In recent years there has been much discussion about incidents of violence in hospitals, particularly in Emergency Departments (EDs) and psychiatric inpatient units.
A recent study found that 90% of ED nurses have experienced physical intimidation or assault at some point during their career. 100% experienced verbal abuse. The effects of this – aside from recovering from physical injuries – include high levels of depression and anxiety.
A mood of opposition to violence has forced some government bodies and unions to speak out against it and to look at why it occurs. Unfortunately, while many organisations have been able to explain the reasons for the violence – including the high rates of presentation of people experiencing a psychiatric illness and “over- crowding and long waiting times” (Australia Medical Association) – none have put forward proposals to actually deal with the issues.
The Australian Midwife and Nurses Federation (AMNF) have highlighted the high incidence of assaults from patients presenting who are alcohol or methamphetamine effected. The union advocates a “zero-tolerance” approach to violence. This of course is completely correct but it does little to change the situation.
Healthcare workers cannot control who walks in the door, within a psychiatric inpatient unit nurses cannot refuse to accept a patient who is admitted on a treatment order. Nurses in EDs and inpatient units feel that they must attend patients and some would undoubtedly be worried about keeping their jobs if they refused. A zero-tolerance approach is fine but the union needs to explain how nurses should implement a refusal to carry out unsafe work.
The reasons for the violence are complex and varied. The main overarching factor is that the health care system is under enormous strain. Funding cuts and the push towards privatisation by successive governments has resulted in a system that is stretched to its limits.
In hospitals, even emergency cases often experience long waits. Other less urgent cases can leave people waiting for hours in EDs frustrated, in pain and exhausted.
Cuts to bulk billing and reduced options for primary health care mean that many patients that might have otherwise gone to a local doctor now present at hospitals for less urgent medical problems. Properly resourced community health would provide early diagnosis and intervention to many patients meaning that their health issue may not develop into an emergency.
The long waits in EDs and ward transfers is often linked to understaffing. Tiny pay increases, poor conditions and the cost of studying a nursing degree also mean that there are less nurses on the ground. Many nurses leave the profession after experiencing assaults feeling that they would be safer and better paid doing something else. In regional areas this situation is particularly pronounced.
The increased presentation of patients with psychiatric illness and those who are affected by methamphetamines and alcohol, while rooted in social issues, is also closely linked to cuts to health funding. Psychiatric services continue to experience massive funding cuts, leading to less money for community-based support.
When you feel you can’t get help in the community, but you know you need it urgently, it is natural that an ED would be your point of call. Within most EDs there are psychiatric teams that are qualified to support people with a mental illness, but getting that support quickly often depends on staffing levels.
Additionally, there may not be any beds available so even those actively harming themselves or others will at times be managed in ED.
Despite the hype about methamphetamines, alcohol remains the number one factor in violent incidents in EDs. 92% of hospital workers experienced alcohol related physical aggression in the last year. Alcohol along with methamphetamine results in a loss of inhibitions often resulting in unpredictable behaviour. These factors combined with long waits, frustration and sometimes psychosis due to withdrawal, are a lethal combination.
Nurses and medical staff should have the right to work in a safe and healthy environment. In order to achieve this, we need to ensure that all those that attend EDs are adequately supported. Primarily this means extra funding and resources for public hospitals as well as a boost in funding to community health services. More people could be encouraged to study nursing and other health professions if university fees were scrapped.
All of this and more could be paid for if we stopped propping up private health and insurance companies and increased taxes on big business and the mega rich. In addition to a zero-tolerance approach, these are the policies the health sector unions should fight for.
By a public health worker