Covid drives increased aggression in NHS

‘More and more of our trainers are reporting that their delegates witness and experience aggressive behaviour at work,’ says James Crown, who leads the NHS training team at UK specialists, IKON.

‘It appears that the stress of coronavirus is bringing out the very worst in people at a time when it matters most that behaviour is under control.’

NHS trusts across the country go to specialists like IKON for training courses that help their staff manage challenging behaviour from patients, visitors and other staff. Conflict resolution skills are a requirement for NHS ‘Skills for Health’ standards.

The increase in challenging behaviour is a worrying one for all concerned and IKON is not alone in recognising it.

Back in March, during the first national lockdown, the Nursing Times featured a front-page report highlighting the abuse facing frontline nursing staff

Susan Masters, director of nursing, policy and practice at the Royal College of Nursing, revealed on social media that community nurses were being “heckled” by members of the public worried about Covid-19.

She wrote on Twitter: “I am speaking up for nurses and nursing in every possible setting.

“Today I heard from community nurses that they are being heckled at and verbally abused in the street and called ‘disease spreaders’. This is abhorrent behaviour, it must stop.”

Although it will be some time before the scale of the increase in challenging behaviour is properly understood, the accounts of it have been unsurprisingly accompanied by reports of nurses leaving the profession and of medical staff across the board facing mental health challenges.

James Crown says that, not only are NHS staff speaking about increases in aggressive behaviour at work, many are attending training sessions and showing clear signs of struggling to cope,

‘We’re seeing staff in our sessions who are clearly struggling with the continued demand and pressure at work. Some are visibly upset during the sessions even before they start.

NHS staff are also having to face challenging behaviour over the phone from people who are angry that the Coronavirus restrictions don’t allow them to visit their relatives.

‘We can all relate to the frustration that comes about when you can’t visit a loved one,’ says James Crown. ‘The trouble is, people are taking that frustration out on the staff who answer the phone. There’s a lot of unnecessary anger too from people whose non-urgent appointments have been postponed. Being subjected to anger and abuse over the phone is upsetting and wearing. It’s not something that anyone should put up with without support.’

Jason Keeley, IKON’s Managing Director, has spent years investigating the triggers that lead people to behave in a challenging or aggressive manner;

‘In many ways, the pandemic has provided the perfect storm for people who find it difficult to manage anger and frustration. In the early stage, particularly, no one really knew what was happening with the result that there was a lot of fear and uncertainty, even without the impact of the virus itself.

Now that fear has been accompanied by isolation and frustration about not being allowed to do what you want. We know that fear makes some respond by lashing out and frustration is only going to exacerbate that.’

Specialist conflict resolution training, such as that provided by IKON, aims to give NHS staff the tools they need to resolve conflict in a way that is safe for all concerned.

‘Of course, it’s better for everyone if conflicts can be resolved before they morph into more challenging behaviour,’ says Jason Keeley. ‘No one wants to waste valuable NHS staff time dealing with aggression or unnecessary physical incidents.’

Specialist training, designed to help NHS staff to recognise and resolve potential conflicts, is intended to be one of the tools used by the NHS to de-escalate challenging behaviour.

‘It’s impossible to escape aggressive people entirely,’ explains Jason Keeley, ‘what the right training can do is teach staff how to deal with such people, de-escalate challenging situations and by so doing, keep everyone safe.’

NHS commissioners need to be sure that the training provided to staff is compliant with national skills measures and also that it communicates the legal and reporting responsibilities to participating staff.

Everyone hopes that, once the effects of Covid are properly understood and once a vaccine is available, people’s lives will be able to return to more-or-less normal. Hopefully, this will remove some of the trigger points from people who are prone to aggression.