Violence against nurses: how workplaces can help to protect staff

What your workplace can do to help prevent and manage aggressive behaviour from patients

What your workplace can do to help prevent and manage aggressive behaviour from patients

  • How one trust is leading the way on conflict resolution training for staff, after a violent attack on an emergency department team member
  • Charity Stand Against Violence calls for a ‘public health approach’ to deal with the causes of violence and its long-term consequences
  • Training for healthcare professionals can potentially prevent violence, the charity argues, benefiting the NHS and the wider community
An image from the Barts Health NHS Trust film for its healthcare staff on workplace violence, showing a patient aggressively confronting a staff member
An image from Barts Health NHS Trust’s film for staff on how to deal with workplace violence
Picture: Barts Health NHS Trust

In 2019, a member of the nursing team working in the emergency department at Newham Hospital in London was stabbed multiple times with a pair of scissors.

Understandably, the incident prompted Barts Health NHS Trust to review its security arrangements.

Geraldine Cunningham of Barts Health NHS Trust
Geraldine Cunningham of Barts
Health NHS Trust

As a result, all emergency department (ED) staff at Newham Hospital will receive training in the management of actual or potential aggression.

The training, to be completed by the end of August 2020, teaches staff techniques to cope with escalating behaviour ‘professionally and safely’.

Psychological support for staff who have experienced aggression at work

‘Managing violence in the workplace is an organisational priority for Barts Health, which we're taking very seriously with support from the board all the way down through the organisation,’ says trust associate director of culture change Geraldine Cunningham.

‘There is an increasing amount of violence and aggression across the NHS and we need to keep our staff safe and secure so they can continue providing compassionate care.’

‘We find that some simple measures are effective, such as noise reduction or keeping people occupied’

Geraldine Cunningham, Barts Health NHS Trust associate director of culture change

Alongside the training, the trust has developed a film for staff members to improve understanding of the issues, and updated its policy on managing abuse and violence to help staff identify what is unacceptable behaviour, and how to manage potential risk and escalate appropriately.

Psychological support after an incident has also been increased so staff feel valued and can ‘return to work well’.

Top tips for conflict resolution

  • Behaviour affects behaviour – maintain a professional approach and be aware of your actions
  • Try to understand why someone is being aggressive or speaking in an abusive way
  • Don’t take their behaviour personally
  • Allow time for reflection
  • Take time to listen to the person's concerns
  • Respect their personal space
  • Get help early if you feel the situation is escalating

Source: Barts Health NHS Trust


Healthcare workers are particularly vulnerable to workplace violence

There is growing concern about the vulnerability of healthcare staff to workplace violence. A 2019 survey of 8,307 RCN members revealed that 29% had experienced physical abuse at work.

In 2018, the Assaults on Emergency Workers (Offences) Bill came into effect in England and Wales and provided increased sentencing powers for offences of common assault and battery committed against emergency workers.

On 6 January 2020 a joint agreement between Her Majesty’s Prison and Probation Service, NHS England, the National Fire Chiefs Council, the National Police Chiefs Council and the Crown Prosecution Service (CPS) came into force.

It provides a broad framework to ensure more effective investigation and prosecution of cases where emergency workers are the victim of a crime, and sets out the standards victims of these crimes can expect.

Figures published by the CPS show there were 20,000 offences charged under the Assaults on Emergency Workers (Offences) Act in the year to November 2019; the RCN has called for a more detailed breakdown of the figures, including the job roles of those assaulted.

Taking a ‘public health approach’ to violence

Adam Fouracre, emergency department advanced clinical practitioner and founder of Stand Against Violence
ED advanced clinical practitioner Adam
Fouracre, of Stand Against Violence

ED advanced clinical practitioner Adam Fouracre would like to see a ‘public health’ approach to violence, with nurses like him involved in prevention, rather than just  becoming (or treating) victims.

Mr Fouracre founded the charity Stand Against Violence (SAV) in 2005 after the murder of his 17-year-old brother Lloyd, who was beaten to death in Taunton, Somerset.

Lloyd was walking home with friends when a group of five young men who had been drinking launched an unprovoked attack. He was beaten repeatedly with a wooden sign, kicked and punched in the face. He died of brain injuries later that night in the ED department where his brother now works.

