Managing patient and client aggression

A female doctor of Asian descent listens to her elderly female Caucasian patient tell her about the problems that she has been having, both mentally and physically. The doctor takes notes so she can properly diagnose her.

Workplace aggression is a common occurrence in the health and community services industry. How employers understand and manage it has important consequences for workers, patients, clients and the public.

Aggression and its impacts

Work-related violence and aggression includes "any incident in which someone is abused, threatened or assaulted in circumstances relating to their work." [1]

Aggression and violence are not easily defined. It's better understood as a spectrum – ranging from rudeness and eye-rolling, through to hateful comments including racist slurs and derogatory remarks, all the way to life-threatening physical aggression. Aggression can also be disguised as passive aggression.

Aggression can be a response to stress and difficult emotions such as fear, frustration, anger and anxiety.

Some of us are fortunate enough to have the skills to cope with these feelings in a way that doesn’t require aggression – others may struggle with this.

People's minds and bodies are affected by any kind of aggression – whether we have a visible injury as a result or not. The impacts are even more profound when this stress builds up over time.

Aggression in the health and community services industry

People working in health and community services serve their patients, clients and the public every day. However, patients and clients can sometimes be aggressive for a range of reasons, including:

  • acute or chronic pain or stress, including from life situations such as poverty and homelessness
  • a physical disorder, such as drug or alcohol withdrawal, stroke, head injury or Alzheimer's disease
  • side effects of therapeutic medications; and
  • mental health issues.

Some of the aggressive colleague and customer behaviours workers may encounter include: [2]

  • verbal threats, intimidation or harassment
  • spitting
  • physical assault
  • throwing objects and projectiles
  • damaging property
  • being disruptive and non-cooperative
  • substance abuse; and
  • bullying and violence.

Aggressive behaviour can happen at any time of day, and the effects can be worse when workers experiencing aggression are isolated.

What can employers do?

Research commissioned by icare in the retail industry has found four areas of opportunity for employers to take action on workplace aggression: [3]

  • modifications to physical aspects of the workplace
  • increased workplace support
  • specialised and focused customer-service training, and
  • incident reaction training. 

Physical interventions should be tailored to the workplace, and might include things such as security buttons for medical staff working at night in hospitals.

Equally important is ensuring employees are supported in a broader sense through providing adequate training and organisational support structures.

Customer service training should focus on understanding aggression, its impacts, how to practise empathy and de-escalation, where to draw the line, safety, and self-care. 

It is recommended that employers track three key metrics of change to monitor the effectiveness of any interventions to reduce workplace aggression:

  1. Frontline service employees' experience of customer abuse
  2. Employee markers of change; and
  3. Organisational markers of change. 

As part of any intervention, it’s vital that people in the workplace support each other. The impacts of stress are worse when people feel isolated. Employers can encourage a healthy and supportive work culture with a top-down as well as bottom-up approach within their organisations.

Proper community messaging should also be used to educate the public on a zero-tolerance approach to aggression. This messaging approach should emphasise something that we all know but sometimes forget: that your nurse or the person assisting you is a person with feelings, just like you and your loved ones.

References

[1] A-Z of work hazards, violence - Safe Work NSW

[2] Managing difficult passengers - Bus Safety Victoria

[3] icare (2019), Respect and Resilience in Retail and Fast Food, on our Publications page. This pilot project drew on data from the retail and fast food industries, and many findings are also relevant for other service industries, such as health and community services.

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