Violence in hospitals can’t be tackled without addressing underlying systemic causes, including inadequate staffing levels, poorly designed hospital environments, and lack of communication between different parts of the sector, according to a new report.
A new study has found that a complex matrix of factors contribute to the creation of violence in the NSW public health system.
The study, Understanding and preventing work-related violence in hospital settings: A systems thinking approach, was funded by SafeWork NSW and carried out by the Centre for Human Factors and Socio-technical Systems.
NSWNMA Assistant General Secretary, Judith Kiejda, said the Association welcomes the report.
“Ensuring safe workplaces for nurses is one of our most urgent priorities. This report demonstrates the multiple and systematic factors that must be addressed to eliminate violence in hospitals,” she said.
The 2019 survey of NSW nurses and midwives found that close to half had experienced an episode of violence during the previous week. The report also cites research that found assaults on healthcare workers have been increasing over the past two decades.
Yet, there have been no WHS prosecutions in a health setting since 2007.
“Violence prevention must be given a higher priority by the employers in our sector as well as by our safety regulator,” Judith said.
The risks of working in a healthcare setting have been highlighted over the past 18 months: tragically, two nurses have lost their lives at work. Other nurses have suffered injuries such as multiple skull fractures or broken ribs. The NSWNMA has called for the regulator to take a more interventionist approach to ensure employers actively work to provide staff with a safe workplace.
A new road map with an evidence-based approach
This report provides a road map for an evidence-based approach to identifying and addressing the multiple causes of workplace violence. It finds that work-related violence is not a problem solely related to patients, healthcare workers, and security staff.
“Work-related violence in hospital settings is created by an interacting network of contributory factors that spans all levels of hospital systems from the operational front-line (healthcare worker, equipment and environment) all the way up to, and including, regulation, government and relevant international bodies,” the report authors write.
“This approach gives us an important opportunity to engage with SafeWork NSW on the issue of employer’s responsibilities, to provide a safe working environment in a much more systemic way,” Judith says.
“For example, we know that forty per cent of the incidents of violence in hospitals happen in a mental health unit. But the reduction in mental health intensive care beds across the state in recent years, from 62 to 50, as well as the lack of appropriate beds and staff settings for high-risk patients in regional areas, are systemic issues that need to be addressed.”
Judith says the report rightly finds that there are systemic communication problems when a patient flagged in one part of the health system isn’t communicated to other parts of the system. In a recent case a patient who was known to be high risk at one Sydney hospital, presented at the emergency department at a second Sydney hospital and injured five members.
“The report highlights systemic issues around communication and lack of responsiveness between and within sectors. The report also gives us the framework for addressing the root problems when, for example, a particular LHD is chronically unresponsive to safety issues and SafeWork notifications,” she said.
Judith says the report high-lights the weakness of approaches that deal with workplace violence only when incidents occur, and only by looking at the immediate environment.
“Asking questions such as ‘Who upset the patient who was violent?’ or ‘Do we need to do some extra training in this department?’ or ‘Do we need to install an extra duress alarm?’ can be helpful, but they don’t address the systemic issues that are leading to violence in the first place.”
Not enough experienced mental health nurses
One of the biggest systemic issues the report highlights is that there just aren’t enough healthcare workers, particularly experienced mental health nurses, to manage patient care with safety, Judith says.
“We constantly see patients who are known to be high risk, and who are very agitated, in facilities that just don’t have enough staff or the appropriate physical environments.
“The report highlights the need for higher nurse ratios, and funding for those speciality areas.”
Judith says the report recommends that an external multi-agency group be convened to look at what needs to happen to implement the report’s recommendations.
“The NSWNMA will be asking to have a seat at the table in any multi-agency body, alongside the Ministry of Health, SafeWork, representatives of LHDs, private hospital employers and police.”
Judith says the report is a “significant” improvement on the recently released Anderson report: Improvements to security in hospitals.
“Its main recommendation was increasing the presence of security staff in hospital settings. This completely ignores the causes of violence in the first place, the huge cost of security, and the needs of regional areas and small hospital settings, where security is often just not available.”
‘This approach gives us an important opportunity to engage with SafeWork NSW on the issue of employer’s responsibilities to provide a safe working environment in a much more systemic way.’
— NSWNMA Assistant General Secretary Judith Kiejda