The ins and outs of staff safety
The ins and outs of staff safety
Agency’s approach to staying safe
It is impossible to guarantee the safety of staff who make field visits. However, there are steps you can take to ensure that nurses don’t knowingly put themselves in dangerous situations, often enough to provide piece of mind and security to nurses.
Most urban providers use escort services of some type to serve this purpose. But choosing when to use an escort isn’t a cut-and-dry proposition. Ranging from the formal to informal, there are many ways to decide when your staff should use an escort.
The informal approach
One way is an informal approach, like that used by the South Shore Visiting Nurse Association (VNA) in Braintree, MA, which covers 37 communities surrounding Boston.
"We have nurse managers for each team that covers a different geographic location, so people get to know their area very well — right down to the streets, the apartments and the clientele," says Mary Walsh, RN, CRNI, and the home infusion nurse manager for South Shore VNA. "We can pretty much pinpoint where we think a problem could arise."
South Shore VNA has a distinct advantage. Because it is owned by South Shore Hospital, one of the benefits is that the VNA has access to the hospital’s security department. When a nurse is slated to visit a high-risk area, Walsh simply requests the use of the services of one of their security personnel (public safety officers).
Walsh is quick to point out that there is no permanent listing of areas where an escort is required. Instead, the decision when to use an escort requires direct and indirect feedback from many areas. One reason for not permanently naming areas as high risk is because of the constant evolution of most communities.
"Clientele in an apartment building can change. While there may be suspicious persons or activity around an area in the summer, during the winter, no one is around because they are all inside," says Walsh. "Variables like that really change whether you need an escort service or the nurse follows personal safety measures." (See South Shore VNA’s Personal Safety Measures, pp. 78-79.)
Such intangibles require the VNA to look at its list of high-risk and safe neighborhoods each quarter to evaluate that areas are properly identified. Walsh notes that there may be a high-risk area in a safe community or vice versa.
"Although we review this once a quarter, what constantly happens is nurses go out and see something such as no lighting in the hallway of an apartment complex in a perfectly fine neighborhood," she explains. "The nurse will come back and identify the problem with the nurse manager on call and let us know it is a problem. The nurse manager then problem-solves to find a solution. We look at the whole picture on a quarterly basis, but every nurse is educated to constantly be aware of the safety issues surrounding the visits."
Do a drive-by
Walsh says that nurses are educated to do a general assessment of an area before each visit.
"We ask them to drive around and make an assessment," she says. "If they are not comfortable, then they should call the patient from their car phone and reschedule the visit."
When surveying a community, nurses are trained to look for the following criteria:
•Is there parking close to where they are making the visit?
•Do they have to use elevators rather than stairwells?
•Is there outdoor lighting so they can easily identify the numbers on the buildings? "We don’t want them searching for an apartment number, especially on evening visits when it is dark," Walsh says.
•Is there any suspicious activity?
At times, though, a particular apartment complex or street may be totally unfamiliar, so the instruction would be to err on the side of caution and use one of your most effective resources for information: the local police.
"We will sometimes call the local police department and tell them, We have to make a visit at this address and we’re sending a nurse. Would you recommend we use an escort?’" says Walsh. "We get their opinion, because they’ll know if it is a high-risk area."
Your local police department is good for more than a phone call though. Walsh once had an officer provide an inservice to her staff.
"We had the Norwood Police Department safety office come out," says Walsh.
"The safety officer talked to us about issues such as when to use Mace and the requirements to carry it. He was an outstanding educator and very knowledgeable."
It is impossible to send an escort with every nurse on every visit, but that’s not to say a lone nurse has to be an easy target. Walsh says there are a few simple steps nurses can take to dramatically reduce the chance of their becoming a victim of violence or abuse:
1."We don’t do any visits for a patient who has a gun in the home," says Walsh. "When we are in the home the first time, we ask about lethal weapons."
2."I teach my nurses to call their phone a cell phone, not a car phone, because it is not just for the car," says Walsh. "The cell phone is your connection to the outside world. Take it with you in your bag so you can call if you have an emergency. You may have to go into the bathroom or close the door while you are in the room with the patient, and those situations have happened to some of our nurses."
This is important even when a nurse has an escort.
Nina Elledge, CRNI, president of Access Professionals, a nurse consulting agency in Castro Valley, CA, says that escorts should not go inside a patient’s residence.
"They are not allowed to go into the home for confidentiality reasons. The security person will escort them to the door and then wait outside until the nurse is done with the visit. Or the nurse will call, and they will come back and come to the door and escort them out of the area," Elledge explains. "They communicate through cell phones and pagers so the nurse does not have to leave the confines of the living quarters without an escort if she does not want to."
3."We suggest that nurses keep a small flashlight in their bag to do a physical examination of their car before getting in by checking the back seat," says Walsh.
4."Take a look at the family dynamics, where especially in hospice situations there can be a lot of tension in a family," notes Walsh. "They should try and pick up on that and try not to get caught in any domestic violence situation."
The difficulty in remaining safe is that many nurses put their patient’s welfare above their own. But in the long run, that doesn’t help the nurse or the patient, according to Walsh.
"Nurses often find themselves caught in the middle because they want to help the patient. I find that nurses will generally put themselves in danger — either knowingly or unknowingly in the interest of the patient — but that’s not right."
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.