Adam Fouracre was in his first year as a nursing student when Lloyd died. He believes that working in front-line urgent care services has bolstered his understanding of the effect of violence on communities and services.

Prevention workshops and conflict resolution training

SAV aims to prevent violence and its long-term consequences through violence prevention workshops and talks attended by young people.

The award-winning charity also offers conflict resolution and anti-bullying training to organisations in a bid to reduce workplace issues. 

Mr Fouracre says: ‘Since 2005, we have delivered countless workshops to hundreds of thousands of young people across the country.’

He is confident that SAV’s work ‘will have prevented a number of violent incidences over the years’.

Stand Against Violence charity training session teaching self-defence to young people
A training session by the charity Stand Against Violence teaching self-defence to young people

The conflict resolution training, led by experienced facilitators, develops participants' understanding of what workplace conflict is, the types of behaviour this includes and the impact of violent and aggressive behaviour.

Training in the NHS can benefit staff and the wider community

SAV has worked with the corporate sector and local authorities; Mr Fouracre hopes its next step will be to deliver training in the NHS.

Conflict resolution training participants learn skills to de-escalate and prevent potential conflict and explore the different ways of dealing with it.  

The course also encourages discussion about appropriate responses to situations. Emotional resilience, communication and assertiveness skills are covered to help staff deal with conflict confidently and positively.

The anti-bullying training enables participants to develop skills that will help them manage situations where they encounter bullying, and empower them to play a role in preventing it.

‘We need our employers to take the issue seriously and invest in training’  

Adam Fouracre, emergency department advanced clinical practitioner and founder of Stand against Violence

Mr Fouracre says the SAV approach could benefit NHS staff who are working with members of the public in emergency or outpatient departments and assist with conflict resolution in staff teams.

‘The profit generated from the training fee is ringfenced to cover our front-line work, educating young people about the consequences of violence and equipping them with the skills to avoid violent situations,’ he says.  

‘Our training provides an invaluable contribution to the workforce, but also means we can reach more young people. Employers can show that through using us, they can have a direct positive charitable impact on their local community.’

An image from Barts Health NHS Trust’s film for staff on how to deal with workplace violence
Picture: Barts Health NHS Trust

Reducing the impact on employees

He points out that conflict and harassment in the workplace has a significant negative impact on employees, including mental and physical ill-health, increased absenteeism and reduced productivity.

‘The NHS is no exception to these issues and should recognise the need to offer training to staff across the board.

‘In the NHS we may see ourselves as separate to standard businesses but we still deal with customers in the form of patients, clients and relatives, and we still suffer absenteeism and sickness. We all know how stress, mental and physical ill-health is rife in the NHS.

‘We need our employers to take the issue seriously and invest in training.’

He has no doubt that healthcare professionals have a role in violence prevention: ‘Violence is a disease in society, much like the epidemiological picture of a virus.’ A public health approach to violence places it ‘firmly in the remit of healthcare’.

Nor should nurses fear that getting involved in prevention is too much to take on: ‘Sharing anonymised data on assaults is a good starting point and one which can build a clear picture of violence in local areas. This will aid early intervention programmes.’

Identifying environmental triggers to predict and prevent aggressive behaviour

At Barts health, where the trust commissioned international training organisation the Crisis Prevention Institute (CPI) to help with its staff training, the programme has been offered to all staff members across the organisation.

A total of 400 have already completed the training, and 21 have since become trainers.

The trust has also looked at tracking patient flow in and out of the ED at Newham Hospital, particularly to identify environmental triggers that might lead to an increase in violence and aggression.

Ms Cunningham explains: ‘Conflict resolution is extremely important, and we’re training our staff to keep themselves safe, not take things personally and be able to de-escalate any situation.

‘Preventive measures are also vitally important. Our training programmes cover the importance of having empathy and understanding people’s backgrounds and what they may have experienced before they came to hospital.

‘We also find that some simple measures are effective, such as noise reduction or keeping people occupied during their hospital stay so that they're not bored.’

Petra Kendall-Raynor is a health journalist

This article is for subscribers only