Nurses who work alone should use safety alarms and other technology and get training in personal safety and risk assessment, according to new guidance issued by the Royal College of Nursing.
The guidance follows a 2015 survey of RCN members, which found almost half of community-based nursing staff had been subjected to abuse in the past two years. In more than 11% of cases, this involved physical abuse or assault as well, the survey found.
“The number of nursing staff working alone will inevitably increase”
The document, launched to coincide with National Personal Safety Day organised by the Suzy Lamplugh Trust, noted that community nurses, health visitors, midwives and others who do home visits often worked alone.
It sets out what nurses can expect from their employers as well as steps they can take to ensure their own safety.
The guidance also flags up a range of other lone-working situations including one-to-one consultations, escorting a patient from one side of a hospital to another and collecting equipment from an isolated part of a hospital at night with staff around.
“Nursing staff who work alone for long, or even short, periods of time are more vulnerable to physical and verbal abuse,” said Kim Sunley, senior employment relations advisor for the RCN
“As more care is provided in the community, the number of nursing staff working alone will inevitably increase,” she said.
“Employers are bound by law to take appropriate measures to protect the safety of their employees, and nursing staff can also take practical steps to reduce risk,” she added.
“Training alone will not reduce the incidence of violence”
Employers should have a lone worker policy, carry out risk assessments, and take steps to manage and reduce risks such as providing nurses with means of raising the alarm, regular checks by supervisors and establishing buddy systems.
This process should include providing training in areas like “dynamic risk assessment”, de-escalation techniques and personal safety – including when travelling on public transport or driving, said the guidance titled Personal safety when working alone: guidance for members working in health and social care.
“While training alone will not reduce the incidence of violence, it is an essential part of an organisation’s approach to managing violence and aggression towards lone workers,” it stated.
Employers should also have systems in place to support lone workers following an incident, or near miss, such as debriefing, investigating the incident and reviewing safety measures, and advice on accessing counselling and liaising with the police.
Meanwhile, nurses should be prepared, knowing how to raise the alarm and getting as much information as possible, especially when going to an unfamiliar place or seeing a new patient.
When they were working alone, they should follow their employer’s lone working procedures and carry out basic checks such as ensuring they had a signal if using a mobile phone-based alarm system or checking alarm batteries have not run out.
Nurses should carry out “dynamic risk assessments” – which involve continually assessing a situation for risks of violence and taking necessary action, noted the document.
The guidance pointed out that nurses can refuse to treat a patient if there is a serious threat “but this needs careful consideration”.
“It may be possible for care to be given whilst the patient’s violence is managed,” said the document. “Each situation needs assessment and you should discuss this with your manager and the rest of the care team.”
In the 2015 survey, 50% of staff felt vulnerable at work, with almost 10% feeling vulnerable often or all of the time. Just 22% said their managers always knew where they were when they were working alone in the community.