Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired wellbeing in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.

As nurses take on the roles previously performed by medical colleagues, so it will become increasingly important to define role boundaries and assess the impact on the quality of care of detainees.

Until recently, workplace violence and aggression in health care had received little attention. Today, however, there are concerns about growing levels of violence towards health-care workers and in particular nurses. The government is now steadfast in tackling workplace violence and helping NHS staff to apply a zero tolerance approach to reduce risk and ensure the welfare of their employees? This article highlights the issues regarding the application of zero tolerance policies and principles to practice. It looks specifically at the consequences of excluding patients from primary care services and in particular at a scheme that has been set up by one general practice to provide an alternative GP service for patients within the Heart of Birmingham Teaching Primary Care Trust. Initial evaluation of this initiative indicates that patients are being successfully rehabilitated back into the community and suggests that further research is urgently needed to draw conclusions about this project, as well as similar health care services that endeavour to prevent and deal with unacceptable and aggressive behaviour in the workplace.

Patricia Bond and Hilary Paniagua discuss the issues of legal negligence and duty of care and consider the potential liability of nurses

Nurses should not have to accept violence from patients as part of the job, but patients also have a right to health care. Patrica Bond, Hilary Paniagua and Andy Thompson look at a scheme to address this dilemma