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Study finds flagging not the solution to ED nursing violence

By Karen Keast | Last Updated: 19-11-2013

Clinical nurse April Stanley-Banks

Nurses should not rely on ‘flagging’ for protection against violent attacks from emergency department patients, according to new research.

South Australian clinical nurse and University of Adelaide masters student April Stanley-Banks researched why nurses are flagging potential violent patients through the electronic reporting system, the Emergency Department Information System.

Ms Stanley-Banks said the flagging system, used in some public hospitals in the state, was only a warning system and not a solution to escalating levels of violence in EDs.

“Nurses were using the system for self-protection as it makes them aware of violence,” she said.

“Violence can make you hyper-vigilant and add stress.


we prevented violence from coming into the department then nurses wouldn’t be so vulnerable.

“There has to be some other means of preventing violence from coming into the ED and nurses feeling safe at work.”

A nurse of 12 years, Ms Stanley-Banks worked at the Lyell McEwin Hospital for 10 years as one of the senior nurses in triage, and recently transferred to become a clinical nurse at the Modbury Hospital’s acute assessment unit, now being established.

Ms Stanley-Banks said she experienced verbal abuse on a daily basis working in ED.

“Although it’s sad and demeaning it’s something that you endure but I have also been hit physically and been spat at,” she said.

“I was once hit by a young female patient in the face, displacing my jaw and putting it out of joint.

“I have been exposed to patients who have had concealed weapons and been threatened with syringes.

“I have also been exposed to bomb threats and threats like ‘I am going to kill you after you’ve finished work’.”

Ms Stanley-Banks said she decided to research the issue for her thesis after noticing a growing number of violent perpetrators were male adolescents, and became concerned about their health care response and also for the safety of nurses.

“The nurses, in an effort to protect themselves, were providing health care delivery that was a bit more peripheral because the patients were exhibiting violence,” she said.

“Some patients would leave before their treatment was complete.

“I was also concerned for the nurses exposed to this type of violence. Some of them were actually victims of violence themselves.”

Ms Stanley-Banks said nurses were expected to accept violence as part of their job.

“I was concerned because I didn’t think the issue was being addressed. People were just accepting it and going with the flow and making the best of it,” she said.

“There was also an accumulative effect on the nurses. I could see their attitudes were changing.

“There was security in the department or police in the department all of the time and it was more or less becoming a combat zone.

“We were accepting it as part of the job and I knew that that wasn’t right.”

The study outlined a series of recommendations, including regular evaluation and feedback of nurses’ reports of violence, developing training programs and policy for flagging, and considering the introduction of police officers to EDs.

“The nurses said they felt the clients don’t really fear the security guards who are there but have more fear of police officers who have the jurisdiction to implement the law,” she said.

“The nurses felt if they had a police officer in the department they would feel secure and safe.

“I also think there needs to be a consideration of making assaulting a nurse a felony.”

Ms Stanley-Banks said the nurses involved in the study wanted measures introduced to tackle the issue.

“It’s about time we started looking after our nurses because there’s an issue of nurse retention and recruiting new nurses,” she said.

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