aggression/violence, Australian politics, Code Grey, conditions, emergency department, health, health care, nurses/midwives, nursing, occupational violence, OH+S, safety, security, TAFE, unions, VET sector, Victoria
Driving home this morning I was distressed to hear a report that the Health Services Union (who represent a number of health-oriented roles, including security) are again calling on the government and hospitals to arm emergency department security staff – and not even with Tasers or other non-lethal implements but with guns.
Australia is not alone in seeing an escalation of violence directed toward health care providers – that it’s a problem is undeniable. It’s also true that attacks on health care providers has only become visible in the past decade, or less. Before my hospital introduced Codes Grey (behaviour of concern or threatened assault) and Black (armed person or actual assault), only rarely were these kinds of incidents noted – and then only the spectacular events.
Like the nurse who was specialing (caring 1:1) for a patient who knocked her unconscious with an IV pole. Or my colleague, who was punched so hard in the face by a recumbent patient that he fell out of bed – and she had to have facial x-rays.
In comparison I’ve gotten off lightly – I’ve been bitten, spat at, had objects (from faeces to metal urinals) thrown at me, had the wall beside me punched (no, really), scratched, clawed, slapped, hair pulled, kissed and groped multiple times, punched in the jaw, and been sworn at far more times than I care to think about. And my experiences are not unique, or rare.
And it’s not just patients – I’ve had colleagues vilely abused by physicians, had jugs of cordial thrown over them by surgeons, witnessed a nurse in theatre have a metal bowl (full of infectious material) thrown at her head, and heard of the same aggressor throwing a scalpel at another nurse. And I’m not alone in having being threatened by management.
For a very long time these events were seen as part of the job – a necessary, and unavoidable evil. Things are getting better from a containment perspective – the kinds of staff-on-staff incidents I’ve described are no longer tolerated here. The prevalence of Code Greys called reassures staff that they, too, can call for assistance when needed – and is eye-opening in its frequency. The knowledge that help is available helps de-escalate fraught conditions, as staff feel less vulnerable – paired with improved teaching of de-escalation techniques many patients and aggrieved family members are more effectively managed before things get out of control. Often informing potential offenders that we’ll call security is enough to calm things down, and when it comes to visitors there’s no tolerance of anti-social behaviour.
But I work on a containable ward. And violence and abuse still happen.
In emergency departments, where emotions run high and people are often ill, affected by alcohol and/or drugs, or head injured, things are far worse.
Which is why most hospitals have security staff stationed in their emergency departments. Ideally those staff have earned appropriate qualifications through an approved Vocational Education Sector service provider, or Registered Training Organisation (RTO) – like TAFE. Perhaps a Certificate II in Security Operations, though I suspect (and this is not at all my area) that a Certificate III would be more appropriate.
Unfortunately the quality of these programs has declined. In 2008 the then Labor state government in Victoria de-regulated the Vocational Education Training sector – and instead of the bar being set by our established, well-regulated and scrutinised Technical and Further Education (TAFE) delivery, operators can set up with few qualifications and fewer scruples. It’s a multi-million dollar industry.
As 7:30 covered last year, the growth of flick-and-tick courses are growing – though construction has been most comprehensively covered, the problem is rife across a number of industries – including security training.
Why is this a problem? Well, as well as the cost to tax payers, students are understandably only allowed access to a certain amount of funds for a limited number of courses – those who come out with shoddy “qualifications” are not only unemployable but have no recourse for appeal, nor options for retraining. And those most likely to access VET sector education are least able to use alternate methods to access training.
Of more direct concern to those of you who don’t need to worry about the impact of this on your own careers or those of your children, is the impact on the community. We run the very real risk of unsafe construction, plumbing, electricity… and health care assistants. And security staff.
It can be difficult for me, as a professional with over two decades of experience and significant education about conflict resolution, to separate the behaviour of an individual from my response. For those less well equipped, less experienced, less trained, this is harder still. Put a gun in the hand of someone with inadequate training, then confront them with an aggressive person and there’s a real potential for tragedy. We’ve seen it outside a number of night clubs – we don’t need to see it in our hospitals.
I’m not saying hospital security staff are unskilled, under-trained, impulsive, or lack experience. I’m saying that the potential is there, and it’s growing. Putting guns in the hands of our staff not only allows easier access to weapons by offenders, it reduces options rather than expanding them.
I believe being armed makes it harder for people to think of other solutions, employ lateral or creative thinking, to utilise de-escalation. There are exceptions, of course – but compare the level and length of arms training police officers and our armed forces have with the training of security staff – particularly in this era of increasing numbers of poorly regulated flick-and-tick VET sector centres.
We need universal, enforced zero-tolerance policies about violence and abuse toward health care staff – not just in emergency departments but in acute care, delivery suites, ICU, aged care, rehab, community care, psych… and for paramedics. These policies need to be broadcast, visible, reinforced and acted upon. None of us should go to work risking out health, well-being or even our lives.
We need more, well-trained security staff, who have experience and who are equipped to deal with situations without conflict, challenge or the meeting of aggression with aggression. I’ve worked with many security staff who have these skills in abundance, and they can make all the difference between calm resolution and a situation that involves restraints, police and a whole lot of distraction from the work we ought to be doing.
Ideally we also need more health care staff in high incident areas – to reduce the waiting times, and to allow staff the opportunity to identify and manage potential situations that will escalate without intervention. But let’s start with the staff we have – and spend the money on education and skills development, not firearms.