Enraged (venting) - page 5

OK, I know y'all can relate... Tonight I received a 23yoM, out drinking and driving, hitting parked cars. He already has 2 felony DUI's on his records. He fought with fire department on scene... Read More

  1. by   Email4KH
    btw, every drunk, drug addict or prostitute i've ever seen or heard of has decided to drink, drug and/or whore.
    "nurse" does not equal "enabler."
  2. by   PANurseRN1
    Quote from TrudyRN
    He is ill, let's not forget. He has an addiction to alcohol. Addiction. A person will sell his soul to satisfy a craving when addicted. It is an illness and the person deserves treatment. He might need jail, too. But he definitely needs treatment. And to be forgiven. There, but for the grace of God, go you and I.
    Get serious! GOK what might have happened had the OP waited for security to get there. Just because she's a nurse doesn't mean she doesn't have the right to defend herself. Now, if she'd grabbed an IV pole and started whacking him over the head with it, maybe...

    I don't get these nurses who think we have to sacrifice ourselves to our patients. If someone is assaulting me, you'd better believe I will fight that pt. off to get free.
    Last edit by PANurseRN1 on Dec 16, '06
  3. by   PANurseRN1
    Quote from TrudyRN
    I thank God that I have never been assaulted. Having worked in Corrections, though, things often got threatening. I would simply raise my voice and say to the inmate, "Don't make me yell for a Deputy!" Before I knew it, several deps were at my side and the inmate had either come to his senses and started behaving safely or was escorted off, his med care to resume at a later time.

    The key here is that I raised my voice and yelled for help. If other staff had been around the OP (and I think they were, based on him saying that they were gathered outside the scanner room), he could pretty easily have raised his voice and conveyed to them that they needed to stat get him Security backup.

    Or, he should require that the doctor order the pt to be controlled with anesthesia/intubation for the scan or take whatever other steps were necessary to keep everyone safe.

    Are you advocating that nurses allow themselves to enter dangerous situations? Are you saying nurses should stay in them if they find themselves in them? What exactly are you trying to say?
    If you haven't been on the receiving end of being assaulted by a pt., then you really don't know what you would do. To put it more bluntly, you don't know diddly. Your post makes absolutely no sense, and actually, it frightens me. I hope newbies and students out there aren't getting the idea that they can't defend themselves.

    Part of being a nurse is getting into dangerous situations, be they exposure to diseases, acting out patients or providing home care in a crime infested area.

    andhow, you can work with me in the ED any day of the week!
    Last edit by PANurseRN1 on Dec 16, '06
  4. by   obliviousRN
    Seriously? SERIOUSLY??????????

    If I am GETTING PUNCHED IN THE FACE by a patient, I am not going to take time out to say "yoohoo - security! Help me please!" Ain't gonna happen. Even if they are 10 steps away. I'm going to fight back.

    I'm going to get out of that situation as quickly and anyway as possible. If that entails hitting the patient, then YES I WILL!

    No, I am not a rage filled nurse (except reading some of these replies)..... but I believe staff safety comes first.

    The question about would we do this to a schizophrenic too? Absolutely - if they were punching me in the face. I don't care what your background is - if you are punching me, I am responding. My facility supports that. They support staff safety, period.
  5. by   obliviousRN
    Also - I see you (TrudyRn) say you haven't been assaulted. I have. I was choked by a patient and there was other staff in the room about 5 feet away. Did I wait for them to help me? Nope - I hit the patient until he let go. I was blacking out and couldn't breathe. You bet your bippy that I was fighting for my life. I was not going to wait for someone else to come to my aid.

    So maybe you can see why I'm so passionate about this. If you haven't been in that situation, I don't think it's right for you to tell the OP they are wrong for how they reacted. I've been there - I know what it's like.

    OK - over and out.
  6. by   TrudyRN
    a most interesting thread
    Last edit by TrudyRN on Dec 17, '06
  7. by   TrudyRN
    Quote from topkat
    too bad the OP didn't have the tazer available in the CT scanner..although it sounds like this guy was so blitzed he probably didn't care or had so much "anesthesia" already on board he couldn't feel it....hope the OP is working thru this..best wishes



    topkat
    I believe she says he was Tazed several times in CT.
  8. by   TrudyRN
    Quote from obliviousRN
    Also - I see you (TrudyRn) say you haven't been assaulted. I have. I was choked by a patient and there was other staff in the room about 5 feet away. Did I wait for them to help me? Nope - I hit the patient until he let go. I was blacking out and couldn't breathe. You bet your bippy that I was fighting for my life. I was not going to wait for someone else to come to my aid.

    So maybe you can see why I'm so passionate about this. If you haven't been in that situation, I don't think it's right for you to tell the OP they are wrong for how they reacted. I've been there - I know what it's like.

    OK - over and out.
    If you're fighting for your life, it becomes another story. Although that would not hold up in psychiatric nursing where, no matter what, staff are not allowed to lose their cool.

    Juries daily make decisions about things they have never experienced. I guess if we, on this board, are limited to responding to events we have experienced, only a very few will respond.

    BTW, I have been the victim of crime, just not on the job.
  9. by   TrudyRN
    Quote from MLOS
    I have never worked in corrections although I once did a volunteer day helping w/adult literacy classes in a state prison setting. Whole different world than a hospital ... totally different level of supervision of inmates and totally different setting designed specifically for command & control, not health care.

