Northern Health creates a safer workplace through assessing and controlling the risks of OVA to minimise harm and create a strong culture of care, and our workplace plays an important role in psychological health and safety.

Rachel Green, Ward 19 Nurse Unit Manager (NUM), shares with us how OVA risks in her ward were reduced by working together.

1. Please share difficulties you have encountered in managing violence and aggression on your ward?

At times, it can be overwhelming for me and the staff involved in an incident. The, toll it takes on my team, not only throughout the OVA incidents, but the aftermath, can be quite difficult. Once an OVA incident has occurred, staff begin reflecting upon the OVA incident with regards to what happened, and what potentially could have happened. This can be quite confronting for some staff, especially those who have encountered multiple OVA incidents.

2. How has your team handled these difficulties? Have they received support, and if yes, what types of support?  

The team has received terrific support from within Northern Health.

We’ve done a lot of training on getting staff to submit a VHIMS / Riskman to report the incident, as well as building confidence in OVA situations in taking a leading role, education on the mental health act and the management of mental health patients on an inpatient ward.

In more severe OVA incidents, where OVA incidents have impacted staff when the patients have been involved in multiple recurrent incidents, I reach out to our OHS Wellbeing Team. The team facilitate and organise ward debrief sessions (psychological first aid) as required, both in a group setting and individually through the Employee Assist Program (EAP) Converge. This service has been really helpful for staff to debrief as a group, as well as receive individual support as required.

The OHS Wellbeing Team has also facilitated wellbeing sessions, encouraging staff to look after themselves, which have been really helpful.

As an acting nurse unit manager early on in my career, the ward had a patient who caused several OVA incidents, which affected staff and myself. Being a new acting manager, I was unsure of what supports were available and who I needed to contact. Through the OHS team, I have been well supported, educated and guided through these difficult incidents, to be able to establish effective processes in order to support staff on the ward as well myself.

3. What actions have been taken, in collaboration with the OHS team, to prevent/reduce OVA incidents on the ward?

Through the collaboration of the OVA Coordinator, Head of Security and Emergency Manager, we ran a series of in-services to give staff the confidence to lead in a Code Grey, give clear instructions on what was needed to maintain a safe work environment and the ability to escalate appropriately to ensure safety for all staff and consumers.

Upon reflection following OVA incidents, gaps in staff safety were identified by the team, One safety point recognised through my debrief with staff, was that some rooms/areas of the ward were not appropriate for managing an OVA risk patient. This led to the implementation of high-risk OVA appropriate rooms. The criteria for these rooms are single rooms at the front of the ward or in areas with appropriate exits and appropriate rooms for staff to retreat to safety.

The OVA coordinator has been instrumental in encouraging staff to have a zero-tolerance for OVA behaviours from patients and visitors. The OVA coordinator has also assisted ward staff in reviewing VHIMS related to OVA and assisting in providing a zero tolerance notice for patients that are repeat offenders or who have had incidences of unacceptable behaviour. This has proven to be successful for the majority of the time with the patients or consumers understanding that their behaviour will not be tolerated.

4. What are some of the prevention strategies that Northern Health have implemented to ensure everyone’s safety on the ward?

Northern Health has implemented an OVA Education/Training group. This includes three Ward 19 OVA champions who attend committee meetings, provide updates and changes to the ward and deliver ongoing training to all staff on Ward 19.

The OHS team has made themselves available to all staff post incidents, often calling to follow up staff post VHIMS submitted, as well as following up with the manager to ensure all supports are in place. This provides the staff with assurance that the organisation cares about their mental health and wellbeing.  All wards have an OHS wall with EAP and Wellbeing contacts readily available if required.

Staff on the ward are aware that OVA incidents can take an increased toll on them, even after the event has occurred. Staff understand that it is important to speak about the incident to help prevent burnout.

5. What are the takeaways from your experience in managing OVA incidents at Northern Health?

The positive is learning how the organisation does support the ward and knowing that you’re not alone. Sometimes, as a new NUM, it can be difficult to navigate how to advocate and support your staff post incidents.

Having the OHS team involved does make the navigation and process a lot less daunting. Staff are grateful knowing that the organisation, including our senior leaders, react and come together to support them and ensure their wellbeing and mental health is being looked after. I think our organisation as a whole does prioritise mental health and wellbeing of staff and I think sometimes it takes an incident for staff to realise how much Northern Health do.

6. What lessons have you learned as a leader? 

As a leader, I have learnt that I can’t always do everything myself and it is important to reach out to others for help. At times, I have felt I was failing the team, however once I learnt of the support that we do have from the OHS and Wellbeing team at Northern Health, things felt better. It wasn’t easy at the start. I took a lot of it on and I would take it home, not being able to sleep properly. There would be no break from it and I would be constantly thinking of the wellbeing and safety of my staff.

Over time, I have developed a great network and relationships within the Surgical Division and the OHS team, which helps me to understand and realise that we are all in it together. I am always able to debrief with someone away from the ward setting, which has allowed me to be able to leave work at work. The OHS Wellbeing Team is always checking in. It is really nice to have someone ask if my team and I are okay.

7. How does the team feel about the processes for managing OVA?

• Rachel Green, NUM: Northern Health cares about the wellbeing of staff by providing resources and supports to help post OVA incidents. The team appreciates the check ins from the OHS team.
• Tessa Bruno, CNS: The Northern Health OHS team provides guidance in some tough situations. We appreciate the ongoing support by the OHS team, Rimon and the security team and our NUM, Rachel.
• Maddison Numa, RN: It was good to build rapport with OHS staff and receive ongoing support from my NUM. The debriefing, post code black, with all parties was beneficial. It enabled me to return to work knowing I was returning to a supportive workplace.
• Cassandra Lewis, RN: The OHS team at Northern Health always do their best to provide a safe and healthy workplace. Unfortunately, last year I was involved in an incident at work which left me distressed and anxious. The OHS team went above and beyond to reach out and provide support to ensure my wellbeing and mental health was looked after.

It is important we all work together to reduce risks and promote recovery after stressful events like OVA. Working together, sharing expertise and supporting one another is paramount, not only during the event but in the days, weeks and months afterwards as people recover in different ways.

For more information, please visit the following intranet pages:

• Staff Wellbeing (THRIVE)
• Occupational Violence and Aggression 

Featured image: Ward 19 staff with the OVA and Wellbeing team.