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Violence in the Field: 37 Safety Tips for Home Healthcare Providers

by Karen Brooks

Every year, half a million nurses are victims of violent crimes, including clinicians in the home health industry. Home care providers face unique risks because they typically do their work without partners or backup, in highly volatile and unpredictable situations, or in private homes that may not have adequate security, or in the middle of the night. Their purpose and attention is focused on their patients - not on the fact that anyone might want to hurt them.

"Thank God, violence is the exception," said Jamey Boudreaux, director of the Louisiana-Mississippi Hospice and Palliative Care Organization. "It's not like we're inside of a prison facility. Violence is the exception in healthcare. It happens, though."

The personal safety issues faced by home care field clinicians, while they are under-researched and under-reported, are well known on the front lines, experts say - by the clinicians themselves, and by those who worry about them.

"Half of the nurses at couple of meetings we've had have small children or grown children, and their families are begging them not to do this anymore," said Pam Albers, LCSW, BACS, of the New Orleans Family Justice Center, program director for sexual assault services at the Crescent House in New Orleans and author of a recent study on the topic of home care industry safety.

After a recent attack on a visiting nurse in New Orleans, LA, the HomeCare Association of Louisiana (HCLA) hosted a meeting to discuss the issue and the steps agencies can take to lessen the likelihood that their field clinicians are victimized.

"These are issues that we did not think of in the past," Boudreaux said. "Hospice nurses have been traveling in the middle of the night for 30 years throughout the country. But there are places now that are not safe, situations that are simply not safe anymore."

Even the best preparations sometimes don't prevent violence, and safety advice given to clinicians should never imply that they could have prevented an attack. The best thing field clinicians can do to protect themselves, Boudreaux said, is to practice the art of awareness and personal safety until it becomes second nature.

"When you're dealing with a patient, you're concentrating on the patient," he said. "So it's really difficult, and these safety issues - while we're trying to help people become aware of them - they're difficult when you're in the middle of patient care. It's a matter of practicing these skills."

SAFETY TIPS
Sometimes circumstances don't allow home care providers to follow every suggestion or tip. But here's a list of hints to help field clinicians protect themselves and promote a safer environment — so that they can concentrate on the reason they're out there in the first place: Their patients.
 

  1. Follow workplace violence prevention programs and policies.
  2. Participate in employee suggestion or complaint programs about safety.
  3. Report violent incidents promptly.
  4. Participate in safety committees.
  5. Take advantage of safety training at work, which might include techniques to recognize escalating situations or how to report problems.

    Getting there and back:
  6. Be sure of the location of your visit and have accurate directions to the house or apartment.
  7. Have more than one person to call in case you need directions.
  8. Let your employer know your location and when you expect to report back.
  9. Know the location of the local police or fire department so that driving there for safety is an option.
  10. Park in a well-lit area, away from large trees or shrubs. Avoid areas with poor visibility by others such as alleys or isolated buildings.
  11. When you're driving alone, keep doors and windows sealed and locked.
  12. Avoid leaving items visible on the car seats during visits. Lock healthcare equipment and personal items in the trunk of the vehicle, but avoid entering the trunk of the car at the patient's home. Prepare the materials needed for the visit in advance and carry them with you.
  13. Before exiting the car, check out what's happening nearby. If you feel uncomfortable or unsure, stay in the car and call a manager.
  14. Make sure your car is filled with gas and in good working condition.
  15. Don't park the car in the patient's driveway. Park in the street.
  16. Confirm with your patients shortly before your visit, so they're expecting you.

    In the field or during a visit:
  17. Use basic safety precautions. Be alert and watch for signals of violence, such as substance abuse, threats, the presence of weapons. Have knowledge of the activities of the neighborhood in advance and avoid visits when the risk may be higher such as times of increased drug or alcohol use.
  18. Maintain behavior that helps to defuse anger. Exude a calm and caring demeanor, don't match threats or give orders, and always acknowledge the other person's feelings.
  19. Avoid behaviors that may be interpreted as aggressive - getting close, speaking loudly, moving quickly.
  20. Know where the bathrooms and exits are, and make sure there is always a clear path to them.
  21. Trust your judgment and avoid situations that don't feel right.
  22. If you're being verbally abused, ask the abuser to stop. If the abuse doesn't stop, leave and then notify your agency. Don't be afraid to shorten a visit if things get out of control or you feel threatened.
  23. Keep your cell phone in your pocket - not away from you in a bag or purse or the car. Maintain the phone turned on during visits.
  24. Do your paperwork and documentation in the home before you go to your car. Don't linger in your car if you can help it.
  25. Encourage patients to put lights on their porches or by their front doors.
  26. Carry a flashlight and use it when you walk to and from your car in dark areas.

    General tactics:
  27. Buddy system - consider working in pairs, either in high-crime areas or on night visits, or know that you can request an escort from local law enforcement in some situations.
  28. Notify your employer if you see unlicensed weapons in the home.
  29. If possible, conduct visits during the daylight hours (especially visits to high-crime areas).
  30. Let your employer know if a situation seems dangerous.
  31. Take a self-defense course.
  32. Consider carrying a personal alarm and/or a noise-making device such as a whistle.
  33. Only carry a minimal amount of cash.
  34. Always carry ID.
  35. Make sure your cell phone battery is fully charged before you head to your visits.
  36. Let someone know when you're done and when you're expected home.
  37. Dress to protect yourself. Wear shoes and clothes that make it easy for you to move quickly. Avoid wearing expensive jewelry or carrying a purse. Avoid any accessory that could potentially be dangerous such as necklaces or scarves.

 

(Sources: The Occupational Safety and Health Administration, the National Institute of Occupational Safety and Health at the Centers for Disease Control, Wild Iris Medical Education, Inc.,the Home Healthcare Nurse journal, "Promoting Personal Safety during Outreach, Shelter and Home Visits" by the Health Care for the Homeless Network, Pam Albers of the New Orleans Family Justice Center, Jamey Boudreaux of the Louisiana-Mississippi Hospice and Palliative Care Organization, and the Homecare Association of Louisiana)


Have you or members of your staff ever felt threatened during a home visit? What strategies have you or your agency employed out in the field, and how have they worked? What do you think is the biggest safety challenge facing field clinicians? Please share your comments here on the Home Health Blog.

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About Kinnser software

Kinnser Software, Inc. provides web-based solutions that deliver clinical and business results to the home health, hospice and private duty industries. Founded in 2003 and headquartered in Austin, Texas, Kinnser Software serves more than 4,000 home health, therapy, hospice, and private duty home care providers nationwide. Kinnser helps thousands of clinicians and other staff in post-acute healthcare to manage scheduling, billing, electronic visit verification, day-to-day operations, and patient referrals. 

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