Analysis

Will a change to the law on violence against emergency workers stop assaults?

Emergency nurses need training to deal with aggressive patients, experts say

Emergency nurses need training to deal with aggressive patients, experts say

Hospital_violence
Picture: Tim George

A new law giving harsher punishments to people who attack emergency workers has been passed by parliament.

The Assaults on Emergency Workers (Offences) Act received royal assent in September.

It means the maximum prison sentence for a common assault will double from six months to one year if the victim is a fire-fighter, police officer or NHS worker.

If the offence is more serious than common assault – which covers, for example, fear of attack and attacks that do not lead to serious injury, such as spitting – and the victim is an emergency worker, this will be classed as an aggravating factor when offenders are sentenced. This could lead to stiffer penalties and fewer suspended sentences.

The move has been welcomed by unions. Unison said it was only right that aggressors should be ‘appropriately reprimanded’ and the welfare of emergency care staff must be ‘paramount’.

75,000

estimated assaults a year

Source: HSJ and Unison 2018

But will it make emergency departments safer? Emergency department (ED) staff nurse Shelley Pearce, who spoke at the Royal College of Nursing annual conference this year about the fear of being assaulted while at work, has her doubts.

She has been attacked a number of times, including being head-butted by a drug user and having a sharp piece of plastic held to her neck by another patient.

‘It’s good news that they are changing the law. Tougher sentences are right, but I don’t think it is going to stop it happening. There were already sentences there and it didn’t stop people.

Education

‘We need to look at why this is happening and how we can stop it. That will require education for the public and staff.’

She says the situation has got so bad in EDs that staff are beginning to see it ‘as part of their job’.

She believes the expectations of the public are sometimes too great, although she also says she has noticed an increase in mental health patients ending up in EDs as a result of cuts.

RCN Emergency Care Association member Justin Walford shares these concerns.

‘After elderly care wards, emergency departments are the places where assaults are most common.

‘I think everyone working in an ED would have their own story to tell. I’ve been punched in the face and on another occasion I was spat at.

‘And this is only half the ordeal – we also have to give police statements, wonder if we should have done something different and then have to go to court. It is a stressful experience.

Lack of respect

‘Generally, people are nice, but I think there’s been a change of culture and move towards a lack of respect for NHS staff.

‘At times, patients come in demanding this or that or they may have googled their condition and think they know best. This can create a situation where staff are being challenged more aggressively, particularly if there has been a long wait, mixed with alcohol and drugs.

21%

rise in assaults in hospitals with emergency departments

Source: HSJ and Unison 2018

‘Most trusts will take a zero tolerance approach to violence and seek to prosecute – the only exception is if there is a medical reason, such as delirium or a mental health problem. Staff accept that.’

Mr Walford says there needs to be greater access to training to help staff deal with these situations.

He says his trust, Brighton and Sussex University Hospitals NHS Trust, is planning to start running a one-day course for staff working in the ED in the near future.

It will cover ways to diffuse situations and breakaway techniques for staff grabbed by patients.

Communication skills

Guidance from the National Institute for Health and Care Excellence (2015) makes clear courses such as this should be offered to all ED staff.

It says training should cover ‘methods and techniques’ to reduce the risk of violence and aggression, including anticipation, prevention and de-escalation.

This requires good communication, knowing when to intervene, and verbal and non-verbal communication skills.

It also says interview rooms for mental health assessment should be fitted with emergency calls systems and windows for observation, and should contain no objects that could become potential weapons.

This is not happening routinely, however. Leeds University’s professor Ian Baker, who has carried out research on how to deal with aggressive patients, believes there is a lack of understanding about the issue, particularly in EDs

‘I don’t think the NHS has really grasped it. It is often security guards who intervene in EDs, and then things escalate.

‘There seems to be a lack of training for staff who do not work in mental health settings, where such training is mandatory. It is something that needs looking at.’

Security support

The NHS has stopped collecting data on assaults against staff. The most recent staff survey suggests 15% of staff have experienced physical violence from the public.

Meanwhile, research by the Health Service Journal (HSJ) and Unison (2018) drawing on data obtained under the Freedom of Information Act suggests there were around 75,000 assaults in 2016-17 in England – a rise of 10% on the year before.

Most were in mental health settings, but one in three was in hospitals with EDs. In the trusts concerned assaults rose by 21% over the past 12 months.

15%

of NHS staff say they have been attacked or abused in the past 12 months

Source: NHS Survey Coordination Centre 2018

The report found the complexity, high pressure and unpredictability of work in EDs were contributing to a rise in the number of assaults, with waiting times and staff fatigue also being factors.

West Hertfordshire Hospitals NHS Trust is one of the few trusts in England where the number of assaults has been reduced over recent years, according to the HSJ and Unison report.

The trust cites regular training, practical security support, visible policing and good alarm systems as vital factors in the reduction.

Conflict resolution

In addition, conflict resolution training has been introduced and promoted. The trust encourages staff to complete this training regularly and often, not only when their mandatory training expires.

Breakaway and restraint training is also provided. Although staff do not want to have to put their training into practice, they report that it has given them more confidence in dealing with difficult situations.

The trust has a ‘pinpoint’ alarm system, in which staff can push a personal alarm that rings loudly, signalling to security staff and the switchboard exactly where they are.

Security staff work on the basis that they must never leave staff who say they feel vulnerable alone. They will stay with these individuals until a situation is resolved and, if necessary, walk them to their cars late at night.

The trust has also part-funded police community support officer roles to ensure a greater number of them are available.

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