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Anti-social behavior

August 29, 2005 -- Recent press articles in the U.K. and the U.S. have highlighted the ongoing physical security risks faced by nurses working on the front lines of health care. Today the BBC published an unsigned piece, "Rise in charges over NHS assaults," reporting a large increase in prosecutions of those who assault National Health Service staff. A short unsigned Associated Press piece published on August 21 in the San Jose Mercury News, "Newspaper: Psych nurses ask for additional security," reported that nurses are calling for heightened security after a "spate of attacks on employees" at the Contra Costa Regional Medical Center's inpatient psychiatric unit.

The BBC piece reports that U.K. Department of Health figures show a 15-fold increase in prosecutions of assaults on NHS staff in 2004-2005 over 2002-2003, following recent security measures. These measures include a "national reporting system to track repeat offenders," a "Legal Protection Unit" to ensure prosecutions are pursued, and a network of "Local Security Management Specialists to investigate alongside police." Health Secretary Patricia Hewitt welcomed the increase in prosecutions, which she admitted also revealed the extent of the underlying problem. The piece cited the examples of a life sentence given to a man who had stabbed a nurse at a York Hospital--even though the nurse had suffered only "minor lacerations"--and an "anti-social behaviour order" against a man who had "verbally or physically assaulted NHS workers 47 times in five months." The Royal College of Nursing (RCN), however, cautioned that the 2002-2003 figures indicated that only 2% of the "violent or verbal assaults" reported to police had been prosecuted. RCN England Director Tom Sandford was quoted as saying that the political will to tackle this problem was there, but that much more can be done. He seemed to link the new security measures to efforts to ease the nursing shortage, noting that "[w]e should be doing everything we can to recruit and retain nurses--nurses who feel secure and valued can then get on with the job of caring for patients without worrying about being attacked." Indeed, it seems clear that clinical care suffers in atmospheres where nurses are not secure.

The AP piece noted that the Contra Costa County Times had reported that 20 employees at the Contra Costa Regional Medical Center were injured in assaults last year, compared to eight injuries in 2003. The paper cited seven "violent incidents" through May 2005, including an attack "where a patient told he would not be discharged hit a nurse, knocking her unconscious." County officials have reportedly issued to each employee a "hand-carried alarm resembling a pen" that "will be activated if it is clicked or thrown on the floor," but some nurses are "even pushing for uniformed security guards to monitor" the psychiatric unit; currently, these guards "patrol the hospital, and often help the psychiatric unit." The California Nurses Association's Joe Schuman is quoted as saying that the nurses are "scared" and many are "ready to go somewhere else"--seeming to confirm the RCN official's linking of security with the shortage. However, the piece notes, some psychiatric unit employees want to avoid a "jail atmosphere." Physician Richard Gurley is quoted as follows: "We're a hospital and these are patients, and we work to treat them with the tender, loving care that we would want our family members to be treated with."

Assuming that Dr. Gurley intended his comment to express opposition to the nurses' requests for the additional security measures, as the piece clearly indicates, we would note that most physicians are not well placed to lecture nurses about the difficult issues in balancing security and humane care, since nurses spend far more time with violent patients. And because nurses generally handle such patients with little help from physicians, nurses are far more likely to be assaulted. Moreover, to phrase such a lecture in terms of condescending cliches about "tender, loving care" seems especially unhelpful in the context of such a rapid rise in serious assaults. In fact, as noted above, nurses who do not feel secure may have trouble providing good physical care--e.g., saving lives--to say nothing of "tender" or "loving" care. And it is not clear how the mere presence of security personnel at a given unit would interfere with care. In any case, the AP piece might have benefited from some response from the hospital management as to the nurses' concerns.

The Center thanks the BBC, the AP and the San Jose Mercury News for covering these important issues.

See the BBC piece "Rise in charges over NHS assaults" in its August 29, 2005 edition and the AP story "Newspaper: Psych nurses ask for additional security" in the August 21, 2005 edition of the San Jose Mercury News .

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