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'Take a stand against violent behaviour in A&E'


Posters telling people not to be aggressive towards staff are commonplace in many organisations - the post office, train stations and yes, even hospitals.

It seems shocking that the one place where staff are under enormous stress - life and death type stress - and struggling to look after people that they should be subjected to spitting, swearing and physical assault. That was a view echoed by Simon Burns, the health minister who came to support the launch of the proposed redesign of A&Edepartments to reduce violence towards patients and staff at the Design Council last week.

The project involved frontline NHS staff in three pilot trusts, design experts, psychologists and behaviourists to understand the problem and try to fix it.

It did what many staff can’t do - look at the environment from the perspective of an anxious relative, or patients who are confused or intoxicated, or just frustrated by waiting.

The project has been applauded for its simplicity in redefining signage and making the wait more tolerable for patients by providing more information about when they’ll be seen, but it has also built in a greater degree of support for staff witnessing such events.

The nurses from the University Hospital Southampton Foundation Trust pilot said they had become accustomed to “low-level aggression”, and didn’t really see it as a problem. But by recognising it, challenging it and changing it, they had made A&E a safer place.

Nurses are typically resilient and stoical, dismissing bad behaviour as part of their job. But this project shows shrugging off the problem is not the best solution. Nurses have the knowledge to make a difference, now they need the confidence to say enough is enough.


Readers' comments (41)

  • michael stone

    Anonymous | 25-Nov-2011 10:28 pm

    I did say 'but I digress'.

    And I do indeed claim that nurses cannot understand the experience of being a patient, without their understanding being influenced by the fact they are also a nurse - it must be true, logically. HOW INFLUENCED is a legitimate question - but I do not believe the answer is 'not at all'.

    I also agree that there are too many attacks on hospital staff, and that some patients are unreasonably confrontational, and that it is not I who am being attacked in A&E, so I have no experience of that.

    But I have a problem when complaint becomes confused with confrontation - just not helpful !

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  • It's all very well and good having a zero tolerance policy but we do need to be careful not to overlook the fact that many medical conditions as well as symptoms such as chronic pain, can lead people to act in aggressive or violent ways.

    Michael is quite correct when he says that one of the problems is that complaint becomes confused with confrontation. I would actually go further than that and say very often a simple question, such as how long a wait will be is often confused with confrontation.

    There is absolutely nothing wrong with Michael talking about end of life care in this context either, as he was talking about poor communication which as we know is a large pre disposing factor to aggression and vilolence.

    I suspect he would've been able to make the point if he was a nurse and the lowest the low: a member of the public

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  • michael stone

    Geeze | 29-Nov-2011 1:09 pm

    Thank you Geeze, I was digressing a bit into EoLC but as you pointed out, it si connected to bad communication and my persoanl experience of the problems that can cause were during EoLC.

    I am heartened that some nurses, do understand that treating a complaint as de facto 'aggressive' can cause confrontations - but, I fully accept that a violent drunk, is de facto a problem !

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  • Another debate down the toilet.

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  • As an A&E nurse, I feel obliged to point out that the highly qualified and experienced staff in many A&Es are very well aware of the reasons, medical and otherwise, for challenging behaviour AND how to deal with it. Interesting that this discussion has been hijacked by a couple who obviously know little of the reality of this behaviour, or how to deal with it appropriately. The so-called Zero Tolerance policy is (as ANYONE who actually works in A&E knows) a joke. Suggesting that the levels of violence and aggression faced by A&E staff on a DAILY basis are in large part due to poor communication, is stupid, downright insulting and displays stunning ignorance! Obviously, neither of you are nurses.

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  • Zero tolerance to eolc interrupting every debate about every topic on this website intended primarily for clinical professionals.

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  • Anonymous | 2-Dec-2011 8:09 pm

    Hear Hear!

    Anonymous | 2-Dec-2011 7:01 pm

    At last, someone who agrees that violence against nurses isn't actually our fault or should be tolerated!!

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  • Anonymous | 2-Dec-2011 9:47 pm

    problem is that it falls on deaf ears despite the comments of quite a few readers following other articles. Such behaviour disappointingly just kills all discussions between professionals.

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  • Half of those who pitch up in A&E are NOT emergencies and could be better managed by dealing with problems sooner (themselves) and/or by attending their GP. They are often the ones who clog up the system in the first place. Then they get aggressive with the staff because they have to wait, whilst staff are dealing with genuine emergencies. So lets stop kidding ourselves that this is down to the staff. I have absolutely no problem with a zero tolerance policy. The trouble is management never implement it or support their staff.

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  • Anonymous | 3-Dec-2011 4:36 pm

    are there clear guidelines for the general public to help them make the decision whether they need to attend A&E or there GP? I get the impression that this is not the case so the blame should not lie with them. I would imagine that GPs work office hours only and on an appointment system. If an individual is worried, anxious or feels it would be harmful to wait for appointments offered or they are unable to be attended to for other reasons then they will go to A&E. If they need attention out of hours then presumably A&E is the only alternative.

    Zero tolerance is not a means of helping a patient find a solution to their problems and helps nobody. It is merely a concept which has originated in 'clever' America and from general management theory which normally everybody in the NHS and patients associated with it hate so much. It can exacerbate the situation which may have otherwise been alleviated by good problem solving skills, by showing tolerance and understanding and by offering adequate care and attention. Causes or anger and aggression among sick or injured individuals and those in their entourage are well documented and do not need to repeated here where space is limited.

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