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Are you lonesome tonight?

The news on the radio on Monday about the safety lone workers (mostly nurses I might add) caught my attention. The BBC had clearly picked up from the RCN survey on whether the situation had improved since 2005, when John Reid, the then Secretary of State, launched the Department of Health document on lone workers.(1,2)

Many of us in primary care find ourselves either in treatment rooms or in people's homes without fully appreciating our personal safety issues. I know I used to rush out on a visit having received a phone call without telling folk where I was going. In this day and age of technology there really is no excuse for organisations to leave their staff without mobile communication that is safe and specific.

I was interested to see that one of the examples cited in the RCN leaflet was from the rural North East. I am pretty sure that the predominate perception of safety issues for nurses visiting homes is in the innercity areas or clinics in rundown estates. Here was an example of how personal safety can be put at risk by geographical isolation and the stresses of people scraping a living off the land.

I hope I don't sound too much like some melodramatic Catherine Cookson novel, but some of the students I teach have placements in these areas and we need to pay attention to these issues.

Often it is not the patients that may be stressed but their families and carers. If you are the next person to come along after an argument or bad news you are the one they are going to shout at and threaten. The context of our patient's/client's lives is so important and the timing of visits or appointments might just fuel the distress that they are experiencing.

The RCN leaflet recommends the following:

  1. Risk assessments - knowing what risks you might encounter on a visit. Being alert to patients/clients attending the clinic and whether they might have a history of violent or threatening behaviour and whether there were any trigger points.
  2. Prevention - have you mobile technology available to you that might help you feel safer when working alone?
  3. Policy - has your organisation/practice got a policy for protecting lone workers and if so have you got a copy of it?
  4. Training - have you been on training day, are they available, and if not, why not?
  5. Support from your employer - do you feel confident that your employer would support you against verbal abuse? Does your employer fully understand the issues/risks you might face?

So ask yourself, what are the procedures in place within your organisation to ensure your personal safety? How tolerant are you of low-grade abuse? Is it something we shrug off and put up with? Are you aware of the guidance for organisations and have you had training in dealing with aggression and/or threatening situations?

Let us know what is happening out there. It would be good to share best practice - if you have good procedures in place to support you let know. Sharing good news and best practice would be great.


1. RCN. You're not alone. The RCN campaigning to protect lone workers. London: RCN; 2007. Available from:

2. Department of Health. Not alone. A guide for the better protection of lone workers in the NHS. London: DH; 2005.

NHS Counter Fraud & Security Management Service Division