Julia Costello, a Nurse Practitioner at Port Macquarie Hospital, has worked continuously in emergency departments since she graduated in 2008. Her witness statement described the increased expectations on ED nurses to be able to de-escalate patients, recognise mental health issues and apply mental health first aid to patients experiencing grief, anxiety, depression or psychosis.

In her witness statement, Julia outlined:

Most emergency nurses I know have had some kind of physical thing happened to them, I’ve seen people punched in the face, I’ve seen someone attacked with an IV pole. I worked with a colleague who has a large scar on her face after sustaining a 10-centimetrecut on her forehead after she was assaulted by a patient.

I have been punched in the head multiple times. I have been kicked in the chest. I have been spat on. I have had people try and rip the skin off my arm.

There has however been an increase in training directed at assisting nurses to become more skilled in managing aggressive patient behaviour.

This training is excellent but it is once-only training, there is no follow up. I am expected to do the training and then retain the skills and knowledge forever.

I have seen in my own practice that the skill of communicating with and de-escalating aggressive patients is a skill that comes with time and experience. It isn’t something that can be simply taught in a once-off training session. It is something that I have learned through practice and role modelling over many years.

In this way, managing aggressive patients went from being a difficult part of my job to an expectation that I will participate in these kind of situations because nurses now have received explicit training, it becomes an expectation that training will be used to de-escalate violent and or aggressive patients in EDs.

Aggressive patients used to be managed via a physical restraint. Now this is only done until the patient can be chemically sedated and is only done so the chemical sedation can be administered in away that is safe for the health staff administering the chemical restraint and the patient.

*This is a excerpt from witness statements of one of our members who participated in the Special Case.