Public Health
Country nurses hardest hit by violence
Anti-violence measures in NSW hospitals are ineffective and nurses are increasingly exposed to more severe forms of violence, MPs told.
The NSWNMA submission to the parliamentary inquiry into rural, regional and remote health services has called on NSW Health to review duress arrangements outside the big cities.
The submission says staff at rural and remote services experience higher rates of violence and aggression than those in metropolitan areas.
Rural and remote facilities often have too few staff to provide an internal duress response.
They often do not have security staff, or if they do, they do not cover all shifts. And they may not have ready access to police.
The submission says a review should consider staff numbers across each shift, the availability of security staff by shift, and the availability of external security companies and police.
The submission draws on research into violence at work, conducted by the NSWNMA in collaboration with researchers from the University of Technology Sydney (UTS).
The research involved more than 3500 nurses and midwives, making it one of the largest studies undertaken on this topic worldwide.
It found that 80 per cent of nurses and midwives had experienced violence at work in the six months before completing the survey.
Seventy-six per cent said violent episodes were becoming more frequent.
Mental health units most violent
According to NSW Health, about 40 per cent of violent episodes occur in mental health units.
Prevention and early intervention into mental health disorders is an important part of reducing exposure to violence, the submission says.
From there, providing treatment early and preventing relapses is also critical.
NSWNMA members in more isolated areas are worried about an increase in inappropriate drop-offs of intoxicated people for mental health assessments.
The submission says that “behaviourally disturbed, intoxicated people are being taken to an ED or mental health unit by police for mental health assessment, even though they are unable to be assessed until they are no longer intoxicated.”
This leaves an aggressive person to sober up in hospital rather than at a police station.
“If intoxicated persons are to be managed in a hospital setting, this needs to be a secure environment with suitable staffing arrangements in place to manage the risk.”
The submission calls for improvements to mental health services in regional, rural and remote areas at all levels, from community-based care through to paediatric intensive care units.
It says NSW Health should develop plans to address shortages in mental health nursing staff, including increased opportunities for mental health nurse practitioners.
Limited or no on-site security
The UTS–NSWNMA study showed that exposure to violence is not restricted to nurses working in emergency departments or in mental health, with workers in a wide range of clinical and specialty areas reporting exposure to violence in the last six months.
Rural and regional facilities often have limited or no access to on-site security, the submission says.
Use of security personnel across NSW Health facilities “lacks consistency or any clear rationale”.
The union recommends that visible, uniformed, unarmed security staff be positioned near emergency departments, psychiatric units and other areas where violent incidents may occur.
Ice aggression worse
The submission says meth-amphetamine use appears to disproportionately affect some regional areas in NSW.
These areas are least likely to have access to training, security or sufficient staff to allow for a duress response in an emergency.
In addition to the traditional areas of concern – EDs, drug and alcohol services and mental health units – the union is also receiving reports of worsening ice-related aggression across all areas of nursing, most notably in cardiology.
Methamphetamine is cardio-toxic and causes damage to heart muscles and arteries.
It can also cause heart arrhythmias and endocarditis.
“Ice users are a very different patient cohort than traditional cardiology patients and wards are less likely to be designed with the management of violence as a key consideration,” the sub- mission says.
It points out that duress alarms are not routinely provided in cardiology and nurses in cardiology are unlikely to have appropriate training in the management of violence and aggression.
Concern for safety
The submission conveys the union’s “deep concern” for the safety of community nurses and midwives in rural and remote areas.
It points out that they are unlikely to have access to security or sufficient staffing numbers for a duress response.
“Nurses visiting patients and mental health consumers, and midwives visiting new mothers and babies in their homes, are often working in isolation in environments not controlled by NSW Health,” it says.
“Risk can vary markedly from one visit to the next” and the risk of violence “often relates to the presence of friends and family members”.
The submission says the union receives reports of “incredibly unsafe practices” including poor or no initial risk assessment before home visits and no access to duress beyond a mobile phone, which cannot always be accessed in an emergency and does not always have signal coverage.
Nurses work in isolation in high-risk environments and there is no system to ensure they have safely exited the home.
The submission conveys the union’s “deep concern” for the safety of community nurses and midwives in rural and remote areas.
The submission conveys the union’s “deep concern” for the safety of community nurses and midwives in rural and remote areas.