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A&E nursing staff ‘resigned to being abused by patients’

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A review of the experiences of hospital accident and emergency staff suggests that workers have resigned themselves to patient violence and aggression.

As a result, UK researchers said a “consistent organisational response” to violence and aggression in A&E settings was “imperative”.

“Staff resigned themselves to the inevitability of violence and aggression”

Study authors

They highlighted that there were over 1.3 million reported assaults on NHS staff in 2016 and around the world, one in four hospital staff has experienced physical abuse.

They reviewed existing qualitative studies exploring the first-hand experiences of staff working in the A&E to provide insight into preventing this issue.

The review, co-authored by Dr Ian Smith and Dr Rebecca Ashton from Lancaster University, looked at the experiences of staff in 18 countries in total.

The researchers found that the highest reports of both verbal and physical aggression were in A&E departments, with nurses subjected to regular verbal and physical abuse.

A healthcare worker who commented for one study said: “People can swear at us, spit at us, bite at us…try and hurt us and nobody puts an incident report in.”

Staff also said they saw some patient’s violence as being more in their control to contain than others. For example, one worker cited in the review said: “If the patient has dementia, that’s a bit different than a drunk patient or just a patient angry about waiting time.” 

But the study authors suggested that staff often missed signs of increasing aggression before an attack and found it hard to understand why they were being attacked then they were trying to help.

Staff also found it difficult to be both a caregiver and the target of abuse, leaving them feeling “wounded”, the authors highlighted in the journal International Emergency Nursing.

“My biggest hurdle was that I feel like a victim, rather than getting to be in the ‘superman’ role,” said a member of staff.

Studies included in the review showed staff found themselves managing in isolation, often feeling inadequate and guilty. “Nobody cared at all, not even the head nurse. You feel abandoned,” said one.

Experiencing violence and aggression led to feelings of powerlessness, with some reluctant to work in emergency departments, warned the researchers.

“Staff often felt isolated when managing violence and aggression”

Study authors

They said: “These accounts imply that staff’s sense of self-worth was dependent on their ability to care and ‘rescue’ patients.”

The study authors said their key recommendations included training staff in understanding violence and aggression, and clinical supervision.

Overall, they concluded: “Staff resigned themselves to the inevitability of violence and aggression, doing this due to a perceived lack of support from the organisation.

“Staff made judgements about the reasons for violent incidents which impacted on how they coped and subsequently tolerated the aggressor,” they said.

“Staff often felt isolated when managing violence and aggression,” added the researchers.

“Violence and aggression in the ED can often be an overwhelming yet inevitable experience for staff,” they said. “A strong organisational commitment to reducing violence and aggression is imperative.”

Before it was closed down, final figures released by the body NHS Protect showed a 4% rise in physical assaults against healthcare workers in England, from 67,864 in 2014-15 to 70,555 in 2015-16. Similar increases had also been recorded since 2010, as previously recorded by Nursing Times.

Last year, a survey of RCN members found 56% of respondents had experienced physical or verbal abuse from patients and a further 63% from patients’ relatives or other members of the public.

It was widely reported on Sunday that woman in the Midlands had left an abusive note on an ambulance dealing with a 999 call, ordering paramedics to “move their van”.

The hand-written message was left on an ambulance in Tunstall, Stoke-on-Trent. The writer said she did not care if “the whole street collapsed” and the crew had “no right to be parked here”.

Mike Duggan, operational manager for the West Midlands Ambulance Service, said the paramedics attending the incident also received verbal abuse.

He shared a picture of the note on the social media site Twitter and said emergency services were increasingly facing growing level of hostility.

Staffordshire Police later revealed that they had arrested a 26-year-old female for public order offences.

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Readers' comments (1)

  • I don't work in A&E I can imagine what the situation must be liked and take my hat off to them.

    I am a mental health nurse, on daily basis my colleagues and myself are subjected to verbal and racial abuse; sometimes physical abuse. We report it, but it appears to fall on deaf ears. I am talking about service users working age; who know what they are doing and saying.
    When reported to the police, it is deemed as part of their condition and we should be able to manage it.

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