Violence Work Conflict

Abstract

　　A study report was requested and to be based on a critical incident that occurs or has the potential to occur in my working environment. My chosen subject was something that can potentially happen on my daily duties, violence at work.

　　The report explains the aims that the Violence in Work Policy and Procedure sets out to do. By reducing staff health risk to a minimum by providing training on a Conflict Resolution course each year. It explains that potentially violent patients are assessed and actions taken to prevent risks from happening to the employee’s. The employee’s are sent every year on a conflict resolution course, which used to be based on employee and client protection including self-defence, has now been streamlined to diffusing situations and body languages of potentially violent patients.

　　We are then shown the procedure regarding the actions taken against clients who are violent in the workplace. What the client’s standpoint is thereafter and what options are available and if needed what further action taken. Employee protection regarding security and policing during daily duties in the Emergency Department are also explained and critiqued.

　　The recommendation was that the training given before the change was more beneficial to the employees. That the system procedure enforced onto patients who are violent in the work place is effective but not decisive enough. Finally, the protection offered to the Emergency Department by the police is insufficient and that the security department should be based in the Emergency Department, instead of the far end of the establishment.
 

Introduction

　　It was requested to present a detailed report, which explains of a critical incident that occurs or has the potential to occur in my working environment. So I have based my report on such topic, which I feel often comes across as a potential threat in my daily working environment, violence in the workplace.

　　This report will cover the employee’s standpoint and rights. What procedures are set in place to protect the employee’s and what training is given to ensure that their working environment is a safe one.

　　It also covers the client’s standpoint regarding procedures enforced regarding the actions taken by the trust when incidences of violence in the work place occur.
 

1. The Employees Role (Violence In Work)

1.1 Aims of the Violence at Work Policy

　　The aims that the Violence in Work Policy and Procedure sets out to do, is reducing staff health risk to a minimum by providing training on a conflict resolution course each year. The conflict resolution course goes through different scenarios on how to, “correctly handle” situations when potential violence could occur and may even help diffuse hazardous or even dangerous situations.

1.2 Assessment of Clients and Definitions

　　When working on our daily duties, if there is a trend developing regarding violence in our workplace, then our employers (or designated responsible person) will have to conduct a risk assessment based to identify the nature and extent of this risk and to implement measures to safeguard the work place so it can be a safer place to work.

　　The definition of violence is, “any incident in which a person is abused, threatened or assaulted by another person”.

　　However, the department of health defines violence to staff as, “the application of force, severe threats or serious abuse by members of the public towards people arising out of the course of their work, whether or not they are on duty”.

　　Incidents can include harassment (including racial and sexual), threats with a weapon, serious injury and even death. The same incidences can also occur on wards where other patients are involved, who are violent and abusive.

1.3 Training Regarding Violence at Work in the Workplace

　　At my place of work, the trust tries to ensure that adequate training is provided (and updated on a yearly basis) and given to all staff, who are in direct contact with patients on a daily basis and being able to conduct themselves and act correctly when faced with stressful or potentially violent situations.

　　A very interesting point is that the guidelines (1998 DHSS Committee on Violence to Staff) states that, “any staff without the required training to deal in potentially violent patients and situations are not allowed to manage, work with or work near situations where violence may occur”. I disagree with this or it has not been enforced, with staff shortages and incidences where employees are not able to attend training.

　　I do not see any evidence in my workplace, where this would halt staff working with potentially violent patients, because as employees of our trust, we are unable to refuse immediate and swift treatment to our clients. It would be down to the employee to bring it to the attention of the employer to make sure that training is completed as soon as possible if missed.

　　The training provided, is a conflict resolution course based at my workplace and has significantly changed over the past two years. It previously was based on awareness, self-defence and how to handle violent patients and incidences when they occur. Since then it has changed to how to diffuse potentially violent situations and body languages of violent patients, with no self-defence used.

　　In my opinion, it was a difficult decision change to make as the employee’s health could be in potential jeopardy, when put in a dangerous one on one situation without any knowledge on how to defend themselves. I assume because the self-defence part of the conflict resolution was removed because either to avoid legal proceedings against the trained employees or because the course itself was quite intense, employee’s may have had slight injury coming from it and thus sickness was occurring. I can personally understand this thinking, because after taking the original conflict resolution course myself, I was on painkillers for 3 days due to the pain, regardless it was beneficial to my safety and gave peace of mind in the workplace whilst performing my daily duties.

2. Clients Who Are Violent or Abusive In The Workplace

2.1 Zero Tolerance regarding Violent or Abusive clients within the workplace

　　Regarding the patients standpoint, the trust recognises that all staff working in the health service is not expected to accept personal injury as part of their role. Keeping this balance in the trust between effective care and treatment can be difficult with violent and threatening clients. Withholding of treatment to violent and threatening patients, pending on the behaviour is always the last resort, with managers making the final decision if need be.

　　Patients and those accompanying them should be fully aware of the standards of behaviour expected of them and the actions that may follow due to unacceptable behaviour.

