In 2020, independent academics from RMIT University and Deakin University conducted a study into the knowledge and adoption of the ANMF (Vic Branch) 10-point plan to end violence and aggression in private aged care facilities.
The study resulted in a report titled Worrying about being hit at work, which was launched at the ANMF OHS Conference held on Friday 18 March 2022. Its findings support what nurses and personal care assistants (PCAs) working in private and not-for-profit aged care facilities have been saying for years: the private residential aged care sector lacks the knowledge and skills – and sometimes the will – to prevent and reduce incidents of occupational violence and aggression (OVA) against staff.
Using a combination of quantitative and qualitative research methods, the academics conducted interviews with 60 participants (10 managers, 20 registered nurses, nine enrolled nurses, six endorsed enrolled nurses, and 15 personal care assistants), and received more than 800 survey responses.
Among their worrying, but unsurprising, findings, were that more than 90 per cent of respondents and interviewees had experienced physical violence including being hit, kicked, grabbed, shoved or pushed; over 70 per cent had been spat on or bitten, or had an object thrown at them; and close to half had been threatened with a weapon. Just under 90 per cent of nurses and carers had also experienced sexual harassment at work – including touching, groping, inappropriate comments or offensive jokes. Almost 100 per cent of staff had been yelled at or sworn at.
Misunderstanding of 10-point plan purpose
The study also found that among staff and especially management understanding about the purpose of 10-point plan was limited, at best; its implementation in facilities was therefore poor. ‘There was little understanding that the 10-point plan was a systematic preventative tool,’ the report concluded.
‘When an incident happens, we certainly don’t go and look at the 10-point plan to find out how to manage it,’ one manager said, displaying a fundamental misunderstanding of how the plan is meant to be utilised. ‘We don’t say “hang on a minute, stop punching, hitting, spitting while we look up the 10-point plan to see how to handle this.” It’s just not realistic.’
In actuality, the plan provides employers with the practical systems, processes and changes they must implement in 10 areas to prevent and reduce the opportunity for violence to occur in the first place. The 10 areas are:
- improving security
- identifying risks to staff and others
- including family in the development of patient care plans
- reporting, investigating and acting when an incident happens
- preventing violence through workplace design
- providing education and training to healthcare staff
- integrating legislation, policies and procedures
- providing post-incident support
- applying an anti-violence approach across all disciplines
- and empowering staff to expect a safe workplace.
10-point plan helps reduce and prevent OVA
Responding to the report, ANMF (Vic Branch) Assistant Secretary Paul Gilbert said it provides ‘further evidence of the dire consequences of the private aged care sector’s focus on understaffing to save costs. It’s unacceptable for nurses and personal care workers to be hit, kicked, bitten, spat on or threated by residents. Being hurt at work is absolutely not just part of the job and there are ways to manage and prevent this resident behaviour.’
The 10-point plan is a blueprint of those methods to manage and prevent resident, and resident family, violence and aggression. Significantly, the RMIT report found that implementation of the 10-point plan in workplaces, in combination with suitable human resource management (HRM) practices, was associated with lower levels of workplace violence, better staff mental health and improved quality of resident care.
Qualitative data findings
Among the key qualitative findings (in-person interviews) of the report are that:
- there is an overall lack of knowledge of the 10-point plan and subsequently poor implementation of the plan
- managers are more focused on financial outcomes and meeting minimum standards for accreditation than on implementing the 10-point plan or similar strategies to better manage and mitigate violence in private aged care facilities
- management seem to lack the knowledge, training and skills needed to systematically implement the 10-point plan
- there is a lack of training and development for nurses and PCAs across private aged care facilities
- there is a management culture of blame about why workplace violence happens, and often nurses/PCAs are held responsible
- all staff have experienced increasing incidents of workplace violence in private aged care facilities.
Unsurprisingly, the report also found that staffing ratios are inadequate, leaving staff unable to provide the level of care residents required and thus contributing to the incidents of workplace violence, from residents or from their families.
Quantitative data findings
Among the key quantitative (online survey) findings of the report are that:
- The 10-point plan mitigated the relationship between workplace violence on nurses’ and PCAs’ and mental health.
- Mental health problems were associated with burnout, which was associated with intention to leave and, interestingly, high quality of resident care. This is an important finding that suggests that nurses, irrespective of feeling burnout, still provide high quality resident care. However, they are more likely to want to leave their job to cope with mental health problems and burnout.
- The majority of respondents had experienced workplace violence at least twice and, more often than not, four or more times.
- There is a general lack of knowledge among nurses and PCAs of the 10-point plan.
The report’s primary recommendation is that private and not-for-profit aged care providers implement the 10-point plan to prevent occupational violence and aggression.
A secondary recommendation emphasises that appropriate human resource management plays an important role, and not just in implementing the 10-point plan. HR departments ‘need to take a lead role in providing systematic, formal and informal supports to mitigate the effects of violence on nurses and PCAs’, it suggests.
Appropriate HR support also includes greater training and development for managers – including around soft management skills, supportive and emotional leadership skills, and effective communication.
ANMF will use the findings of the report to encourage Victoria’s approximately 600 private and not-for-profit aged care facilities to implement its 10-point plan. It will also be used as evidence in enterprise bargaining negotiations to secure clauses that strengthen private aged care employers’ industrial and legal obligations and responsibilities to provide a safe workplace.
The plan has been included in the Victorian public sector nurses and midwives enterprise agreement since 2016. This EBA covers almost 180 public aged care facilities.
‘In 2022 private aged care employers should not still be blaming staff for violence when personal care assistants and nurses have no power to implement the systemic and structural changes required to make workplaces safe,’ Mr Gilbert said. ‘The practical information is there; we just need private aged care leadership to champion a significant culture and knowledge change to stop the violence.’