safe and secure, and that nothing untoward will happen to endanger our lives.

The thought that someone might threaten or attack us never occurs.

Yet for some professions, such as the Police, Fire Service, emergency medical technicians and nurses, the possibility for violence is always there. May 6-11 is Nurses Week, and in addition to honouring nursing and nurses and acknowledging a nurse who has demonstrated a high level of practice, the Bermuda Nurses Association is aligning itself with the International Council of Nurses' theme, "Nurses, Always There for You: United Against Violence''.

To that end, Nancy Acton talks with nurses in the King Edward Hospital's Emergency Department, and also Mental Health Services programme manager Glenn Caisey of St. Brendan's Hospital, about the prospect of violence in their respective workplaces, and how they deal with it.

Registered Nurse Sue Wale has worked in the Emergency Department for 26 years, and in that time she has seen a rise in violence.

"Violence towards staff wasn't a concern 26 years ago, but over the last seven to ten years it has been getting worse,'' she says.

While noting that nurses are trained to understand that "a certain amount of anger comes out in people who do not wish to be sick but are'', Miss Wale says that there has been an overall change in the public's attitude.

"We notice people are more aggressive and more impatient -- but I think that also goes along with the whole scene in Bermuda,'' she says.

"Increasing alcohol and drug use also add to the problem.'' Miss Wale recalls incidents where medical staff have been hurt in the process of a member of the public trying to attack a patient under treatment, and there have also be occasions when they have borne the brunt of emotional outbursts from relatives and friends of patients.

Similarly, clinical co-ordinator Miss Lynette Raynor remembers when she found herself in the middle of an angry group of youths following a road fatality.

The fact that she was smaller than any one of them, and alone, never occurred to her.

Instead, she acted professionally and gained control of the situation.

"It was only afterwards that I thought, `What have I just done?' and that I didn't have anybody there to back me up,'' she said.

However, the nurses stress that violent incidents are the exception rather than the rule here -- unlike emergency departments in hospitals in Britain and the United States, for example, where violence toward staff is a daily occurrence.

This is because, when the new and bigger Emergency Department was opened, staff were aware that additional security measures were required.

Putting these in place has meant a higher degree of safety and control, more peace of mind for the professionals on duty, and ultimately a reduction in unpleasant eventualities.

Security begins in the "check in'' area of the Emergency Department, where the public must wait for further attention.

The actual treatment area is protected by locked doors, and admission is only by permission of the attendant medical staff and the ever-present security guard.

At night, all doors to the rest of the hospital are locked, and security cameras are "on duty'' 24 hours a day.

Emergency medical technicians (EMTs) -- the men who go out on ambulance calls -- are good at "sussing out'' potential trouble, and can provide back-up security for the medical staff if required.

The Police are also geared to respond instantly to any calls for help from the Hospital.

All this is in addition to other security measures which must remain confidential.

When nurses go out on ambulance calls they are "totally focused'' on the patient and have no personal fear, but Miss Raynor says "at the same time we have to know that the area is deemed safe''.

"We work it out between the EMTs, the Police and the Fire Service,'' she explains. "We can't just go in cold because there might be someone there with a weapon and we could lose (more) lives.'' (A similar situation exists where public health and district nurses go out into the community. They are likely to run a check on their destination if they are unfamiliar with it, and if, on arrival at a residence they sense a a problem or entry is denied, they will follow alternative courses of action rather than put themselves in potential danger).

In fact, the Emergency Department nurses cannot recall a single situation in the community where they felt they were in real danger. Rather, they say the public still respect them, both as women and professionals, and recognise that they are there to help rather than inflame a situation.

Regarding emotions which can escalate if not addressed correctly, the Emergency nurse says these may come from patients who grow angry at seeing others who come in after them being teated first, as well as families and friends to whom nurses must convey bad news, such as the death of a patient.

In the first instance, to defuse potential volatility, the Emergency Department has a triage nurse whose job it is to assess each patient's medical needs in the check-in area and then determine the order in which they will be treated.

"The sickest patients get treated first,'' Miss Wale explains. "If someone is having a heart attack, obviously they are going to be seen ahead of someone who has a chest cold, even though the latter patient may have been waiting for several hours.'' Of course, many of the people who turn up at Emergency do not have serious medical problems at all and should be seeing their regular doctor instead, but since it is the Department's policy not to turn anyone away, waiting is simply part of the process when everyone is busy attending to more urgent cases.

In the second, nurses no longer go alone to convey bad news to waiting friends and/or relatives because of the potential for an emotional or irrational response.

Viewing the overall picture, Miss Raynor says that, because of increased abusiveness and violence in the community, a lot of it driven by substance abuse, Emergency Department nurses are now much more aware of the potential for trouble than they needed to be in the past, but at the same time they are not afraid because of all the security systems which surround them.

"The main thing is to be aware,'' Miss Raynor says. "There is always the potential that something could happen at any time, but not to the detriment of the patient, so as professionals we must not become complacent.''