Knife attack reveals safety failures 

Association inspects Blacktown Hospital as staff demand better security and ratios.

A 35-year-old Blacktown Hospital nurse suffered knife wounds to her wrists and arms when attacked by a patient.

The assault happened in an unlocked staff tearoom in a medical ward.

Just a week before the attack, Blacktown nurses and midwives had rallied in support of the NSWNMA’s campaign for a new nurse-to-patient ratios system.

The campaign aims to address safety, workload and other issues linked to inadequate staffing.

At the time of the incident, three nurses were working in the ward. Under the safe staffing system sought by the NSWNMA, five nurses would have been rostered on.

Staffing levels at the hospital have been an ongoing concern. From January to June this year, the NSWNMA uncovered around 1250 hours of missed nursing shifts in breach of the award minimum.

Speaking to the media following the knife attack, NSWNMA Assistant General Secretary, Judith Kiejda, said violence in the public health system is spreading from high-risk areas, such as emergency departments and mental health units, to all hospital areas. 

“Nurses are fed up with the current staffing system because there is no mandated ratio for every shift on every day. When incidents like this occur, nurses need all the support they can get,” she said.

“There must be more measures in place to protect nurses and midwives when they’re on the job, so their focus is on caring for patients, not the possibility of being violently assaulted.”

 A meeting of Blacktown’s NSWNMA branch called for changes to hospital security, including swipe-access locks on doors to staff-only areas.

Members also resolved to wear grey armbands for two days to highlight violence in the workplace.

Branch president Christine Boxsell said members earlier wore red armbands in support of ratios.

“This time we chose grey because black is worn for a death and we never want to have to wear that,“ she said.

“Grey armbands were worn by all staff classifications throughout the hospital – nurses, doctors, allied health, cleaners, everyone.”

Access exists to items usable as weapons

Christine joined NSWNMA officers in a safety inspection following the attack.

The inspection identified improvements needed in access to staff-only areas, duress alarms, ward design, access to the emergency department and after-hours access to the whole hospital.

General Secretary Brett Holmes conveyed the inspection team’s findings in a letter to Western Sydney Local Health District.

Brett said it was good to see that electronic swipe access was being installed on the staff tearoom door at the time of the inspection.

However, he wrote, patients could access other areas of the hospital without lockable doors to obtain items such as knives, scissors and needles that could be used as weapons.

Also, doors with appropriate locks were propped open and staff toilets did not have measures to ensure staff-only access.

At the time of the inspection, ward B35 had two fixed-point duress alarms at the nurses’ station and medication room and one personal duress alarm.

“There was no clear understanding from staff in the ward about the circumstances in which the personal duress device would be worn or who should wear it, with the result being that it appears to sit in a drawer.”

Brett said the assaulted nurse was unable to access a duress alarm and it was fortunate that another nurse was able to use the duress alarm in the nurses’ station in order to call for help.

In addition, there was no indication to the person operating the alarm that it worked when they pressed it.

Anyone can enter most wards at any time

These and other failings fell short of standards set out in mandatory NSW Health policy.

Christine Boxsell told The Lamp that swipe access had since been installed on the B35 staff room and main hospital dining room.

However, the fire exit door was able to be accessed from outside and, due to renovations, access to the ED was now through the main hospital entry, which is unlocked 24 hours per day. That means anyone could access most of the wards at any time.

Christine said all nurses in B35 had been issued duress alarms following the union safety inspection.

“We had another episode in B35 the other day when a patient pulled a nurse by the hair.

“She immediately activated her duress alarm and security came straight away.

“That’s an improvement, but we don’t know if and when nurses in other wards will be given personal alarms.”

The inspection team recommended the hospital investigate options to remove “entrapment points” in the ward such as the nurses’ station, which has only one entry/exit point. The inspection noted serious problems in the ED including the inability to remotely lock it down, lack of secure staff areas, patient access to items that could be used as weapons and staff not wearing duress alarms.

Lockers provided for ED staff were too small, resulting in bags being kept on the floor, which posed a trip hazard.

This was a breach of the Nurses and Midwives’ State Award, which provides for “a full-length locker fitted with lock and key or other suitable place for the safekeeping of clothing and personal effects”.

Christine said Blacktown Hospital’s director of nursing and midwifery told the branch that management were working on an “action plan” in response to the safety inspection recommendations and would communicate the results to the branch.

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