Providing an alternative to zero tolerance policies

Abstract

Until recently, workplace violence and aggression in health care had received little attention. Today, however, there are concerns about growing levels of violence towards health-care workers and in particular nurses. The government is now steadfast in tackling workplace violence and helping NHS staff to apply a zero tolerance approach to reduce risk and ensure the welfare of their employees? This article highlights the issues regarding the application of zero tolerance policies and principles to practice. It looks specifically at the consequences of excluding patients from primary care services and in particular at a scheme that has been set up by one general practice to provide an alternative GP service for patients within the Heart of Birmingham Teaching Primary Care Trust. Initial evaluation of this initiative indicates that patients are being successfully rehabilitated back into the community and suggests that further research is urgently needed to draw conclusions about this project, as well as similar health care services that endeavour to prevent and deal with unacceptable and aggressive behaviour in the workplace.

At the crossroads of violence and aggression in the emergency department: perspectives of Australian emergency nurses

“…For example, if a person with a head injury initiates violence, a zero tolerance policy would result in that patient being asked (3.25) to leave the department, potentially resulting in patient harm. 24,32,33 In light of these challenges, it has been suggested that rather than a single 'one size fits all' zero tolerance policy, EDs should consider implementing proactive policies that encourage a safe environment, free from violence, and encourage a culture of reporting. 24 Such policies should take into account underlying health concerns and be aimed at the early recognition and prevention of violence.…”

Patient-related violence at triage: A qualitative descriptive study

“…A Zero Tolerance policy has been adopted by the National Health Service in the United Kingdom, where staff have the power to impose sanctions on the perpetrators of violent episodes (Paniagua et al, 2009). However to date there is little evidence to suggest that this approach has been successful in either altering the public's perceptions of the acceptability of violence towards nurses (Paterson et al, 2008) or in reducing the prevalence of violence in healthcare settings (Paniagua et al, 2009).…”

Workplace violence: A call for action

“…While a zero-tolerance policy has been shown in the law enforcement sector to reduce criminal recidivism rates, transferability to health care settings must be modified. The United Kingdom (U.K.) National Health Services implemented such a policy to reduce violence against staff by establishing relationships with law enforcement and prosecutorial services in order to tackle violence and prosecute offenders when indicated [20] . The U.K. government views those patients who commit violence against health care providers infringe on the providers' human rights.…”

“…Resultantly, perpetrators may be denied care due to violent actions. However, refusal to care for patients is being questioned nationally due to its ethical significance [20] . The blanket application of a zero-tolerance policy is difficult, because the definition constituting WPV is not consistently interpreted and some perpetrators are deemed as not accountable for WPV due to their mental state.…”

“…The blanket application of a zero-tolerance policy is difficult, because the definition constituting WPV is not consistently interpreted and some perpetrators are deemed as not accountable for WPV due to their mental state. In recognizing this, the U.K. National Health Services prohibits the withdrawal or denial of care in cases of patients who are mentally ill or under the influence of alcohol or drugs [20] . The Australian Health System also has a zero-tolerance policy.…”