Community nurses face multiple threats to their safety
Community nurse Drew Payne reflects on the numerous risks of the job
The RCN recently conducted a survey of 1,300 community nurses, and to say the results made uncomfortable reading is an understatement.
Half of those surveyed have been subject to abuse at work in the past two years, and one in nine had been physically and verbally attacked. Yet only 13% had personal alarms or lone-worker protection devices, despite these having been widely available since 2009 for lone workers, and initially government funded.
The lack of personal alarms, which have all but vanished from use, is undoubtedly a serious safety issue. But it is just one of many factors affecting community nurses, not least of which is the increased pressure on community services without any extra resources.
Hospitals have to treat more patients for less money, so are discharging patients much sooner. An increasing number of ill patients are being treated in the community, but no extra resources have been put in place to meet this increasing demand.
Patients' expectations of what can be provided in the community are often unrealistic. Measured against the very public targets of A&E departments, they expect instant access to services, and want medical input for things they could manage themselves – ‘It is the nurse’s job to change my dressing’ is just one example. The community is not an acute service, yet many patients react with anger and frustration when faced with the limitations of its scope.
Working practices are putting community nurses at risk. Nurses are working on their own on late shifts until 10pm, twilight and night-time community nurses are working on their own, and community nurses are working in uniform, making them more vulnerable.
Then there are the poor or unrealistic lone-worker policies, staff working without easy access to senior nurse support, and staff working with unrealistically large caseloads with no time to do full risk assessments. Add in the pressure to meet targets for the numbers of patients treated, and the situation soon becomes intolerable.
Senior managers' poor handling of abusive patients, perhaps because of the fear of generating complaints, can often make the situation worse. The NHS has always been poor at dealing with abusive patients, but it is worse in the community because the argument always comes back as: ‘They are home-bound, who else will see them if the community nurses won’t?’
A friend of mine, another community nurse, was punched at work by a patient. The same patient had slapped another nurse, and been racially abusive to others, yet senior management would not remove treatment. Community nurses were only spared further abuse when the patient went into hospital.
Cost-cutting measures have put community nurses' safety at risk, but it goes much deeper than just lack of personal alarms. We know of the problems caused by under staffing on hospitals wards, so why aren’t we more concerned about the same problems in the community?
About the author
Drew Payne is a community nurse in north London.