A statewide program to reduce hospital violence includes more training for emergency department nurses.

NSW Health is training emergency department staff to manage “disturbed and aggressive behaviour” in the wake of serious assaults in the state’s hospitals.

Training packages for nursing, security and medical staff are being implemented for EDs across the state.

Nurses are being put through a “violence prevention and management program” which consists of three e-learning modules and a face to face workshop followed by 12 practice sessions.

The modules are designed to help nurses assess risk, communicate with aggressive patients and de-escalate potentially dangerous situations.

In addition, the ministry has put 89 ED staff through “train the trainer” programs so they can deliver aggression management training.

The training push is part of a 12-point plan to combat hospital violence agreed between the ministry and health unions following a shooting incident at Nepean Hospital ED in 2016.

Training particularly useful for new ED nurses

Clinical nurse specialist Nick Turnell says the workshop on preventing and managing aggression in emergency departments should be particularly useful for new ED nurses.

Nick works at a major Sydney hospital and attended the workshop run by the Health Ministry’s Centre for Education and Workforce Development.

The workshop teaches verbal means of managing and de-escalating aggressive behaviour along with techniques for physical self-defence.

Nick, who has almost eight years experience of ED nursing in Sydney and on the Central Coast, was familiar with much of the course content.

“The self defence stuff, such as techniques to free yourself if someone grabs hold of you, was new to me.

“I had already worked out the rest of it on the job even though it was never formally taught.

“It is one thing to learn in a cool, calm environment but you don’t get much time to think about how to react when you’re grabbed by an aggressive patient.

“After some time working in ED you do learn ways of handling aggression.”

Nick’s workplace is one of the busiest EDs in the state. In recent years, he has seen a colleague bashed and require surgery to her nose and another nurse knocked unconscious.

“It is easy to say to a nurse on a training course, tell the patient this or do that.

“Reading a text book does not tell you what it’s like to have an aggressive person come at you. Not every situation unfolds in a textbook manner.”

He says his ED is fortunate to have “a pretty good skill mix. We only hire people with at least a year or so of ward experience.”

“We train each other on the floor. Senior staff tell junior staff how they would handle someone, based on their experience.

“You look for red flags that suggest agitation or aggression. You aim to verbally de-escalate the situation, get the patient seen to as soon as possible and get them gone.

“You don’t want to get physical, you don’t want to have to take someone down.”

A visible security presence is important

Nick says it is important for security staff to have a high visible presence in EDs.

“Our security guards do a lot of walk throughs which is good. Patients tend to behave better when they see two people with security written on their backs.

“And ED staff do feel safer when they see security doing their walkthroughs.”

Frustration over long waits to see a doctor is a common cause of aggression.

“We can’t tell people how long they will have to wait to see a doctor because things are always changing in the ED.

“It can be a very vulnerable place to work because it’s always full and we are exposed to a lot more people than the nurses on the wards get to see.

“On the positive side, we do get more staff and security are more visible.

“If it comes to the point where we have to take someone down in ED there is not a lot of waiting.

“I feel for nurses on the wards because there are fewer of them and it takes a lot longer to get a security guard up there.”