Violence gets worse – but incident reporting is flawed
Physical violence in NSW hospitals has significantly increased and nurses are disproportionately affected. However, NSW Health’s system for reporting incidents is flawed.
Mental health wards are easily the most violent health system workplaces, experiencing 39.5 per cent of all incidents of physical violence in NSW hospitals.
The next most dangerous are emergency departments (9 per cent of physical violence) and aged care wards (4.5 per cent).
The numbers are published by the NSW Auditor-General, Margaret Crawford, in a report titled Managing the health, safety and wellbeing of nurses and junior doctors in high demand hospital environments.
The report says nurses are dispro-portionately affected by violence.
Nurses make up about 40 per cent of the total hospital workforce in NSW and were impacted by 85.5 per cent of hospital health and safety incidents during the first half of 2019.
Physical violence in hospitals increased by over 13 per cent from 2017 to 2018 (more recent data was unavailable due to the re-deployment of ministry staff to deal with COVID-19).
The Auditor-General finds that the hospital information management system known as IIMS or IMS+ is not capable of rapidly recording multiple risks in wards where incidents are common.
The report recognises that in areas such as mental health wards and EDs, incidents occur in high numbers and incident reporting can be extensive.
“In these wards, staff are required to manage clinical workloads along with all incident reporting requirements,” it says.
“NSW Health’s incident management system is not designed for rapid reporting. A number of screens must be navigated, and a range of classification details must be completed to progress through each stage of the system and ultimately finalise a record.”
Manual handling equipment
The report finds that nurses do not always have access to essential safety equipment – particularly manual handling equipment.
Nurses report that equipment is sometimes poorly located or hard to find, and sometimes they lack training in how to use new equipment.
In some hospitals, staff advised that equipment was broken or there was insufficient equipment for all hospital wards.
The report says NSW Health’s rostering system is designed so that staff working hours comply with health and safety regulations.
It says the system sends alerts to managers when staff hours fail to comply with health and safety guidelines.
However, all nurses interviewed for the audit explained they do not log excess hours in the HealthRoster system “because it is not customary for nurses to claim overtime for administrative tasks, so they do not record, claim or seek remuneration for excess hours.”
“As there are no records of their hours, there is no information for managers to understand the levels of overtime.”
Almost 90 per cent of nurses interviewed for the audit reported working unpaid overtime and almost one-third did so on a daily basis.
“When asked why they do not claim overtime, all nurses we spoke to advised that they are not permitted to claim overtime to complete outstanding administrative tasks,” it said.
“Any overtime requires pre-approval from more senior managers, and these approvals are only made for overtime that is for clinical overflow tasks.”