OPINION: Violence and the healthcare setting

1 January 2014

Michael Geraghty, Nurse Practitioner in the Adult Emergency Department at Auckland City Hospital, calls for a zero tolerance policy against violence and verbal threats in our hospitals.

One of the joys of having teenagers who have left the roost (or imminently about to) is reclaiming the radio station of my choice in the car. I’m showing my age here, but to me, the National Programme is mostly interesting, at times educational, and occasionally plays good music. All in all, it’s good listening fodder whilst driving, and thanks to Jim Mora, I was alerted to this recently published article (paywalled), discussing a topic dear to all healthcare professionals.

Having worked in the emergency department at Auckland City Hospital for the past 15 plus years, it never ceases to amaze me how supposedly average members of the public seem to think that normal social values and rules of communication have no place the minute they walk into the hospital. Behaviours that would never be tolerated in a queue at the bank, supermarket etc. seem to be considered ‘okay’ in the ED setting – despite being given very good service (most of the time).

What value do they place on this service that it is taxpayer funded (i.e. free)? Or is it the fact that it is free that seemingly gives them the right to abuse, threaten, and at times, physically assault staff?

One of many dilemmas that ED staff always face, particularly working with the undifferentiated, undiagnosed patients, is the fear that the intoxicated youth with a laceration to his head may, in fact, have an underlying intra cranial bleed, and as such, is not safe to be restrained and arrested without appropriate scanning/observation first. As a direct consequence of this fear, we often put up with all sorts of unacceptable behaviours doing what we believe is the right thing for that individual.

In my time, I have seen violence in all its manifestations, from deliberate focused attacks on staff members to cars being purposely driven into the department (yes, really), through to the more tolerated aimless acts of violence perpetrated by patients with organic deliriums, dementia etc.

It has to be said that these events are often memorable because of their infrequency, whereas the verbal insults and sarcasm directed mainly at nursing staff is so commonplace that we treat it as part and parcel of ED work. I don’t think it would be true to say we are immune to these verbal assaults, just more wearied from them, and we take the path of least resistance – ignore them.

But before anyone runs off to learn Karate or similar, there are a number of things nurses and others can do to mitigate violence in their work places:

At all times treat patients and their families respectfully – a hospital is a stressful and alien setting to most people, and it is our duty to keep people as informed as we can about what we do.

Anticipate and manage potential episodes of violence before they intensify – we are often aware that a situation is escalating and we should do whatever is necessary to contain it.

Maintain a zero tolerance to any form of violence and report all episodes at a suitable time – any patient or family member that initiates any form of verbal threat or worse should be prosecuted.

My final thought is: what’s next? The article linked above was cited on the radio and the national newspapers, so what will health professional organisations as employers now do to protect their staff?

Addendum: I have consciously chosen not to specifically mention alcohol intoxication and violence. I think most New Zealander’s are aware of the detrimental effect of alcohol use in this country and also that alcohol accounts for an unnecessary amount of admissions to EDs throughout the country. This is another topic in itself!

June 6 2014

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