the issue of staff empowerment: staff having the confidence to walk away from a situation. Whilst we (the H&S team) in my LA encourage this and most managers when faced up will agree. I am not so sure they instil the confidence/empowerment in staff that they can walk away regardless of the care issue when/if they feel threatened. Of course some staff, esp social workers sometimes seem to feel they have some invisible shield around them and often expose them selves to and stay in situations that they clearly should get out of ASAP. I am not sure how we overcome this attitude that in my experience often results in some staff feeling indeed almost accepting that it is part of the job... .

Posted By Jim O'Dwyer
It's my experience that, despite the alarming statistics, the vast majority of nursing staff don't really worry very much about the prospects of becoming a victim of violence at work. They're more likely to suffer higher levels of anxiety about not being able to find a parking space when they get to work!

But, what is concerning is that the vast majority of those that do feel vulnerable, would, it seems, prefer to suffer extreme levels of anxiety about attacked and even sustain assaults rather than confront their managers about the adequacy of the safety arrangements.

Overcoming this (endemic) reluctance to challenge the appropriateness of the working arrangements is the key not only to improving the quality of protection against violence but also reducing the frightening number of medical errors that are occurring.

I think it would help convert staff and management attitudes if everyone knew that:

- S7. Health and Safety at Work Act 1974 makes it each employee's legal responsibility to take "reasonable care" of their own health and safety.

- The law expects employees to behave as an 'ordinary, cautious person'

- The law leaves no excuse whatsoever for tolerating unsafe working conditions

- If an employee disregards an obvious risk and suffers injury, the law can interpret their actions as 'Volenti non fit injuria' - in other words, they volunteered to take the risks, in which case any compensation award they may be entitled to could (and probably would) be reduced in proportion to how significantly their own actions contributed to the severity of the outcome.



Re: Lone Working

In March 2005, the NHS Security Management Service published comprehensive advice and guidance to Trusts on Lone Worker protection.

The Document is titled "Not alone - A Guide for the Better Protection of Lone Workers in the NHS" and you can download it FREE on this link:

http://www.cfsms.nhs.uk/...one.worker/not.alone.pdf

However, like an awful lot of other Guidance issued in the NHS, it hasn't been implemented, it hasn't been enforced and neither are the individuals responsible for the shortcomings held to account.

Best wishes,

Jim O'Dwyer

Posted By Jim O'Dwyer
Hi Chris,

UNISON have provided an authoritative guide to legal and professional conduct issues which provides practical guidance to health service staff (at all levels) in situations where there may be a conflict between what their employer expects them to do and what they believe is in the best interests of patients, the health of colleagues or themselves, or the wider public interest.


These situations might include:

- Being told to follow potentially unsafe instructions

- Being expected to work in an environment unsafe for staff or patients

- Working in a workplace where a climate of fear prevents proper concerns about patient care or staff safety being raised

- Being asked to implement a questionable delegation of tasks or roles

- Being asked to collude in inappropriate allocation or reduction of resources not in the best interests of patients.


The “Duty of Care” handbook is intended to assist good practice and improve services by giving guidance on:

- What to do in urgent situations where there may be a conflict between, on the one hand, what the employer immediately expects of the employee, and, on the other, the individual employee’s duty of care to patients, colleagues and their employer, and the public interest.

- What to do when there are longer standing concerns, such as excessive workload, inappropriate delegation of tasks or roles, or a bullying culture which makes raising concerns difficult.

- How to ensure that proposals for changing services, service delivery or the available resources tackle concerns about unsafe practice effectively and positively, so that the improvement of services and safe practice go hand in hand, rather than being in conflict.


You can view/download “The Duty of Care” free online on the UNISON web site.

This is the URL: http://www.unison.org.uk/acrobat/13038.pdf

It is also available in hard copy from UNISON, 1 Mabledon Place, London WC1H

Tel: 0845 355 0845 (quote stock number 2135)


I hope this info helps you.

Best wishes,

Jim O'Dwyer