Tidal wave of hospital assaults
Nurses and DHB staff are being attacked and abused at an unprecedented level, data shows. Andre Chumko, Thomas Manch and Felix Desmarais report.
It was Boxing Day, and Lily Smyth waited drunk and angry in the wha¯ nau room at Hutt Hospital. The mental health crisis team was not on hand. An agitated Smyth, 28, picked up a childsized table and threw it at a nurse before landing punches on three others.
Judge Mary O’Dwyer would later label it a ‘‘rampage’’ in court. The nurses were concussed, seriously bruised, and still require treatments for head injuries, six months later.
Attacks on hospital staff have reached something of a crescendo in recent weeks, with stories of nurses and security guards being broken and bruised.
The sharp end of the abuse, in cases like Smyth’s, has been attributed to a mental health crisis spilling into wards: people are left to reach crisis point and be delivered to poorly equipped nurses in under-resourced wards. But the full picture reveals a spectrum of abuse faced by health workers. Data obtained by Stuff under the Official Information Act shows more than 10,000 incidents of physical, verbal, psychological, sexual assault and abuse across district health boards (DHBs) over the past four years.
Canterbury DHB had some of the most sobering figures, with 2383 recorded physical assaults, 1450 verbal abuse incidents, and 380 psychological harm events between February 20, 2016 and February 20, 2019. This equates to two physical assaults a day.
The DHB’s director for planning and funding, Carolyn Gullery, says staff work hard to maintain a safe environment and are encouraged to record all incidents of violence and aggression.
In 247 of the physical assaults for that period, injured staff had to receive medical treatment, she says. Those incidents were later accepted as ACC work injury claims.
In Taranaki, the data details staff with bruised body parts, swollen hands, ‘‘crush’’ injuries, skin tears, ‘‘persistent ringing’’ in ears and hearing loss, jaw contusion, stomach pains after being kicked, open wounds, and more.
Staff are reported as being ‘‘traumatised’’. In one incident in 2018, one was left with abdominal bruises, frontal haematoma and concussion. On the same day – September 30 – another staff member suffered a head injury, cut lip, bleeding nose, split upper and lower gums and back pains after a patient assault.
Anne Kemp, Taranaki DHB general manager for safety and environment, says: ‘‘Underreporting of verbal abuse,
threatening behaviour and assault incidents [does] occur.
‘‘The type of assault recorded varies, and includes, but is not limited to, pushing, shoving, spitting, throwing objects and liquids, hitting, slapping, punching, striking, kicking and biting. At times, we see an escalation in the number of incidents often involving specific patients.’’
Taranaki’s data shows most contributing factors to assaults are ‘‘patient’’ factors (including cognitive, behaviour, physiological/disease-related), social factors, work/ environmental factors, staff factors and communication issues.
The DHB is currently reviewing its security processes to ensure it is ‘‘doing everything that is practicable and reasonable in order to prevent physical and mental harm’’.
In Whanganui, staff have been attacked with crutches, had their groins grabbed and been slammed against a door frame. They have been punched in the head and face, and had nails dug in deep enough to leave bruising and grazing to the inner arm. They have also been spat on, had their fingers bent back and had urine thrown on them.
In three particularly bad incidents in 2016, a staff member suffered a needlestick injury after being kicked; a patient attempted to pull a staff member over a railing; and a patient slashed a staffer with razor blades.
Verbal abuse incidents within the DHBs ranged from abusive text messages to threats of violence, verbal abuse with racial or disability content, bullying and psychological harassment.
As Wairarapa DHB notes, ‘‘all inpatient areas can be susceptible to violent incident[s]’’.
Waitemata¯ DHB, which serves the largest population of any DHB, says there is a direct link between population size and the opportunity for aggression towards staff. ‘‘Employees deal with a broad cross-section of the community in their day-to-day work, and this often involves reaching out to people when they are at their most vulnerable and anxious, including those with mental health conditions, which can result in unpredictable behaviours,’’ human resources director Fiona McCarthy says.
Counties Manukau DHB chief executive Fepulea’i Margie Apa says many patients assaulting staff are ‘‘acutely unwell and/or in distress’’. She urges ‘‘caution’’ in interpreting the DHB’s data in comparison with others’, due to differences in reporting systems, and DHB sizes and services. Still, she accepts the reported incidents would ‘‘not be the totality of the cases where staff deal with aggression or verbal abuse’’ – in other words the tip of the iceberg.
SYSTEM REDESIGN REQUIRED
The four nurses assaulted by Smyth– who was sentenced to community detention and supervision – stood outside the Hutt Valley District Court and decried a lack of adequate security on June 10.
Duty nurse manager Nathan Clark, punched in the chest and jaw, was dissatisfied with the DHB’s response.
‘‘Increasingly nurses are dealing with more violence in our workplaces . . . It’s just a powder keg.’’
A review by Hutt Valley DHBremains unseen. The DHB declined a third request from Stuff for an interview, though it says the review will be released soon.
E tu¯ union security advocate Mat Danaher says it believes the most severe incidents occur when DHBs contract out their security services, leaving guards with inadequate training and equipment, and low wages for extremely long hours.
But more, and betterequipped, security staff may not be the answer.
New Zealand Nurse Organisation organiser Drew Mayhem says nurses increasingly face patients ‘‘prone to explode under stress’’, and a redesign of emergency departments is required.
‘‘If you have a look at the physical environment, it’s not being utilised to its best capacity.’’
For instance, he says, Hutt Valley Hospital has a doubledoor entrance into its emergency department, sometimes operated by a security staffer, but often left unattended and set to automatic – meaning anybody can walk through. ‘‘You can’t walk in and assault someone at IRD, or ACC, or walk into a bank. You would not be able to get that close to cause harm.’’
Also needed, according to Mayhem, are dedicated mental health staff in emergency departments, to help triage and de-escalate situations, and maybe a separate entrance for those in distress.
Platform Trust chief executive Marion Blake says DHBs need to invest in better community-based mental health services, so patients are not left showing up at emergency departments at crisis point.
‘‘The community services that did exist both in the Hutt Valley and in Wellington have been slashed . . . Guess what happens? They end in crisis in an emergency department. We’re not providing any alternative.’’
In Australia, some hospitals are piloting a model that sees distressed people, or those with addiction problems, enter through a separate door. Patients there are also supported by a mental health peer support worker – someone who has lived experience of mental illness.
‘‘You don’t solve problems by putting [on] more security guards . . . We’ve got to start solving these problems further upstream,’’ Blake says. ‘‘In a way, the recent Government inquiry into mental health said exactly the same thing.’’
THE POLITICAL RESPONSE
Health Minister David Clark says there is ‘‘no doubt’’ there has been under-investment in frontline mental health services. ‘‘That’s exactly why we increased DHB mental health funding in our first Budget by $200 million, initiated the Inquiry into Mental Health and Addiction the public called for, and responded with a $1.9 billion mental health package in the Wellbeing Budget.’’
That funding includes a further $213m over four years for more psychiatric nurses, and other DHB mental health services. ‘‘We’re also investing a further $200m in new mental health facilities, which means more places for New Zealanders who need inpatient support.’’
The mental health package includes $8m for improving the response to the roughly 15,000 people each year who present to emergency departments needing specialist mental health support. ‘‘That money will be used to strengthen the workforce to better respond to people experiencing a mental health crisis or who are at risk of suicide,’’ Clark says.
It should also reduce demand on police. ‘‘Increasing support to New Zealanders who are experiencing mental distress, or before they end up in the back of a police car, in the cells, or at a hospital emergency department, is better for everyone.’’