Violence against nurses: are tougher penalties the answer?
The new law and alarms for lone workers are a step in the right direction, say experts
The new law and personal protection devices for lone workers are a step in the right direction, say experts
In emergency departments, mental health wards and in the community, nurses go to work every day at risk of assault by those they care for.
Now a new law promises to increase the penalty for any attacker.
The Assaults on Emergency Workers (Offences) Bill, which will come into effect in England and Wales in November, has been hailed a significant step forward by the RCN, whose members have campaigned for the change.
The act will double from six to 12 months the maximum prison sentence for anyone who assaults an emergency worker, which includes NHS nurses.
What should you do if you are assaulted at work?
- The RCN's guidance is clear: if you've been assaulted, you should report it to the police, even if a patient is very ill or confused
- Check your employer’s procedures for responding to such an incident, and report it to your manager
- NHS Employers is clear about its stance: ‘The NHS has a zero-tolerance attitude towards violence and can pursue legal action against offenders whenever appropriate,’ says chief executive Danny Mortimer
It will also force judges to consider tougher sentences for offences such as grievous bodily harm and sexual assault if the victim is a nurse or other emergency worker.
Supporting staff to report incidents
But when the new law comes into effect, its impact on the levels of violence nurses face will depend on other factors too.
RCN national officer Kim Sunley welcomes the new law, but tells Nursing Standard the next step is ensuring that managers support nurses who report incidents.
‘We’ve heard anecdotally of members being told to “just get on with it, don’t report it to police, you might breach confidentiality by giving the name of the assailant to police”, which is not true,’ she says.
Announcing the new law, the Ministry of Justice said 17,000 NHS staff had been assaulted in England in 2015-2016.
However, Nursing Standard has learned there were 70,555 assaults recorded against NHS staff during this period in England, with the ministry discounting the remaining 53,555 ‘due to the patient’s medical condition’.
‘Justice shouldn’t stop at the hospital gates’
Kim Sunley, RCN national officer
Ms Sunley argues that medical conditions are not reason enough for immediate dismissal of assaults.
‘Justice shouldn’t stop at the hospital gates, just because a person has a condition doesn’t mean a case shouldn’t be investigated,’ she says.
She also notes that the government was quoting figures collected by the now-defunct NHS Protect. Because the body collecting that data no longer exists, how will the impact of the new law be measured, she asks.
‘It does bring up the question, how can we measure the effectiveness of the act, and of local measures, if we don’t have the data,’ she says.
Technology is only a part of the solution
Nurses working alone, particularly in the community, can feel especially vulnerable. To counter this, many employers have introduced personal protection devices for these staff (see box).
The likely number of assaults on NHS staff in England throughout 2016-17, according to a joint HSJ-Unison investigation
While Ms Sunley welcomes their wider use because they make staff feel safer, she says the devices on their own are not enough.
‘Some of the challenges, historically, have been about encouraging staff to use the devices, because of “big brother” concerns,’ she says.
‘The introduction of the devices has to come with a strategy of training and explaining the value of them.’
Technology is always only a part of the solution, she says, with communication from management about known threats, and staff feeling comfortable reporting incidents other important factors.
‘I’m aware of a case where a physiotherapy team went in to see a patient and when they were assaulted that information never went across to the district nursing team,’ she says.
Personal safety devices: ‘standard kit’ for lone workers
Last month, three companies were named as the preferred suppliers of personal safety devices for at-risk workers in the NHS.
About the size of a USB stick, the devices enable nurses who are or feel threatened to subtly alert authorities that they need help.
Send for Help co-founder and marketing director Will Murray says the company currently provides 18,000 devices to 180 trusts and boards across the UK.
He believes personal safety devices should become a standard part of kit for any nurse who works in a dangerous setting.
‘In the same way that someone who works on a construction site isn’t allowed on a building site unless they’ve got a hard hat, high-vis vest and steel-cap boots, we consider high-risk individuals should carry a personal safety device,’ he says.
The latest models feature two-way audio and dead-man’s-switches, which could detect a sudden attack or serious vehicle accident.
A Nursing Standard investigation earlier this year revealed there were at least 1,544 assaults against nursing staff working alone in England between 2015-17.
District nurse team manager Arielle Goodbourn, who works for care provider Livewell Southwest, says for lone workers a personal safety device provides some peace of mind.
‘It is good to know you can call someone in an emergency situation and that they will listen to the conversation and call the appropriate responder,’ she says.
But while the devices offer some reassurance, they haven’t eliminated the risks of working alone, she says.
The Health and Safety Executive (HSE) acknowledges that issuing alarms may help reduce the fear a nurse feels, but says there are other things an employer can do, such as providing training in dealing with aggressive or violent people and in how to de-escalate an incident, and making sure handover information highlights any potential problems.
Personal protection devices alone will not prevent incidents from occurring, its guidance says, ‘however, if used correctly and in conjunction with robust procedures, they will improve the protection of lone workers’.
