ABSTRACT: This article looks at how to identify – and deal with – the risks posed to you at work by members of the public. It does not cover risks posed by animals, equipment, chemicals and so on, nor does it cover bullying at work.
The Health and Safety Executive’s definition of work-related violence is ‘Any incident in which a person is abused, threatened or assaulted in circumstances relating to their work’
Veterinary nurses may find themselves in potentially violent situations owing to the nature of their work. Particular areas which may lead to violence at work are:
reception – asking for payment dealing with clients in consults home visits answering the telephone (‘phone abuse).
Why are we at risk?
There are a number of reasons why our working environment provides a potential risk.
Cash on the premises
We may be seen as a fairly easy option for robbery as we tend to have minimal security.
Drugs
We hold not only controlled drugs, but also a wide variety of other injectables and tablets which have a market value.
Client Emotionality
Clients may have heightened emotions when attending the practice because their pet is ill or may be injured, and there is the prospect of an unexpected account to pay. This may lead to their being more emotionally reactive, which can manifest itself in violence.
Clients being drunk or ‘high’ on drugs
Again, these conditions may lead to clients being more emotionally reactive than usual. Furthermore, social inhibitions limiting violent behaviour may be relaxed or absent.
Strategies and advice
Reading the situation
It is vital that, during an encounter, staff are aware of the danger signs which are common before physical violence occurs. ‘Violence at work (UK)’ states a series of likely stages preceding an attack (Table 1). People may display all or some of these behaviours.
To prevent a client who is displaying any of these warning signs escalating the behaviour to violence, immediate appropriate action must be taken.
Dealing with potentially threatening situations
1. Managing the situation
Unfortunately, some staff members may inadvertently inflame a situation by inappropriate body language, tone of voice and/or choice of words. The phrase, “Why do I always get the difficult clients?” by a staff member may in fact relate to inappropriate handling of conflict situations by that person.
Conversely, some people seem innately more adept with difficult clients than others. These people will be using some or all of the following techniques to diffuse the situation.
Remain calm, polite and professional at all times. Introduce yourself and use a soft, calm tone of voice. Do not rise to insults or criticise. Do not argue. Stay in control, be assertive (that’s not the same as bossy).
Empathise with the person’s complaint (“Yes, I can understand why this has made you angry.”)
Listen to the client and try and find a solution to his or her problem. Apologise for any errors made.
Ensure you understand exactly why the person is angry or upset. Confirm with him or her that you understand their complaint. Don’t patronise or appear to lose interest. Use positive body language (head nodding, for example), not negative (such as head shaking or eye rolling).
Resolve any issues that you can at the time, even if this is just a part resolution of the whole problem.
Devise a solution if possible, confirming with the client that he or she understands and is happy with this course of action. Importantly, do not stand directly in front of the person; and keep your distance (avoids their personal space and makes you less easy to hit!). Do not look away from the person – an attack is more likely then.
2. Pass to someone senior
If you are unable to deal with the problem, then offer the client the option of speaking to someone more senior/experienced with these situations. If this cannot be done at the time, then offer the client the option of being telephoned, or of their writing a letter of complaint to the relevant person.
If the client wishes to take a complaint further, explain the options to them, including a complaint to the Royal College of Veterinary Surgeons (RCVS).
3. Escape
If the above measures are not calming the situation, the threat level escalates and you fear for your safety, then leave.
Dealing with an actual attack or threat of violence
Fortunately this is a very rare situation.
Try and stay calm.
Get away from the situation if possible (run), do not waste time and energy trying to fight back or restrain an attacker. This prolongs the attack and may increase injury.
If threatened with violence do not attempt to withhold whatever the attacker wants – cash or drugs, for instance.
They can be replaced … you can’t.
Do not under any circumstances go anywhere with an attacker. You have advantages if you are in a familiar environment. Serious harm can be inflicted if you are taken somewhere of the attacker’s choosing.
Contact the police as soon as possible.
Home visits
Care should be taken seeing clients away from the practice.
