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Living in fear: Nurses' hidden struggle with abuse at home

Levels of domestic violence are 'appalling' among nurses, according to a new report from the Cavell Trust independent charity. Published at the end of last year, the report claims that nurses are three times more likely to suffer abuse at home, including being threatened or experiencing violence, than the general population. 

Involving responses from over 2,200 healthcare professionals, including nurses, midwives and healthcare assistants, Cavell Trust’s report, Skint, Shaken, Yet Still Caring also describes the increasing financial hardship faced by healthcare professionals struggling to cope with almost a decade of austerity and pay rises that have lagged behind the levels of inflation. 

The research paints a picture of a profession pushed to the edge, with nurses unable to afford basic necessities – like a warm home or a spare pair of shoes. An increasing body of evidence describes a profession under pressure at work and at risk at home. As increasing numbers of nursing professionals reach breaking point, one question remains unanswered. What happens when those who care need to be cared for?

 

Inside the research 

 

The Cavell Trust’s study focused on establishing the physical, emotional and financial health and wellbeing of nurses. “As a charity, we needed to get a sense of the scale of the problems that nurses face today,” says the Cavell Trust’s chief executive John Orchard, describing how the information will help the organisation target those most in need. “We weren’t focusing on domestic violence, but the results are shocking,” he says.

One of the report’s most striking findings is that nurses are three times more likely to have experienced domestic abuse than the average person. The study found that 4.4% of nurses claimed to have been victims of some form of threatening behaviour from their partner, compared with just 1.7% of the general population. 

One in 10 nurses has faced some sort of non-violent abuse, including financially controlling behaviour, verbal abuse and being prevented from seeing friends. This is four times the level recorded nationally.

At its most extreme, nurses are almost twice as likely to have been the victim of a physical attack, with 2.4% claiming to have been punched, slapped or kicked. Of those surveyed, 1.7% had been injured at some point by their partner.

According to the research, both male and female nurses are affected. Of the 100 male nurses who completed the survey, 5% had been the victims of physical attacks and 15% had experienced non-physical abuse from their partner. 

Orchard is keen to stress that the findings are from a small survey, with 2,200 nurses – a fraction of the 315,000 qualified nursing staff and healthcare assistants working in the NHS. While drawing conclusions from such small numbers of respondents is problematic, the research shines a light on an important area that remains hidden. 

A growing weight of evidence shows that the situation could actually be much worse than even the Cavell Trust’s research suggests. “One in three nursing professionals is likely to experience domestic violence of some kind, but it could be as high as one in two,” claims Claire Richards, a former nurse, and now director at the National Centre for the Study and Prevention of Violence and Abuse (NCSPVA).

In an in-depth survey of 84 healthcare professionals from across the UK, which was funded by the Cavell Trust, Richards and colleagues at the NCSPVA found that almost half of the nurses they spoke to (47%) had experienced domestic violence at some point in their lives. Follow-up interviews with six respondents allowed researchers to explore the issue in more depth. According to Richards, we’re only beginning to understand the extent of the problem. 

 

Risk Factors

 

It remains unclear why nurses appear to be at greater risk of domestic violence than the general population. But in the analysis of the data Richards and her colleagues collected, they suggest that the characteristics that bring people to nursing are those that may make them more likely to be victims. 

“The six Cs of nursing are the core parts of the nursing culture,” says Richards. It’s these attributes, described by the NCSPVA as ‘altruistic values and the desire to care for others’, that she believes may make healthcare professionals more vulnerable. It could be that this commitment to caring may see them remain in relationships they believe they can change.

Richards also believes that nurses may focus on the welfare of their patients to the detriment of their own wellbeing: “Nurses say they may sometimes be reluctant to talk about domestic violence,” she claims. “We are more exposed to violence in clinical settings than the general public.” 

Other theories posited by the NCSPVA include a perceived lack of managerial support for those raising issues. One thing the NCSPVA is clear about is that 'care must be taken not to blame healthcare professionals for their victimisation'.

 

Recognising the problem

 

The NCSPVA research found that some nurses felt their ‘employers reportedly provided minimal levels of support’. 

For Ruth Warden, assistant director of development and employment at NHS Employers, the issue may be one of managerial confidence and competence. “Managers may have the competence to have the conversation, but not the confidence,” she says. 

It’s all about starting a dialogue, she believes: “The bottom line is if you can support line managers to have those conversations we can help staff in difficulties,” she says. 

At a personal level, the research also suggests that nurses may fear being judged, or having their competence questioned by admitting that they are experiencing domestic violence. 

The NCSPVA report claims that ‘respondents felt reluctant to seek help from their employer for fear of embarrassment, a perceived lack of confidentiality and anticipated stigma’. It’s what Richards believes is a culture in nursing where “private matters should remain private”. 

“There’s potentially a fear of how an employer might respond and being stigmatised,” says Richards. It’s a complex issue, and Richards and Orchard both suggest caution before jumping to any premature conclusions, with both advocating additional, targeted research. 

 

Money Matters

 

To make matters worse, research points to large numbers of nurses facing money worries, although the limited scope of the research means it doesn’t explore the links between financial hardship and domestic abuse.

In simple numbers, the Cavell Trust research found that nurses are ‘about twice as likely to be deprived of the basic necessities’ when compared with the general population. The indicators are taken from the 2012 Poverty and Social Exclusion (PSE) Living Standards Survey, and include things like the ability to heat and maintain a home, replace broken white goods or enjoy a hobby or a yearly holiday.

The Royal College of Nursing (RCN)’s Head of Employment Relations Josie Irwin is clear where the problems lie: economic hardship because of the public sector pay policy. RCN figures quoted by Irwin indicate that nursing pay has fallen by 14% as a result of inflation since 2010, and shows no signs of improving.

Irwin has a warning. “We’re heading for a perfect storm,” she says. “Unless the Government starts to do something about pay, we’re going to enter into a horrible spiral where there aren’t enough staff. That makes the circumstances for those who remain worse.”

Unison’s Head of Nursing Gail Adams echoes these concerns. “The continuation of the government pay restraint is having a catastrophic impact on nurses,” she says. As nurses struggle to make ends meet, many are working additional hours.

“Working excessive hours could have an impact on patient care,” warns Adams. “We’re not facing a nursing crisis, we’re experiencing it,” she says. 

 

Time for change

 

All the evidence paints nursing as a profession in need of serious help. Overcoming issues such as domestic violence and financial hardship may seem insurmountable, but there are a few simple things that can be done to make a difference.

At a local level, people need to be open to the possibility that colleagues may be struggling, Richards suggests. “Be prepared to think the unthinkable,” she urges. “The signs are often there; we just need the courage to ask. These open discussions are important.” 

Managers and colleagues also need to be more vigilant. “Nurses are incredibly focussed on patients, and put them over and above everything else,” Warden adds. “We can’t expect managers to be experts, but they can create safe environments that allow nurses to raise issues that they are facing.”

For those without a manager, or those unwilling to approach theirs for help, there is support available. Whatever issues are being faced, sharing those issues with a colleague, a friend or with one of the many charities that can offer support is the first step in making a change. 

For Orchard, how we care for nurses proposes a fundamental question for the values we have as a society. “Ultimately, it comes down to what kind of society we want to live in,” he says. “Nurses shoulder an enormous burden. I want to be part of a society that cares for those people who care for it.” 

Orchard’s point is clear. In caring for the carers, we all have a role to play.