Safeguarding practice in emergency care

Mandy Rumley-Buss asks if we are achieving our competencies in meeting our adult safeguarding responsibilities 

Mandy Rumley-Buss asks if we are achieving our competencies in meeting our adult safeguarding responsibilities 

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Yet another news item about a member of staff filmed being abusive towards a vulnerable older adult in a care home.

The person in question was filmed by the resident’s daughter who reported her to the police, and she has now been sentenced.

I am reminded that working in emergency or urgent care settings we are guardians of those who present for care. They may be vulnerable and need us to recognise they are victims of abuse.

However, I wonder if we are primed and knowledgeable enough about what to look out for and how to respond. Are we achieving our competencies in meeting our adult safeguarding responsibilities?

A new intercollegiate document on adult safeguarding sets out the roles and competencies of all healthcare staff, including the chief executive and members of the trust board (RCN 2018). It clarifies the competencies expected of nurses working in urgent and emergency settings.

For example, do you ‘undertake regular documented reviews of own (and/or team) safeguarding practice as appropriate to role (in various ways, such as through audit, case discussion, peer review, reflective practice, supervision and as a component of refresher training)’? If not, why not?

Self review suggestion

Have you undertaken at least eight hours interdisciplinary and inter-agency training on safeguarding and do you have appropriate supervision in place?

The guidance sets out that, at level 3 – the expected level for nurses working in an emergency department (ED) – competencies also include knowing how to undertake your own documented reviews and on behalf of your team.

Nurses are also expected to know how to apply lessons learned from audit and serious case reviews to improve practice and record any concerns in a manner that is appropriate for adult safeguarding protection and legal processes.

Are you able to demonstrate these competencies in your department?

Our patients need us to be vigilant and understand how different types of abuse can occur, including abuse by radicalisation and self-neglect.

The guidance states that all of us should be equipped to carry out ‘history taking and physical examination in a manner that is appropriate for safeguarding and legal processes, as appropriate to the practitioner’s role’ (RCN 2018).

It also highlights the required competencies for board members, the chief executive and clinical commissioning group members.


It has been endorsed by 17 organisations including the Royal College of Physicians, British Geriatrics Society, College of Paramedics, Royal College of Occupational Therapists and Royal College of General Practitioners.  

The next step is to ask yourself what you, and your department, need to do to ensure you are competent in handling safeguarding issues.

Our vulnerable patients need us, and we owe it to them to make sure we can access the appropriate level of training to achieve the competencies required to support adult safeguarding.


Royal College of Nursing on behalf of the contributing organisations (2018) Adult Safeguarding: Roles & Competencies for Healthcare Staff: An Intercollegiate Document.

About the author

Mandy Rumley-Buss is an independent nurse consultant and nurse practitioner 

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