Caring can be a calling, but never a call for attack

The 2023 NHS staff survey¹ showed nearly 26 per cent of participants had reported at least one incident of harassment, bullying or abuse from service-users, their relatives or other members of the public in the 12-month period.

And would you believe the corresponding 2022 figure (the latest available) for paramedics showed they experienced a much higher volume of abuse (45.8 per cent), while more than a quarter of ambulance staff told the 2023 survey they’d been sexually harassed by the public².

In South Africa and Egypt, reported incident rates ranged from 54 per cent to 100 per cent and 59.7 per cent to 86.1 per cent respectively³ and included beatings, shootings, stabbings, robbery, verbal assault, hijacking, rape, attempted murder, attempted rape, and strangulation. Health workers globally are at risk of abuse and violence, with verbal, physical, sexual and psychological abuse being increasingly reported.

In some cases, the abuse is not intentional. It is understood that some patients unintentionally become violent and aggressive due to their medical condition. A patient coming out of a low sugar event or a seizure may well get violent due to confusion, with a trained health worker aware of this and usually able to take steps to protect themselves. It is the unprovoked and unexpected events that they are not prepared for - that frustrated family member who thinks it’s okay to take a slug at the nurse, that angry patient who insults the person giving them care.

Occupational hazard

These events are all reported in the line of duty, clearly making them an occupational hazard. As OSH professionals it falls to us to address abuse and violence as an occupational hazard. So what can the OSH professional do? Here are some pointers.

• Recognise violence and abuse as occupational hazards and give them the same focus afforded to other hazards.
• Conduct risk assessments to identify and address the hazards. As psychosocial hazards, abuse and violence are very often poorly risk rated, leaving health workers vulnerable.
• Develop and implement zero-tolerance policies and back these up with workplace specific procedures to follow as needed. Staff, the public and patients need to be aware of these policies.
• Conflict may give rise to abuse and violence, so training health workers in how to avoid and manage conflict will aid de-escalation.
• Avoid lone working, especially in areas such as emergency units where tensions may run high.
• Ensure health workers have a means of raising the alarm, eg provide coded calls or alarm buttons if the potential for escalation is identified.
• Train staff in how to manage their stress so they can better respond to situations.
• Organise debriefing sessions to allow workers to verbalise fears and anxieties and talk through their experiences - this supports their mental health.
• Conduct incident investigations for all events, including verbal abuse cases. Identify why events occur to help manage the root cause.

The NHS trusts also need to consider how delayed appointments, people’s inability to make appointments and long waiting times, for example, are contributing factors. They would do well to reflect that, sadly, it’s the front-line workers, like nurses and doctors, who fall victim to abuse stemming from frustration.

Many health workers see their role as a calling rather than a job and often go above and beyond the call of duty to put their patients’ needs above their own. Yet, of course, it is no less distressing to hear of the escalation in violence and abuse these workers are facing.

While I understand and appreciate the need for body cameras and other drastic means of protection, this is not a straightforward solution. You never know when you are going to need a health worker – a sudden heart attack, an allergic reaction to a bee sting or just for some good old-fashioned advice. Whenever it is, it’ll be when you most need help. As OSH professionals, if we’re not there for them and don’t do more to protect their health, safety and wellbeing, they may not be there when we need them.

References

1. NHS Staff Survey in England. 2023. Harassment, bullying and abuse (see page 11).
2. Batty, David. 2024. 'More than a quarter of ambulance staff ‘sexually harassed by public'. Online 7 March 2024. Accessed 11 March 2024.
3. Njaka S, Edeogu OC, Oko CC, Goni MD, Nkadi N. Workplace violence (WPV) against healthcare workers in Africa: A systematic review. Heliyon. 2020;6(9):e04800. Published 2020 Sep 14. doi:10.1016/j.heliyon.2020.e04800