Exclusive: The threats to safety faced by nurses who work alone

Nurses who work alone are subject to a multitude of dangers ranging from stalking and harassment to assault, an investigation by Nursing Standard shows, underlining the need for employers to improve safety measures

Nurses who work alone are subject to a multitude of dangers ranging from stalking and harassment to assault, an investigation by Nursing Standard shows, underlining the need for employers to improve safety measures

  • Lone nurses have been victims of sexual assault, strangulation, hostage taking
  • Expert says problem is likely to be far worse than figures show
  • RCN has issued safety guidance for nurses working alone, including steps to reduce risk

Picture: Jim Varney

The worrying extent of a host of dangers facing nurses who work alone has been revealed in an investigation by Nursing Standard.

Our survey of trusts in England reveals that lone nurses have been the victims of hundreds of assaults and the target of numerous incidents of stalking and harassment in the past three years, underlining the need for employers to improve safety measures.

The investigation revealed that there were at least 1,544 assaults against nursing staff working alone from 2015-17, including sexual assault, strangulation, hostage situations and attacks with weapons.


Stalking or harassment incidents against lone workers were reported by nine trusts

We surveyed 56 mental health, community and learning disability trusts in England and received viable data back from 31 organisations.

Legal action

Nine of these trusts were aware of cases of stalking and harassment in relation to lone workers, such as district nurses, mental health nurses and other community workers.

Devon Partnership NHS Trust reported 16 cases of stalking and harassment, while others such as Oxford Health NHS Foundation Trust did not specify the number of cases.

Apart from the viable data, a further 15 NHS trusts said they were unable to differentiate lone workers on their recording systems and did not know how many assaults or stalking cases had taken place, while others provided figures that applied to all staff. The remaining ten trusts did not respond.

Only a handful of trusts reported any legal action arising from the incidents.

‘Lone workers face a unique set of dangers’

Kim Sunley, RCN senior employment relations adviser

RCN’s Kim Sunley says figures
are ‘extremely worrying’.

RCN senior employment relations adviser Kim Sunley says the figures are ‘extremely worrying’.

‘Lone workers face a unique set of dangers. They often work out of hours, enter tense situations with little information about the patient or client, and have limited contact with colleagues,’ she says.

She emphasises the importance of risk assessments, personal safety training and use of lone worker devices, and says certain patients should be visited by staff working in pairs to ensure safety.

Ms Sunley wants to draws the attention of employers to RCN guidelines to help them reduce the threat to lone workers.

Robust procedures

Greater Manchester Mental Health NHS Foundation Trust has recorded two stalking and harassment incidents since 2015 and has a policy on how to deal with such behaviour.

The trust’s director of nursing Gill Green says: ‘If any of our staff, male or female, are facing stalking behaviour or harassment we have robust procedures to support them.

‘Our stalking policy sets out a number of safety measures our staff are expected to take, including limiting personal information, keeping social media profiles private and being assertive.


Lone healthcare workers have a 9% higher risk of sustaining injury from a physical assault than those who do not work alone.

Source: NHS Protect data

‘When these situations arise we always work with the victim in a way which empowers them to take responsibility for their own safety.

‘A line manager will work with them to develop a safety plan and we work closely with the police to bring perpetrators of stalking and harassment to justice.’

Suzy Lamplugh Trust policy officer for personal safety Saskia Garner says the problem is likely to be far worse than the figures show.

Ms Garner says: ‘It is concerning that nearly a third of respondents recorded cases of stalking and harassment against lone workers. In reality, many more incidents may go unreported.

Picture: Neil O’Connor

‘We would urge employers to consult with staff to identify risks and regularly review and update and circulate policies to ensure staff are adequately protected.’

Ms Garner also questions the fact that many trusts report being unable to provide specific figures for incidents affecting their lone workers.

Trusts should be aware

She advises that trusts employing lone workers should be aware of specific incidents affecting them and points out that the law requires employers ‘to consider carefully, and then deal with’ any health and safety risks for people working alone.

‘It is something that staff should understand, providing a framework to tackle lone worker issues within your organisation which need to be included in a lone worker policy.

‘It would be useful therefore for employers to identify and record incidents specific to those who work alone to identify specific issues to be addressed.’

‘Risk assessment is a key part of managing lone working’

Helen Mackenzie, director of nursing and governance

Berkshire Healthcare NHS Foundation Trust is aware of nine cases of harassment and 175 assaults against lone workers since 2016, and the board is clear that this information is vital to staff safety.


A five-point plan from the RCN to keep lone workers safe urges employers to have a policy, risk assessments, a prevention strategy, training and incident support.

Trust director of nursing and governance Helen Mackenzie says: ‘We record these incidents to help us understand how lone working affects our staff and to make sure that our managers and security management specialists provide timely and appropriate support.

‘Similar to how patient incident reporting improves patient safety, lone worker incident reporting improves staff safety.

‘Risk assessment is a key part of managing lone working, and if an incident occurs a flag is placed on the patient’s record highlighting the type of risk and any actions to be taken, such as staff visiting in twos.’

RCN West Midlands safety representative Mitzi Wilson has supported lone workers involved in incidents over the years, including when nurses have been targeted when leaving work alone. She says she has heard of incidents that included an attempted carjacking.

Using technology to keep staff safe

Somerset Partnership NHS Foundation Trust is aware of reports of stalking and harassment against its lone workers, but says it works hard to keep its staff safe when alone, in particular using technology to track and keep in touch with staff.

Head of security and registered mental health nurse Andrew Sinclair says: ‘As a trust, we use technology to protect staff and can dynamically track all lone workers to ensure their safety.

‘Staff are required to keep electronic diaries and contact information up to date, and they risk-assess each patient and each visit to identify and mitigate against any risks or dangers.’

Mr Sinclair says violence and aggression against lone workers at the trust is low – this year it has not seen any incidents, but it recognises that even verbal attacks can be very upsetting. 

‘Managers and staff across the trust work hard to make sure those working by themselves for significant periods of time in the community, in isolated work areas and out of normal working hours are protected as much as possible.’

RCN guidance for nurses working alone

The RCN guidance on safety for nurses working alone says employers must implement safe systems of work for these staff members and ‘control measures’ that prevent or reduce risks, such as:

The Reliance Protect ID badge
safety device, worn here, features
two-way audio, GPS and an alarm.

  • A means of raising the alarm
  • A mobile phone
  • Visiting or working in pairs
  • Access to electronic diaries or notice boards with lists and times of visits
  • Buddy systems
  • Regular checks by supervisors and/or work colleagues
  • Equipment such as satnav and a torch for visits to unfamiliar areas or at night
  • Parking permits to allow parking close to clients’ homes, especially if parking is difficult out of hours
  • A contact who staff can inform of their location before they enter and after they leave a client’s home or when locking up a building

Measures that can be taken in hospital buildings to prevent incidents or reduce the risk of them escalating include controlled access, CCTV, security patrols, static alarms and checking the layout of clinical rooms.

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