2.2 Procedure Regarding Clients Who Have Been Violent or Abusive to Employee’s

　　The Zero Tolerance procedure is designed to improve our workplace’s ability to put a stop to incidences involving violence and abuse. It includes a dynamic aspect, whereby patients who are extreme or persistent in their unacceptable behaviour can as a last resort will be excluded from the trust itself. The zero tolerance policy has been introduced in the contexts of the Government’s national zero tolerance initiative against violence in the NHS.

　　As an example, on our daily duties, working in the Emergency Department we deal with a lot of patients that are a potential risk, acting with such unacceptable behaviour. Such as threatening or abusive language, that could lead to a forthcoming incident, normally when this happens, the security staff are crashed bleeped for assistance and upon arrival will try to diffuse the situation and protect their fellow employees and their clients in the department.

　　If the patient’s unacceptable behaviour increases, then the client will be asked to leave the department or be removed from the trust property by the security staff. When an act of physical violence towards staff occurs, the police will normally be contacted and the client will be arrested for his actions.

　　After these such occurrences, an application of the Procedure of Care will be completed, thus the patient in question will receive a formal written warning (a “Yellow Card”), due to the consequences of the incident. This warning will cease after one calendar year, pending on whether the patient complies with the terms, if they agree, their clinical care will not be affected in any way. Failure to comply will include exclusion from the trust (a “Red Card”), unless the patient requires emergency treatment.

　　In my opinion, this gives the trust a potentially difficult stance, because say for example a patient attends the Emergency Department, strikes a member of staff and gets escorted off the premises. This patient is then issued a Yellow Card, then refuses the Procedure of Care application and is then issued a Red Card. It is then still within the patients rights that he/she can attend the same Emergency department for emergency treatment and thus become a potential risk once again for the employees.

　　Exceptions to the rule include violence and aggression as a result of an illness or injury, mentally ill patients and all patients under the age of 16. Security will be present at all times when risk to employee’s and clients are at risk.#p#分页标题#e#

　　A police officer is situated in the Emergency Department on Saturday and Sunday nights; due to the increased drink related incidences and violent/abusive patients brought into the department. I personally feel that there should be a 24hr police officer on duty on-site, because there have been many occasions where the police have brought potentially violent patients into the Emergency Department to receive treatment, then vacate the department, leaving the employees with this potential risk.

Conclusion

　　The main conclusion of my report that can be drawn is that I feel that adequate training and support is given to the employee’s in their place of work regarding Violence at Work. The conflict resolution course however beneficial to the employee’s who come across such abusive and violent patients in the workplace, has been changed.

　　In my opinion, this change can only be down to employee’s sickness or avoiding client legal action against trained staff, this defeats the purpose that the employee’s cannot protect themselves based on a one on one situation, when body language and diffusion sometimes wont protect the staff from bodily harm (e.g. patients with Mental Health problems).

　　Regarding admissions to the Emergency department, clients who physically attack employees and after being escorted off the premises are given a second chance (Yellow Card) and upon completion of a Procedure of Care application, the client’s rights are resumed. However if the client refuses to comply with the Procedure of Care application, they are then barred from the trust (Red Card), but regardless it is still in the patients rights still be allowed to attend the Emergency Department for treatment. Which I think will make employee’s question this system in place as its putting their health at risk once again. The benefit is swayed in favour of the clients, not the employee’s and employers.

　　Finally, when working on the Emergency Department, police are present on during night shifts over the weekend. I feel that there should be an officer present at all times, as the security department building is located at the opposite side of the establishment. Thus, response times from them are questionable, especially when they also provide cover for another hospital within the trust and could be present there at the time of this incident.
 

Recommendations

　　My recommendations regarding the conflict resolution course is that it should be kept to the way it was previous, giving staff training on how to successfully defend themselves, in times of threat within the workplace. This is far more beneficial than staff sicknesses and as far as legal threats regarding trained staff is concerned, if the actions taken by the employee’s were performed correctly, then the employee’s will have the legal backing of the trust. Unfortunately, the only way this is going to possibly change, is when something happens or if the new approach to the conflict resolution course is realised.

　　Unfortunately, the policy regarding actions and preventions (Yellow and Red Cards) taken against clients who are violent in the workplace applies to all trusts. Only the Government can make changes to this, based on numbers throughout the United Kingdom based on Zero Tolerance and attacks on employees. Thus, occasional incidences in my establishment will not change the policy in its method and way of thinking.

　　My recommendation regarding the cover provided by security and police is to either have a police officer present 24hrs a day. If that is not possible then another option would to base the security department at the main admission waypoint in my establishment, the Emergency Department, rather than the opposite end of the building.

Bibliography

E1 47 : Preventing Crime in the NHS (1993)

Department of Health – Improving Working Lives

Zero Tolerance Policy : Withholding Treatment from Violent and Abusive Patients in NHS Trusts (Version 2, February 2006, Assistant Director of Operations, St.Helens & Knowsley Hospitals NHS Trust)

Violence at Work Policy (St.Helens & Knowsley Hospitals NHS Trust)

DHSS Committee on Violence to Staff (1998)

HSE Violence at Work, Guide For Employers (INDG69 revised 10/1996)