Community nurses offered no protection from abusive patients, survey finds

Large numbers of community nurses experience physical and verbal abuse at work but very few are given personal alarms by their employers, an RCN survey reveals.

The survey of more than 1300 community nurses revealed nearly half had been subjected to abuse while working in the past two years, and one in nine had experienced physical as well as verbal attacks.

RCN general secretary Peter Carter said: ‘It is horrifying to hear of a worsening situation, and one where people who go to work each day to care for people end up feeling alone, afraid and under attack instead. There are times when a patient or relative can be aggressive or disruptive due to a medical condition, but there are still things that can and should be done to keep nursing staff safe.'

The survey also found only 13% of nurses had access to personal alarms or lone worker protection devices.

Personal alarms became widely available in the NHS in 2009 and were initially government-funded, but according to some nurse respondents, these devices have been withdrawn as part of cost-cutting measures.

Dr Carter said: ‘Sadly, it seems that the safety of staff is something that is subject to compromise when money is scarce. This is an utterly false cost saving. Not only do staff often need time off following physical injury or assault, but the risk of stress and burnout is severe and can continue into long-term absence.’

He added that in 2007, the then health secretary Alan Johnson had promised that every lone worker would be given a personal alarm that looked like a name badge, which when pressed would alert a call centre that would in turn contact the worker's base to say there was a problem.

'The reason those devices were so welcome is that, in many cases, the police said ‘we cannot prosecute because it is one person’s word against the other,' said Dr Carter.

'Alan Johnson found £70 million and that was put in the system to fund it for two years. What we know is that most of that £70 million was not spent on lone worker devices at all. The vast majority of lone workers do not have those devices. That again is something we feel is deplorable.'

The RCN's survey revealed examples of nurses being held captive by patients or their relatives. One nurse said: ‘In one specific incident I was locked in a family home and they refused to let me leave. I was there some time and received no call from the office to determine my safety. After the incident there was no follow-up with the family, no additional safety plan and in fact it was down to me to visit again. I took a student for back-up.’

Another said: ‘I was verbally abused by a patient’s relative. I informed the office, but still had to visit and no further action was taken other than documenting it on patient notes. I didn’t feel supported, and was wary about visiting that patient due to the relative, but I felt I had to, because I would have failed my patient by not giving them the treatment they required in their home.’

The survey also revealed half of staff feel vulnerable at work, with nearly 10% feeling vulnerable often or all of the time.

Only 22% of respondents said their managers always knew where they were when they were working in the community, raising serious concerns about how they could seek help if they were the victim of a serious attack.

Only one in 25 nurses said they always had adequate information about the patients they were due to visit, and a third of nurses said they had received personal safety training.

Dr Carter said: ‘More and more difficulties are being encountered and I think it is probably a reflection of society. There was probably an era when it would have been unthinkable to assault a district nurse.

'If you look at the move for more primary care, more care at home, in the community, which most people would say is a good thing, logic would suggest that unless you have got good lone worker policies and people being supported, then those incidents will arise.

'If you are in situation by yourself and someone gets very difficult, and remember, the vast majority of these nurses are women, working alone, they can be in extremely vulnerable positions. Of course, it is just as difficult for men. What we are seeing is an intolerance with some people and nurses are increasingly saying they are feeling vulnerable,' he added.

Earlier this week at RCN congress in Bournemouth, nurses voted unanimously in favour of RCN council taking action against organisations who fail to provide sufficiently robust lone working systems to protect staff.

At total of 98% of nurses voted in favour of the resolution submitted by RCN UK Safety Reps Committee.

Proposing the resolution, committee member Neil Thompson said there is a complacency about lone working not just among organisations but also among nursing staff.

'It is important to have robust lone working systems and processes,' he said. 'The big challenge in my own trust is to get staff to take notice and use the systems provided for them. We need to be mindful of what we are doing when lone working so we do not put ourselves and others at risk.'