‘It’s happening every day on every shift’
Emergency department nurse Shelley Pearce knows all too well the dangers nurses face on a daily basis.
Ms Pearce, who has experienced multiple assaults at work, recalls one incident when she was a healthcare assistant and was held hostage by a patient.
‘She had a piece of plastic to my neck, and it was only the fact that I took her to the lift that I was able to summon assistance,’ she says.
‘There was no learning from the event, sharing of information or even a “how are you”’
Shelley Pearce, emergency department nurse
She says her workplace’s response to the incident was indicative of the general lack of learning and reflection in the nursing profession in relation to violent incidents.
‘When I went back to the ward the following day… in the handover it wasn’t even mentioned,’ she says. ‘There was no learning from the event, sharing of information or even a “how are you”.’
Ms Pearce suggests other nursing disciplines could learn from the way mental health nurses respond following incidents: ‘If there is an event they ask, “right, what happened 20 minutes before that?”.’
Ms Pearce describes violence against nurses in emergency departments as endemic and says perpetrators generally receive nothing more than a slap on the wrist.
The monthly average cost to the NHS per personal protection device
Source: Send for Help
‘It’s happening every day on every shift, we’re all getting shouted out, we’re all getting punched, we all have these things happen but not enough is being done about it,’ she says.
‘I’ve been in situations where I’ve had someone I’ve pressed charges against, given a statement for, they’ve been fined £50 and within six weeks they’ve re-presented and behaved in the same manner.’
While Ms Pearce welcomes the new law for England and Wales she says it must not be the only action against violence towards nurses.
She wants to see more education for nursing students on de-escalation and breakaway techniques, and greater support for nurses who experience violence.
‘Rather than that person being penalised for behaving in the manner that they are, it’s turned around on the nurses to be the bigger people,’ she says.
‘It’s like being an abused partner – you rationalise it as being part of the job and you just take it.’
The Scottish example
The new law in England and Wales comes more than a decade after similar changes were introduced in Scotland.
But what difference has the Scottish law made - not just to the number of people convicted under the law, but to the number of assaults in the first place?
The Emergency Workers (Scotland) Act 2005 made it a specific offence to assault a police, fire service or ambulance service officer, doctor, nurse or midwife while they are on duty. The offence carries a penalty of up to 12 months imprisonment and/or a £10,000 fine.
incidents of physical and verbal abuse towards staff were reported at NHS Greater Glasgow and Clyde in 2017 – the most for any trust in Scotland
The latest available data from the Scottish Government show that 58 people were given a custodial sentence under the law in 2015-2016.
However, this figure pales in comparison to the number of assaults reported for the same period: in 2015-16, 407 assaults against emergency workers were reported to the public prosecution service for Scotland; of these the prosecutor proceeded with 296 cases.
It must be noted these statistics include all emergency workers covered in the bill, not just NHS staff.
The prosecution service’s chief legal officer, lord advocate James Wolffe, has pointed out that in a ‘significant number of cases’ charges were dropped due to the mental or physical health of the accused.
The issues that contribute to aggression
RCN Scotland associate director employment relations Norman Provan says it is not enough to rely on stronger penalties, and issues that exacerbate aggression among patients needed to be addressed.
‘While the knowledge of potential prosecution under the Emergency Workers Act may be a deterrent, more needs to be done to address staffing levels’
Norman Provan, RCN Scotland associate director employment relations
‘We understand that patients sometimes feel frustration with the service they are receiving,’ he says.
‘Nursing staff recognise and share patients’ frustrations at the impact that staff shortages can have, but patients expressing their annoyance through aggression is simply unacceptable.
‘While the knowledge of potential prosecution under the Emergency Workers Act may be a deterrent, more needs to be done to address staffing levels and ensure the right support for is available for patients and staff across services.’
Northern Ireland ‘disparity’
Meanwhile, due to the political paralysis in Northern Ireland, no new laws to protect nurses and other emergency workers in the country are likely to be enacted.
RCN Northern Ireland director Janice Smyth says the suspension of the Northern Ireland Assembly means the country's nurses are experiencing ‘unacceptable disparity’ with their counterparts on multiple issues. Protection against violence at work is among these issues, she says.
‘Seeking enhanced legal powers to deal with those who attack nurses and other health staff is simply not an option in Northern Ireland at the moment’
Janice Smyth, RCN Northern Ireland director
‘The RCN, in partnership with other health unions, health and social care employers and the Department of Health, is involved in regional work to tackle the broader issue of violence against health staff,’ she says.
But she adds that their efforts will be restricted by the political situation. ‘Regrettably, seeking enhanced legal powers to deal with those who attack nurses and other health staff is simply not an option in Northern Ireland at the moment.’
Even with the new law in England and Wales, nurses are keen to point out this is just one step in the right direction, not the solution to the problem.
As Ms Sunley said when the campaign to enact the legislation was won in July: ‘This is not the end of the fight. These attacks do not happen in a vacuum, and improved staffing levels, properly funded services and better support from employers would help further mitigate the risk that too many healthcare staff run day in, day out.’
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