Nine out of ten nurses and health care workers have been assaulted, abused or harassed by patients or their carers in the past year, according to new research from Federation University.
The survey of more than 1200 Victorian nurses and health care workers also revealed high levels of workplace aggression from supervisors and colleagues.
"Unfortunately violence and aggression towards nurses and healthcare workers has become entrenched in the healthcare sector and accepted as normal," said Associate Professor Danny Hills, author of the report Workplace Aggression Experiences and Responses of Victorian Nurses, Midwives and Care Personnel.
"Most healthcare workers fear reporting these incidents or believe that little if nothing is ever done to make their workplaces safer, so they start to see it as normal themselves."
Mr Hills' study found the rate of workplace aggression experienced by Victorian healthcare workers is more than 20 per cent higher than national figures for medical practitioners, and has not decreased in the past 30 years.
It's not part of our job to be abused and threatened and punched and kicked, but we do have to manage it.Marcus Hovey
At Ballarat Health Services, reported incidents of occupational violence increased 32 per cent over the past two financial years with 2186 incidents reported in 2017-18 - or about six per day.
Of those incidents, less than one per cent or about 21 cases resulted in a staff injury, illness or condition.
"This result is a worrying trend and Ballarat Health Services continue to prioritise strategies to reduce these incidents," hospital management wrote in the annual report.
Mr Hills, who has studied workplace aggression for almost 20 years, said it appeared the trend was increasing across the state.
"It's very clear that the systems put in place to protect healthcare workers are inadequate or failing - we need to understand why this aggression is occurring if we're going to reduce it," he said.
"I suspect that's because it's a bit symptomatic of how things are ... there's more propensity to lash out rather than trying to argue rationally for what you might need or a service you require," he said. "And health services are treating people who are more acute, more unwell, who might be drug affected or other reasons."
In one case, a nurse in the study said she was tackled to the ground by a 140kg man when trying to help another nurse the man had attacked.
According to Worksafe, occupational violence and aggression can look like:
- eye rolling and sneering
- yelling, swearing, calling names
- standing over someone
- spitting, shoving, tripping, grabbing, hitting, punching
- threats of violence, threats with weapons
- sexual assault
The research, published in the Collegian journal, found aggression was most likely to come from patients, their relatives or carers, then coworkers..
Exposure to verbal or written aggression was much more prevalent than exposure to physical aggression, but rates were very high for both forms of aggression.
The most prominent perpetrators of co-worker aggression were immediate supervisors and other senior staff, peers and medical practitioners. While most of the exposure was verbal or written aggression, up to 28 per cent of nurses, midwives and care personnel reported that they had experienced physical aggression from these sources in the previous 12 months.
Most respondents just accepted incidents of verbal or written workplace aggression, but some said they did nothing because they were afraid of the repercussions.
"It is the incivility that is endemic in so many health care workplaces, including in relation to those who work in and interact with health care organisations, that likely sets the climate for the generation of and exposure to so much explicit aggression and even violence that is inherent in health care work," Mr Hills wrote.
We heard stories of people being beaten by patients and forced to take sick leave and told not to report it to Worksafe or they'd lose their jobs, or more systematic situations where somebody might want to report bullying behaviour from a senior person then then feel like human resources backs the other person, not them, and they get vilified.Associate Professor Danny Hills
Mr Hills said fear of aggression in the workplace impacted on the health and wellbeing of staff, which in turn could affect the quality and safety of patient care.
The study found most Victorian nurses, midwives and care workers who experienced aggression or violence rarely or never took time off work, nor did they seek medical or psychological treatment, support or advice.
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"We simply can't accept it as normal," Mr Hills said.
"We heard stories of people being beaten by patients and forced to take sick leave and told not to report it to Worksafe or they'd lose their jobs, or more systematic situations where somebody might want to report bullying behaviour from a senior person then then feel like human resources backs the other person, not them, and they get vilified."
BHS Management of Clinical Aggression (MOCA) coordinator Marcus Hovey said incidents across the service were increasing not just because of actual incidents, but also from a change in culture encouraging staff to report all incidents of aggression including "near misses".
"It's not part of our job to be abused and threatened and punched and kicked, but we do have to manage it," Mr Hovey said.
Mr Hovey said while there were some clinical reasons for aggression altered conscious state, delirium, psychosis and dementia, it could also stem from fear, frustration, powerlessness which staff could help to de-escalate if they identified rising aggression levels early.
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