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Nurse encounters abusive patients at work and suffers
psychological injury
A case in 2023 concerned a woman who worked as a nurse and made
a claim for compensation for PTSD.
The woman worked in the emergency department of a hospital in
northern NSW from 2011 to 31 January 2019.
Staff in the emergency department were regularly subject to
abuse by patients.
Around 2015, the nurse had a particularly upsetting encounter
with a patient, LF, who was verbally abusive, yelled profanities at
her and threw a blood pressure monitor across the room.
On 31 January 2019, when the nurse arrived for her shift, she
saw LF's name on the patient handover sheet. She began crying
uncontrollably and suffered a panic attack for the first time.
She left work that day and has been unable to work since.
The nurse was diagnosed as suffering from post-traumatic stress
disorder (PTSD).
Nurse seeks workers compensation for permanent impairment
The nurse brought proceedings in the Personal Injury Commission
of NSW, seeking payment of permanent impairment compensation for
PTSD, a psychological injury.
The question before the commission was whether the nurse had
developed PTSD over time due the nature and conditions of her
work.
CASE A
The case for Mr S
CASE B
The case for the lenders
I suffer from PTSD which developed over time due to the nature
and conditions of my work between 2011 and 31 January 2019.
During the course of my employment, I was exposed to numerous
traumatic incidents, including vitriolic outbursts and verbal and
physical assaults by violent, drug-affected patients and mental
health patients.
During almost every shift, patients would become angry,
abusive, aggressive and violent, because without a doctor present,
I was not able to prescribe the opiates and benzodiazepines they
wanted. Going to work under such conditions caused me to become
anxious and agitated.
One day I watched a highly agitated patient smash a glass door.
I also saw other nurses being chased by highly agitated patients
and having to lock themselves in the drug room to escape.
I complained to my manager about the disturbing incidents and
lodged several incident reports.
My GP has testified that in 2013 I experienced irritable bowel
syndrome, interrelated with stress, including work stress. I was
referred for psychological treatment and prescribed antidepressant
medication.
The incident with LF around 2015 caused me to feel extremely
upset, agitated and fearful, both for my own safety and for the
safety of the other patients in the waiting room.
In 2019, I had just started seeing my psychologist to address
the impact of the various work-related events, when I was triggered
by seeing LF's name on the patient handover sheet.
My psychological injury clearly developed over time due to the
nature and conditions of my employment from 2011 to 31 January
2019. I am therefore entitled to compensation for PTSD.
The nurse's PTSD did not develop over time due to the
nature and conditions of her employment between 2011 and 31 January
2019.
As the nurse's manager has testified, at times patients
became verbally aggressive, but that was to be expected in an
emergency department. Although the nurse lodged several incident
reports, her manager has testified that she continued to work
normally and never complained about experiencing work-related
stress, notwithstanding that she had opportunities to do so.
There is no contemporaneous evidence of psychiatric
symptomatology as a result of the alleged traumatic events since
2011. The treating evidence and independent medical evidence all
support a finding that the only work-related events which were
causative of the nurse's psychological condition were the
events involving the patient LF in 2015 and the events on 31
January 2019. There is no evidence which establishes a causal
connection between the nurse's emerging psychological symptoms
and other incidents at work. As the nurse is alleging a
psychological injury in the nature of a disease of gradual onset,
this is insufficient to prove her case.
As our independent medical expert has testified, the
nurse's employment was not the main contributing factor to her
PTSD. Her personal life stressors were. The incident in January
2019 simply aggravated a pre-existing psychological condition. In
August 2007, a date which predates the nurse's employment by
four years, she was referred for psychological treatment. The
referring doctor noted that the nurse described feeling
increasingly teary and stressed for the past year. A mental health
care plan stated that she had "generalised anxiety".
Since the nurse's PTSD did not develop over time due to the
nature and conditions of her employment from 2011 to 31 January
2019, she is not entitled to compensation.
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