Violent resident puts nurses at risk

A situation involving a violent resident with complex needs at a rural nursing home has highlighted the risks facing staff and other residents at aged care facilities.

Members of staff at a private aged care facility in rural NSW were placed under mental stress and at risk of physical harm when a resident with complex and acutely challenging behaviours – including violent outbursts – was admitted to the facility.

The resident was one of the small percentage of people under 50 who are in nursing homes because there is nowhere else to put them. She had a history of violence – including assaults on nursing staff at a previous aged care facility – and the receiving facility was not suited to high, complex care of this kind.

‘The true extent of her challenging behaviour was not made clear, but the facility was at fault because it had an admissions policy that was inappropriate for the care needs of that resident,’ said NSWNA Assistant General Secretary Judith Kiejda. ‘She was aggressive towards staff and residents most of the time, and had a number of major violent episodes. She created a sharp weapon and on one occasion it took several police officers to restrain her.’

With no duress alarms available or a duress response plan in place, no safe havens, and no staff with the level of training required to care for a resident with such acute needs, the impact on nursing staff at the facility was severe.

The local NSWNA Branch at the facility initially approached management with their concerns, then the Union’s OHS team became involved and did an assessment of the entire situation.

After yet another major violent episode, the resident was eventually transferred to a public sector facility with a high-care mental health unit more suited to her needs.

‘These kind of facilities are very safe for residents because they can’t get weapons, and cutlery counts and other such measures are carried out,’ said Judith. ‘The staff are specifically trained for acute care and that’s not what happens in aged care. Aged care facilities usually have just one RN for the whole place and the rest will be AiNs or ENs.’

The NSWNA made recommendations to management as well as lodging a formal complaint with WorkCover. As a result, duress alarms are now in place at the facility. ‘We are still waiting for them to do a duress response plan,’ said Judith. ‘Management has said it will employ security personnel to provide after-hours support on a needs-be basis when the police aren’t as readily available. The facility has also changed its admissions policy so it does not take in residents it is unable to properly care for.’

What to do if you’re experiencing violence and aggression at work

It is the responsibility of staff to report risks to management, and both the NSWNA Branch and the OHS Committee should be involved. Workplace violence is grossly under-reported by nurses, but you have an obligation to report. ‘Not only is it in your best interests but it’s also in the best interests of other residents as they can be injured as easily as nurses,’ said NSWNA Assistant General Secretary Judith Kiejda.

If reporting your concerns to management doesn’t lead to satisfactory outcomes, contact the NSWNA. ‘We have the expertise, and we can intervene on behalf of our members to assist them to resolve OHS issues and to achieve safer and healthier workplaces. Protecting the confidentiality of our complainants is always of the highest priority in our dealings with the industry’, said Judith.

OHS problems in aged care

This case highlighted significant areas of concern, not only at this particular facility, but in most OHS cases that NSWNA officers investigate in aged care workplaces:

  • The design of many aged care facilities is inadequate for the needs of high-risk residents. For example, there may be many areas where nurses can be trapped, with no escape route or safe haven.
  • Duress equipment is often unavailable or unsuitable.
  • There is no written duress response plan formulated to inform regular and temporary staff of what should be done in this type of emergency.
  • In country areas, support services for duress response such as police are often not available because of the time it takes to get there, and some police stations close at 10pm or midnight.
  • Lack of self-defence training for nursing staff.
  • Lack of staffing and inappropriate skill mix increase the risk of injury arising from violence/aggression risks.
  • Inadequate or inappropriate admissions policies can result in admission of residents whose complex needs cannot be safely met by the receiving facility, often placing staff and residents at risk of violence.