We explore the complexities of protecting health workers, as research demonstrates how risk stretches beyond the workplace. Domestic violence, for example, is a hidden – but clear – problem, as health providers look to adopt new strategies against violence and aggression.
The harmful consequences of violence and abuse against healthcare staff are widely recognised by hospital administrators. The daily reality of heightened aggression weighs heavily on staff focus, performance, and motivation; it increases sickness and absence; and makes retention and recruitment harder.
It’s an issue that goes right to the heart of the way resources in healthcare are managed, as providers struggle to maintain the quality of care delivery and patient experiences.
It’s an international problem too; the same pattern of increasing concern about violence is evident in health systems from the US, the UK, and Europe, to Australia.
In a new paper on this topic by Eric Clay, President Elect of IAHSS (the International Association of Healthcare Security and Safety) in the US, the violence statistics from the last decade, drawn from a variety of credible sources, all point steadily upwards.
“Two decades ago, it was blamed on the combined effects of rising workloads, work pressures, excessive work stress, deteriorating interpersonal relationships, social uncertainty, and economic restraints. All of these factors are still valid today, with the added issues of staff shortages, bed shortages, and a rise in behavioral health challenges among patients,” Clay explains.
It’s also a formidably complex issue to tackle.
Two facts make this point most clearly: first, and perhaps not surprisingly, the majority of aggression against healthcare workers is patient generated. Emergency department staff, nurses, and physicians are the most victimized, according to a large body of evidence.
Further reading: The healthcare sector ‘must focus on NHS staff safety and security’ amid rising workplace violence, says NAHS
Second is a fact which gets much less attention: healthcare workers are also more likely than the population at large to be victims of domestic violence.
Why is that relevant, and why does that matter to employers?
It’s a hidden but pernicious form of abuse that can affect the individual’s ability to do their job, and it can also spill over into workplace settings where it impacts colleagues and patients. In the US for example, the largest number of deaths of healthcare workers in hospitals are related to intimate partner violence.
Data on the problem has been available for years. In a 2010 US study, 45% of healthcare workers (a large majority, women) reported that they had been the victims of domestic violence (BMC Women’s Health Journal); and almost half of fatalities of private healthcare workers in hospitals were domestic violence related, according to 2018 figures from the U.S. Bureau of Labor Statistics.
In the UK a nursing charity report in 2016 estimated that nurses, midwifes, and healthcare assistants were three times more likely to be survivors of domestic abuse than the population average.
But whereas general violence and aggression in healthcare settings is visible and easily understood, domestic abuse is largely hidden.
In July 2023, two companies were fined a combined total of more than £400,000 after staff working at a South Wales mental health hospital were subjected to violent attacks by patients over a three year period.
It should come as no surprise that health sector workforces are disproportionately affected by domestic abuse, warns Kim Urbanek, CEO of K4 Consulting, and Public Safety Manager for an Illinois Healthcare System.
Nursing roles, for example, are still predominantly female, and women are at significantly greater risk of domestic violence.
In addition, people working in caring professions are predisposed to put their own wellbeing second, and that increases their risk of being mistreated. In other words, they have some of the characteristics that make them “perfect victims” warns Urbanek.
“We are resilient, we are always providing help and not asking for it, always making sure that everyone else is OK. We are the ones who haven’t taken a lunch break, who haven’t gotten enough sleep, who haven’t done self-care, because caregiving is about addressing others’ needs.
“And when you have this mind-set it can be very difficult to ask for support. There’s a sense of shame that comes with domestic violence and it’s embarrassing, so there’s a tendency to compartmentalise it, or rationalise it, or push it away to avoid it.”
It’s an issue that Urbanek is working to highlight, along with like-minded colleagues in the UK and Australia.
A forum in August 2023 brought together leading violence prevention practitioners including Danielle Austin, Incident Response Manager at St Vincent’s Health Network in Sydney, Australia, and Laura Smith, Clinical Violence Prevention Specialist, Dorset Healthcare NHS Trust, UK, along with subject lead Sienna Kozin of CriticalArc, a technology provider which is working with healthcare providers globally to support new staff safety strategies.
Credit: Unsplash by Greg Rosenke
Ms. Austin believes that domestic violence is a risk factor facing healthcare settings but that the threat has not been properly addressed, in part because senior administration, as well as policing, security and safety planning, have traditionally been male-dominated roles.
“This is a societal problem, but if you don’t expect to see it, if you are not looking for it and not planning for it, you are putting your head in the sand.
“When somebody is escaping from domestic violence, and has gone to a place of safety, they still have to work and earn money. So, for perpetrators, one of the easiest places to locate them is at work, especially if that person has a predictable shift pattern.”
Most violence occurs after victims leave; most fatal situations occur once they have broken free, she points out.
So, making domestic violence a greater priority in safety planning and risk management policies can have two-fold benefits, improving wellbeing for the individual, and reducing risks for the facility and the organisation.
But another reason why this has not happened is that it is such a difficult and sensitive problem to address, says Laura Smith.
“Where a patient is being aggressive, nurses will go and manage the situation. But where domestic abuse is concerned, nurses need the support of other nurses and colleagues, but have they got the skills and resilience to handle that? Burnout and empathic distress are already at such high levels.”
From an organisational perspective, staff who are expected to intervene and support colleagues impacted by domestic abuse – whether that’s clinical staff, or security and policing teams – will themselves need better support and structures.
“Where do they go with that information after it’s reported? What support mechanisms are in place? There needs to be a real upskilling of staff.”
Urbanek argues for a grassroots effort to convince administrators that the issue needs to be better understood, and more openly discussed. As a next step, she is working with other invested organisations to develop training resources for healthcare providers and says she will be working with her peers in the UK and Australia to move the conversation forward.
We are also starting to see health providers adopt new strategies against violence and aggression generally, that offer some hope, argues Darren Chalmers-Stevens, Group Chief Operating Officer, CriticalArc.
“Less reactive and more proactive approaches are being developed by a generation of professionals who are looking at the problem differently. They see that established strategies are not working, or not working well enough, and they are determined to influence change.”
Crucially, because the solution to violence and aggression needs collaboration between disciplines and agencies, the new influencers include leaders in policing, clinical practice, and senior executive positions.
Efforts to establish these wider and more effective partnerships are being given a practical boost through the introduction of staff safety solutions which involve the participation of multiple stakeholders, Darren Chalmers-Stevens argues.
“We’ve supported projects in challenging health service settings in the UK and Australia, as well as in the US, so we know from practical experience that collaboration works.
“In practical terms, a police or security control room team can be given the latest technologies that empower them with a much clearer picture of real-time events – showing them instantly which staff member is calling for help, where that person is, who they are, what their risk profile is – but that’s only part of the equation.
“For example, to make a duress solution truly effective for healthcare workers, department heads and clinical teams need to be fully on board. Every member of staff has to be given a way to request help that’s easy to use. The technology needs to work wherever the employee is, on site, off site, or traveling between.
“And for a system to make a real impact it has to earn a high level of confidence by demonstrating a consistent, fast, and effective response.”
This article was first published on our sister site for fire and security news, IFSEC Insider.
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