Increasing workplace related violence against health workers is a serious concern that must be addressed in the Health and Social Care industry.

Workers from the Health Care and Social Assistance industry, which includes hospitals, Aged Care and Disability support, fulfil an essential role in caring for some of the frailest, most vulnerable members of our society. Therefore, it is disturbing to hear that these same workers are being subjected to an escalating level of workplace related violence, as reported by many health and safety regulators around the world.

The World Health Organisation (WHO) have identified between 8% and 38% of health workers suffer physical violence at some point in their careers, with many more threatened or exposed to verbal aggression¹. In Australia there have also been reports of an increase in workplace related violence against healthcare workers, with the perpetrators identified to be patients, residents, visiting friends and family^2,3.

Under-reporting, and feelings that ‘violence and aggression is part of the job’ are commonly held views across the Health and Social Care sector^2,3. WorkSafe Victoria reported that “the violent and aggressive behaviours that many workers face on a daily basis are among the factors driving an increase in mental injury (workers’ compensation) claims”².

Employers prosecuted for failure to manage workplace violence

Health and Social Care employers can be prosecuted for failing to manage workplace violence and aggression in their workplace. In 2021 a regional health service was fined by WorkSafe Victoria for failing to inform their staff about occupational violence and aggression risks in the workplace². An incident at their workplace occurred in 2018 where a member of their staff was exposed to inappropriate sexualised behaviour while attending to a patient with an impaired cognitive condition. When a WorkSafe VIC inspector attended the same workplace later on, they found that the health service employer had failed to update the patient’s record to reflect the incident. WorkSafe VIC found this action exposed workers to potential future incidents of inappropriate behaviour from the same patient, and thus the health service employer was fined $20,000 for breaching their duty of care towards their workers.

Identifying work related violence risk factors

Work related violence arises when health workers provide service to clients and patients. This includes:

• Verbal aggression and threats – including language that is offensive, humiliating and discriminatory which may or may not involve shouting
• Throwing objects
• Striking, kicking, scratching, biting and spitting
• Physical intimidation and physical assault
• Threats with any type of weapon
• Threatening or intimidating behaviour which occurs in writing, via text message or other forms of electronic communication.

Employers need to consult with their staffs to identify areas of risks where a worker can be exposed to violence or aggression. These areas of high risks include:

• Providing care or services to people who are mentally ill, distressed, confused, affected by drugs or alcohol, or receiving unwelcome or coercive treatment
• Lack of information around client history and behaviour
• Working alone, in a remote area or in a high crime area
• Handling valuable restricted items such as medicines
• Working in an unpredictable environment such as a client’s home
• Communication difficulties between client and service providers

A review of the Aged Care industry reveals “a diverse workforce that is experiencing rising consumer expectations… much outside its direct control. This includes issues such as system funding design and regulation which impact on how care is delivered”⁴. Unreasonable expectations from the client (or their families) of what services a worker can provide may lead to frustration and escalate to workplace violence and aggression. Similarly, a dissatisfaction of the services an organisation can provide may lead to venting against its workers in the form of violence and aggression. 

Steps to prevent workplace violence against health workers

Employers and managers should promote a workplace culture where violence and aggression is never allowed. Steps that employers can take to prevent work related violence include:

• Strong policy against violence by patients, relatives and visitors

     This policy should be clearly communicated and sanctions enforced when there is a breach

• Training workers on what to do during and after an incident

• Encouraging staff to report incidents

Reporting episodes of violence should be encouraged and each reported episode should be promptly investigated. A survey of health workers in NSW conducted in 2019 found that staff will not report incidents if they perceive there are no benefits to reporting (such as no follow up and no feelings of support), and that health workers prefer a transparent reporting system where they could monitor the progress of their report³.

• Improving communications to reduce unrealistic expectations or misunderstanding of clients and their families

Employers should ensure a system of prompt communication when there are delays in service delivery, including informing clients of the cause of delays.

• Employing security personnel in high risk areas and calling them immediately during episodes of violence
• Training for workers on identifying and managing high risk patients

Employers should ensure training for their employees in identifying the early signs where a patient/ client may become violent, as well as training on how to care for high risk patients/clients. Employers should also keep their patient records up to date to ensure workers are kept informed of high risk patients.

• Safe client home visiting

Employers need to create procedures to protect their Care workers who are working alone or remotely. This include training in safe home visiting where workers are taught how to identify client behaviours of concern and how to avoid potential risks before they occur.

Protecting your valuable workers

Violence and aggression against health workers is never acceptable. It compromises the physical wellbeing of health care staff as well as the quality of care to the patients. Employers in the Health and Social care industry have a duty of care to protect their workers. They must ensure a Work Health and Safety Management System is in place to manage and control the risks of workplace related violence to their workers.

Because at the end of the day, no worker should get hurt just for doing their job.

 

 

Citation

1. Work Health Organisation, 2022, ‘Preventing Violence Against Health Workers’, https://www.who.int/activities/preventing-violence-against-health-workers, accessed on 6^th June 2022.
2. WorkSafe Victoria, 2022, ‘WorkSafe Annual Report 2020-21’ Victoria State Government, https://www.parliament.vic.gov.au/file_uploads/WorkSafe_Annual_Report_2020-21_bMgFchmm.pdf accessed on 6^th June 2022.
3. Pich, J., 2019, ‘Violence in Nursing and Midwifery in NSW: Study Report’, NSW Nurses & Midwives Association, University of Technology Sydney.
4. Australia Department of Health, 2018, ‘A Matter of Care Australia’s Aged Care Workforce Strategy’, Aged Care Workforce Strategy Taskforce.

Resources

A. NSW Government, ‘Health Care and Social Assistance – Work Health and Safety Sector Plan to 2022’, https://www.safework.nsw.gov.au/__data/assets/pdf_file/0008/555920/SW09276-Healthcare-and-assistance-WHS-sector-plan-to-2022.pdf, accessed on 23 May 2022.

B. ACT Health, 2018, ‘Nurses and Midwives – Towards a Safer Culture’, ACT Government, https://www.health.act.gov.au/health-professionals/nursing-and-midwifery-office/towards-safer-culture , accessed on 7th June 2022.