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Working in fear

New research finds nurses working in very remote regions in Australia are fearful for their personal safety, writes Annie May

Its main function is to look after people – the public – but for its staff, the health industry may be one of the most violent industries in Australia, especially in remote areas.

This is according to a new study that found incidents of workplace violence for remote area nurses have increased in the past decade, despite being recognised as a major issue. Research also shows that nurses working in small communities experience more workplace violence than their metropolitan counterparts.

“Nurses working in very remote regions in Australia are fearful for their personal safety,” said the study, published in the latest Australian Journal of Advanced Nursing.

It also found there was a strong link between nurses who had experienced all types of violence and showing symptoms of post-traumatic stress disorder (PTSD).

To protect these nurses, and the diminishing rural health workforce, the study calls for a firm and united front that sends a clear message of zero tolerance of workplace violence.

“Working in fear for your personal safety can be a major occupational stressor, and violence in the workplace has been cited as a common reason for resignation in the remote area nursing workforce,” said lead author Tessa Opie from the University of South Australia.

“Alarmingly, nurses are not only resigning from the field, but fewer candidates are choosing to enter.”

Looking at 349 nurses working in very remote regions across Australia, two thirds reported concerns for their personal safety. Of these 14.3 per cent felt this concern at least once a week. More than 80 per cent of the group also worried about violence in the community, with 33.2 per cent concerned at least once a week.

In the 12 months preceding the study, the form of violence most commonly experienced by remote area nurses was verbal aggression, at 79.5 per cent. This was followed by property damage at 31.6 per cent, 28.6 per cent experienced physical violence, 22.5 per cent sexual harassment, 4.9 per cent stalking and 2.6 per cent sexual abuse.

These figures don’t include the witnessing of violent incidents, which are also shown to increase fear. The type of violence most frequently witnessed towards others was also verbal aggression (85.7 per cent), then physical violence (59.9 per cent), property damage (53.9 per cent), sexual harassment (32.1 per cent), stalking (14.3 per cent) and sexual abuse (10.9 per cent).

Those nurses who reported higher levels of exposure to violence also reported higher levels of PTSD symptoms, including difficulty sleeping, difficulty concentrating, irritability, feeling distant or cut off, reliving of the trauma and feeling emotionally upset when reminded of the trauma.

On comparing this study to a similar one undertaken in 1995, the authors found a significant increase in the incidence of physical violence in the past 13 years. Increases were also found for stalking, property damage and aggression. While there were increases in the incidence of sexual harassment and sexual abuse, these were not significant.

This study only considered nurses working in very remote Australia, but Opie said a similar trend had been found for nurses working in the public, private and aged care sectors.

Opie said this was despite the various taskforce recommendations and zero tolerance policies that have been established in response to workplace violence in the nursing profession.

“Workplace violence poses a significant threat to the physical and psychological well-being of remote area nurses. While this issue has been acknowledged and responded to at a policy level, there is an increasing need to actively implement these policies in administration and practice,” Opie said.

The strong implementation of such policies would require the participation and collaboration of all stakeholders, the study recommended. This includes remote area nurses themselves, state and federal governments, unions, occupational health and safety representatives, and other professional bodies.

“The issue of workplace violence is a difficult one to research as victims are often traumatized and receive inadequate emotional support,” Opie said.

The study said there was a capacity to establish zero tolerance assessment teams to evaluate the needs of the workplace and oversee worksite specific policies and procedures. These could also support the role of an occupational health nurse who implements compulsory education programs targeting the identification and management of violence in the workplace.

Additionally, there may be systems for mandatory reporting of violent and aggressive incidents, as well as mandatory debriefing for those individuals affected, it said. Management could benefit from training that focuses on best-practice provision of staff support.

Any workplace interventions should also target the physical work environment itself, including improved security in the home, workplace and when attending to on-call or out-of-hours duties, the study recommends.

“Previous research has demonstrated that while nurses acknowledge the existence of policies for the management of workplace violence, they also report that policies do not necessarily ensure safety. The time has come to transform policy into robust practice.”

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