Take a mobile telephone with you.
Ensure someone knows where you will be going and when you are due back. Arrange for someone to call you if you do not check-in with them.
Preferably don’t go alone, and certainly not if the client is unknown or you are unsure.
If you feel there is a risk to your personal safety, don’t go (or leave, if already on the visit).
Employer’s responsibilities
There are a number of pieces of legislation concerning violence at work:
1. The Health and Safety at Work Act, 1974.
2. The Management of Health and Safety At Work Regulations, 1999
3. The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR), 1995
4. Safety Representatives and Safety Committee Regulations, 1977 (a) and The Health and Safety (Consultation with Employees) Regulations, 1996 (b).
In summary, this legislation states that employers have a responsibility to try and ensure the safety of their workers, including conducting risk assessments and consulting with employees concerning matters affecting their Health and Safety. Also, appropriate notification must be made in the event of a serious incident, including acts of violence done to a person at work.
Conducting risk assessments
Every practice is different and will have different risk levels and areas of concern. Input regarding risk should be obtained from all staff members and detailed records regarding any incidents that occur should be made.
Examples of areas to consider could be: taking payments wearing name badges de
aling with angry clients working alone/at night telephone abuse.
Devising and implementing protocols
Developing protocols to manage (reduce) risk will enable staff to have a strategy in place if they find themselves in a threatening situation. Staff training regarding these protocols may be appropriate.
Thought should also be given to the design of rooms to allow staff the opportunity to use furniture, such as consult tables, as barriers between themselves and threatening clients. Room layout should ensure that clients do not stand in front of the only exit, so that escape can easily be made by staff if necessary (Figure 1).
Figure 1: Rooms can be designed so the consult table is situated between the staff member and the client, and an exit route is easily accessible
It can be helpful if other staff members are within sight of you when dealing with difficult situations, just in case of problems.
Additional security features
Obvious use of security features can help reduce violence against staff, especially so if violence is theft motivated. The police will often be willing to give advice on security issues and this may include the use of:
CCTV cameras alarm systems
signage advertising the fact that security systems are in use (Figure 2) security lighting
Figure 2: Signage advertising the fact that security systems are in use
personal alarms for staff to carry (Figure 3)
Figure 3: A personal attack alarm
security doors using keypads to gain entry from, for instance, public to hospital areas buzzers to control front door entry security staff, if the risk is deemed to warrant this.
Victim support
It is vital that adequate support is given to victims of violence at work – and maybe also other worried staff uninvolved in the incident – by management and colleagues, if distress is not to be further increased. This may include time off work and the option of talking through the incident with a colleague or trained counsellor.
Further support can be obtained from the following organisations:
BVNA, www.bvna.org.uk or 01279 408644
Conclusion
Improving personal safety at work can be achieved by a combination of awareness of the issues involved, assessment of the risks of a particular workplace, devising appropriate protocols and adequate training of staff.
It is, however, the responsibility of every employee to look after his or her own personal safety and not assume a blase attitude to this area. Although incidents of violence at work are, fortunately, very rare, a little forethought and planning will help you deal with them if they happen to you.
Author
Jenny Thompson
BSc(Hons) RVN DipCABT MBVNA
Before starting her veterinary nurse training, Jenny worked as a police officer for North Yorkshire Police, and was based at York. She started her VN training in 2000 and now works as head nurse, student nurse trainer and assessor, dog/cat behaviourist and E-SQP at a small animal and equine practice in Surrey. Jenny currently sits as an elected member on the RCVS VN Council and has recently gained a position on the new VN Preliminary Investigation Committee.
References and further reading
Violence at Work (UK), www.Violenceatwork.co.uk Crimestoppers, www.crimestoppers-uk.orc Criminal Injuries Compensation Authority www.cica.gov.uk
Health And Safety Executive, www.hse.gov.uk Safe Workers, www.safeworkers.co.uk Suzy Lamplugh Trust, www.suzylamplugh.org
Veterinary Nursing Journal • VOL 25 • No6 • June 2010 •