Call for 24/7 trained security as survey finds daily violence normalised across EDs

Violence is becoming "normalised" in understaffed emergency departments, forcing more experienced staff to quit, warn doctors.

About 85 percent of emergency department leaders in a new survey had at least one incident of violence in the past week, but many are not officially reported.

The survey by the Australasian College for Emergency Medicine showed:

• Eleven out of 13 (85 percent) responding Directors of Emergency Medicine reported that there had been an incident (or multiple incidents) of violence within the past week.
• More than three-quarters (77 percent) reported that verbal violence occurred daily or frequently (one or more times a week) in their ED.
• More than one-third (38 percent) reported that physical violence occurred daily or frequently.
• Less than half (six of 13) indicated that they "always" report incidents of physical violence, while only one reports verbal violence every time.
• Six (46 percent) reported having access to ED-based security officers, including five with 24-hour cover.
• Only one reporting ED in a regional area had access to around-the-clock, ED-based security officers.

The College, which is responsible for training emergency physicians and advancing professional standards, is calling for every ED in the country to have dedicated, trained security officers to safeguard staff and patients around the clock.

More than three-quarters of department heads reported that verbal aggression happened daily or multiple times a week in their EDs, while more than a third (38 percent) experienced physical violence on a daily or weekly basis.

The college's New Zealand chair, Dr Kate Allan, an Auckland-based specialist, said it was horrendous for staff to be under attack "from the very people they're trying to help."

"You hear a lot of abuse being yelled at staff when you're walking through a department, and I'm sure patients who have been in an ED for a long time have also seen and heard the behaviour.

"People can strike out, some people come in with concealed weapons. So there's a lot of things that can happen in that environment."

Last month, a nurse leaving her shift at Palmerston North Hospital was held up at gunpoint by a man who jumped into her car.

That same night, another staff member was knocked unconscious.

However, most incidents went unreported.

Fewer than half the directors of emergency medicine surveyed said they "always" reported incidences of physical violence, while only one said they always recorded verbal violence.

The report, based on the survey responses, said many respondents felt that violence, particularly verbal violence or "near misses", was not being taken seriously by hospital executives, unless it resulted in serious injury or the police became involved.

"Several respondents felt that reporting incidents that had not resulted in physical injuries was largely futile, as it rarely prompted any action or change in the department.

"It was also reported that many staff were also concerned that reporting incidents may reflect badly on their personal ability to cope in an ED setting."

In some cases, ED staff who reported an incident said they ended up being blamed for it.

As a result, rising violence had become "normalised" in many EDs, Allan said.

"It feels like it's become part of the job. People don't report it because it seems like it's become normal behaviour. And that's the most alarming thing."

The fatalism could extend even to ED leaders.

The survey was sent to the heads of all 20 accredited emergency departments, of whom 13 responded.

Overcrowding, long waits, drugs and alcohol compound the pressure

The government target is for 95 per cent of ED patients to be admitted, discharged or transferred within six hours - but currently, one in four are waiting too long.

Allan said long wait times - especially for psychiatric patients - plus lack of access to GP care, more patients under the influence of drugs and alcohol, and extreme workforce shortages were adding to the explosive mix in over-crowded EDs.

"If we could stop that overcrowding in our emergency departments, that would really help alleviate some of the violence and aggression that we're seeing."

Last year's Budget included $31m over four years for increased security at eight of the riskiest EDs (Dunedin, Christchurch, Wellington, Waikato, Middlemore, Auckland, Waitākere and North Shore), as well as "surge capacity" in busy periods elsewhere, and additional training for security staff.

However, there were more than 30 EDs nationwide, Allan noted.

"All of those departments deserve and should have embedded 24-hour security. And they also need to be formally trained and embedded within the department so they're working the team.

"They need training within a hospital setting because that's a specialised environment.

"It's critical that we have consistent training, so if you go to one hospital or ED, the security response is the same as at another hospital. That is not happening at the moment."

Another survey of ED specialists found about 40 percent were considering leaving the job within 10 years, due in large part to dangerous working conditions and burnout, Allan said.

"That's due to 'moral injury', which comes from working in an environment where you are exposed to violence on a daily basis while you're just trying to do your job."

At rural hospitals in Waikato, cleaners are doubling as security staff.

One so-called "security-orderly", who asked to remain anonymous, told RNZ that it made for a stressful job.

"It's all to do with the race to the bottom, who can deliver the services at the lowest price. By the government contracting out these services, they are saving money, apparently."

Taranaki ED nurse Lauren Miller, who chairs the College of Emergency Nurses, said it was not appropriate to expect cleaners to "do security", nor vice-versa.

"They need to be solely focused and available at all times for the staff and the patients," she said.

Emergency nurses had been campaigning for years for every ED to have security staff on site at all times.

"But not just 'present' - we want them to be present and active.

"Security guards need to have specific education and training to meet the needs of the emergency department, and should be integral members of our multi-disciplinary team.

Health NZ has yet to respond to the survey findings or RNZ's questions.

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