The systems and processes designed to protect health care workers are not as robust and comprehensive as those in place for patients, according to the Victorian Auditor-General’s report.

Auditor-General John Doyle, in his Occupational Violence Against Healthcare Workers report, found safety initiatives and actions targeting occupational violence and aggression (OVA) are failing nurses, midwives and paramedics.

Mr Doyle found shortcomings in all audited agencies, including public health services, Ambulance Victoria, the Department of Human Services (DHHS) and WorkSafe, which have all implemented recent reforms aimed at preventing and managing occupational violence.

Alarmingly, his report found incidents categorised as ‘mild’, ‘near miss’ or ‘no harm’ included cases ranging from attempted strangulation to a pregnant worker being kicked in the stomach, workers being punched in the jaw, face, chest, head and kicked in the head, hit with an object, slapped in the face, personal threats and sexually inappropriate conduct.

“How is it that these sorts of incidents can be assessed as only ‘mild’ or ‘no harm’? Categorising these incidents in this way understates the seriousness of these occurrences and does not enable future incidents or risks to be prevented and managed.”

Mr Doyle criticised training for staff, excluding mental health and emergency department staff, for being inadequate.

The report also found under-reporting is widespread due to cumbersome incident reporting systems, logistical barriers and a perceived lack of inaction from management to respond to “all but the most serious of incidents”.

Mr Doyle stated employers should actively identify and address barriers to under-reporting and called on health care workers to report any incidents that threaten their health and safety - whether the incident was intended or not.

“One reason for this under-reporting is staff compassion for patients whose aggression arises from a clinical condition,” he stated.

“Staff commonly reason that the patient ‘couldn't help it’. Despite relevant policies and procedures highlighting the need for health care workers to report occupational violence incidents, there is still a widely held view - consistently reported by staff across all the audited agencies - that clinically caused violence is an inevitable ‘part of the job’.

“It is not just ‘part of the job’. Without reporting, how can employers know the true level and impact of occupational violence and take appropriate action?”

Mr Doyle made 10 recommendations aimed at improving protection for health care workers and warned the audited agencies will be reviewed again in two years’ time.

The Australian Nursing and Midwifery Federation (ANMF) Victorian Branch labelled occupational violence an “urgent and critical health care issue” and called for immediate action to implement the recommendations.

“The DHHS, WorkSafe and employers have failed to take this issue seriously in the past,” secretary Lisa Fitzpatrick said in a statement.

“We have recently been very pleased with the work being done at WorkSafe to tackle OVA on a strategic level but echo Mr Doyle in calling for better prevention, training, reporting and investigations around OVA incidents.

“We would like to see more work around post incident support, which the agencies that were audited appear to do well, but is not something our members generally experienced.”

Ms Fitzpatrick urged all nurses and midwives to report every OVA incident “no matter how insignificant they may think it is”.

“Nurses and midwives, and indeed all health care workers and patients, deserve to have a safe workplace.”