Self-employed or agency nurses often deal with a wide range of activities and locations, often working remotely, which can pose a threat to your personal health and safety.
These type of risks are often enhanced while you are lone working, due to the lack of immediate support of colleagues or security personnel which exist in a typical medical centre environment.
Whether you are working alone on an overnight shift in a care home or conducting personal in-home client visits, hazards such as physical violence, verbal abuse, sexual harassment, accidents and emergencies are a major concern.
Agencies and/or employers need to be aware of these risks and implement measures and policies to control and reduce them. Failure to provide adequate protection to those working under your instruction could result in employers’ liability or professional negligence claims under your Nursing Agency Indemnity Insurance policy.
Think Health and Safety
Employers, and in some cases, staff agencies, are responsible for the health, safety and welfare of all of their employees, including nurses working remotely.
An employer has a duty to assess the risks of all their workers and contractors and take steps to avoid or control risks where necessary. Should an agency place a nurse without assessing the risks appropriately and a nurse suffer injury, you could be held negligent and face compensation claims.
The critical area of consideration for both medical employers and staff agencies is the completion of appropriate risk assessments. This should include a general risk assessment for overall risks and individual risk assessments if you are aware of patients who pose a particular risk of violence or aggression.
In terms of general risk assessments, employers or agencies you should consider:
- General risks to the workers from patients, service users, relatives or visitors
- The risks associated with the design of the work environment, including the layout of rooms, alarm systems, access to car parks and other potential hazards
- Specific risks associated with lone medical workers, whether community-based or in a fixed medical centre location
For individual roles the risk assessments should include:
- The mental, emotional and physical condition of the individual(s) being treated, including stress levels
- The effect of medical conditions or ingestion of drugs, alcohol or medicines on the individual(s) condition
- The individual(s) history of violent or aggressive behaviour
Once risk assessments have been completed, these should be regularly reviewed and updated while ensuring that any recommended safety measures and additional control measures are being implemented.
Independent Working Policy
Lone or independent working policies should also be created based on the risk assessments, and all lone working nurses should be trained and fully aware of them. These policies should include clear guidance on safety and how to advise on responding to certain hazardous situations.
Supervision and training should include how to manage patient aggression and violence, including conflict resolution and the use of any provided personal safety devices. Agency workers should receive periodic training refreshers to update their skills.
#1 Incident Reporting
Incident reporting procedures and contacts should also be laid out clearly in the independent working policy, including reporting for "near misses". All “incidents” and “near misses” should be reported as soon as possible so any necessary actions can be taken, such as contacting the police or sharing information about a particular patient with other agency staff or employees, as well as your client directly. Employees/agency nurses should be properly debriefed on incidents and receive appropriate post-incident support as needed.
#2 Violent and Aggressive Behaviour
Violent and aggressive behaviour is one of the major concerns for nurses and agency workers working in the care sector. Actions such as biting, punching and shouting can come from any patient or third party, particularly if the individual is confused or frightened, or has mental or learning disabilities. Training nurses and agency staff to be prepared for violent incidents will not only help them avoid potentially dangerous situations, but it will also encourage their confidence.
All remote working nurses and agency staff who may be involved in an aggressive incident should receive a basic level of training that covers the following:
- Different causes of violence, including mental instability, impatience, frustration, anxiety, resentment, alcohol and drugs
- Recognition of warning signs that can lead to violent or aggressive behaviour
- Relevant verbal and non-verbal interpersonal skills
- De-escalation techniques
- Local working practices, control measures and incident reporting procedures
Agencies and employers also need to consider the specific needs of the actual work activity; for example, if a care worker or nurse is caring for someone with dementia, specific dementia awareness training should be included as well.
#3 Individual Safety Solutions
There are a number of key systems and procedures which are available to help agencies to manage remote working safety. Each has specific advantages and disadvantages, as such best practice is to develop your own system that fits your overall risk management framework.
#4 Mobile Phone Management
A dedicated mobile phone system can allow nurses to check in with employers or to leave a message on a central computer system with details of a specific visit and the time the visit will take place. Once the visit is completed, the worker will call back to check-in. If the worker does not call in, the computer system will alert the employer, as well as the police if no one can be reached.
Some disadvantages of using a mobile phone system include that it may require a 24-hour receptionist, and that mobile phones are rarely useful when someone is physically attacked.
#5 Personal Alarms
The use of personal alarms can be a good tool to shock and disorient an attacker, allowing the nurse to gain a few extra seconds to get away in a physical attack. Some aspects to consider when choosing a personal alarm include the type of sound it emits, the duration of the sound and the ease of use. The sound needs to be loud enough to actually shock the attacker—at least 130 decibels.
The sound should also be continuous and differ from typical sounds such as car alarms. The alarm should be easy to use, and preferably something that can fit in the palm of the hand. However, activating an alarm does not mean help will arrive. There might not be anyone within earshot, or people may ignore it.
Consider the work environment your remote worker is in when deciding if a personal alarm is appropriate. Still, if they are working in dark or remote areas, it can provide peace of mind and additional safety.
#6 Self-Defence Training
Remote workers and those working in potentially hazardous conditions may benefit from self-defence training or a legal self-defence spray to use in the event of a violent incident. However, before proceeding to offer this, agencies or employers should realise that there is also the potential that it could escalate violence, placing both the nurse and the patient at greater risk of injury.
Liability issues should also be considered if excessive or unnecessary violence or force is used. Strict policies and training governing the use of self-defence tactics should be in place.
#7 System Flags
Agencies and clients can use a flag system, where potentially violent patients are ‘flagged’ as dangerous during individual risk assessments, and recommendations of who can care for this person are put into a system.
If a patient has a history of aggression towards a certain nurse or demographic, such as females or young workers, using an accompanying care worker or an alternative member of staff may reduce the risks. However, there may be times where accompanying workers are unavailable or a violent incident may occur regardless of patient ‘flags’. Therefore, appropriate training and other systems should also be in place to minimise risk and reduce indemnity exposure.
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