    I could be wrong, but I read your post to be taking the OP to task for defending herself. Your suggestions included: 1) not working with "this type of patient" and 2) calling security. Again, I could be wrong, but your original post, and your subsequent posting, suggest that the OP is somehow at fault for losing her temper or being prone to violence or something.

    So I asked the question: have you ever been assaulted? That is, have you ever been in a situation where you needed to act to minimize physical harm to yourself NOW, not as a hypothetical situation but NOW?

    I found your suggestions outrageously naive for someone who has been practicing for any length of time. In the time it took for the 10, 12, 20, or however many steps it took for the police officers and others to get to the OP, she was being punched. This is a real event - not a cartoon where the action gets paused for the OP to call security.

    I wholeheartedly agree that this terrible incident could have been avoided if the police had stayed within arms length of the patient (as they do in my facility). But the bottom line is that that did not happen, and the OP took steps to minimize physical harm to herself.
    I wonder why they didn't stay with the patient. Did the OP tell them to and give them the lead aprons so they could? Or did she position them outside the room? Did they suddenly get scared and refuse to stay with him?

    She can certainly defend herself as necessary. I won't make this point again, as I have stated it several times here already and no one seems to believe I mean it, so no point reiterating it again.

    There are other problems, though. First, the pt was cuffed to the cart. If so, he was somewhat controlled. Next, the OP will likely never again, at least I hope she won't, allow herself to be the only one with a pt who is out of control like this. I hope she definitely gets the cops in there with their arrestee. Let them hold his arms over his head. Next, I hope she insists that the doctors anesthetize and tube the pt so all of this becomes moot.

    Also, she says that she is totally upset with herself for losing control. So she was perhaps more angry than scared, is how it sounds to me. She knew he was restrained partially and she knew cops and her tech were just outside the glass. Also, it sounds like there was maybe too much talk. It is certainly pointless to explain very much to an upset drunk. Just try once and then do what must be done, without further ado. And certainly don't threaten to "paralyze" him and treat him harshly. That in itself is a battery, I think. Again, I'm no lawyer but that's my guess.

    Something else she says - that the pt thought he had a right to treat her like that. Guys, this patient was not thinking about the nurse and how to treat her. She gives him way too much credit. He was drunk. All he cared about was going home. That's it.

    Just a word about Corrections. The ratio of guards to prisoners was about 1:100 where I worked. Terrible odds, very, very dangerous setting. You learn to avoid trouble whenever possible and to be nice so someone will, hopefully, help you if things really go south. Also, while health care is not the primary business of a prison, the prisoners have a legal right to health care. That means that the nurse is an extremely important part of the prison setting and is very much involved in the daily routine.
  10. by   wildmountainchild
    TrudyRN,

    I think you are missing out on one very important aspect of all this:

    You can't control all variables. Sometimes, things happen and you have to react.

    Sure it would have been great, without the benefit of 20/20 hindsight, to realize he wasn't as calm as he looked, or to have insisted the police were in the room. But...it happened...it was violent...lessons were learned. But to sya someone should stop working/helping potentially violent patients because of what happened smacks of holier-than-thou judgementalism.

    Come on...you've never been in a stiuation where you acted one way and then later wished you had acted another? I doubt you're as perfect as your judgemental attitude would suggest.

    As for the guy being handcuffed and therefore being "restrained". Really. My husband is in law enforcement. One out of control guy, in less than 5 seconds, broke another guys nose and knocked him unconscious WHILE HANDCUFFED AND WITH TWO OFFICERS TRYING TO RESTRAIN HIM (kicked him in the face).

    That you think a nurse, who doesn't have the training that law enforement officers have, was supposed to intuit that this guy wasn't going to kill her in the seconds that went by as she was being assaulted is absurd.

    And it's great that in psych nursing you turn the other cheek. But I bet you would change your tune if your psych patient tried to rape you, or stab you with a pen (unfortunatly these things have happened, a nurse was raped at a center only a block away from where I live).

    She was justified, ethically, morally, and socially justified. Not a court in the land would find her at fault.

    You live and you learn. Next time she probably will handle a similar sitaution w/ more finesse. All the more reason she should work with that type of patient in the future.
  11. by   one_speed
    Hey Folks,

    Thanks for an intersting thread for an early morning read. I think this ties in very nicely with the other threads on this forum to do with violence in the ER. (family vs. RN, pt vs. Rn, Family vs. Pt.). I'm an RN practicing in a regional Hospital / Trauma center in Canada. Small town granted (no worries with gang warfare etc.,... thank God), but we do get our share of drunks, addicts, and violent patients and family members. Our legal system might me a little more sane in that defending ourselves against the violent patient later in a court of law is less of a concern perhaps than in the US.

    An interesting point was brought up earlier by a corrections RN about preventive practices, not just paralysing and tubing, but I'm thinking more seclusion and physical restraints.

    Typically as soon as there is an issue of an intoxicated person becoming violent (pulling IV's, swinging at staff, etc.) the first thing out of the bag of tricks are wrist and ankle restraints. If they are really out of control, then comes the IM injection of vitamins H + A. If the clinical situation warrants further investigations (ie CT head for an assault victim) we will consider the use of rapid sequence intubation for further diagnostics.

    A funny thing happened one night shift when we were helping a violent intoxicated person. I had just restrained the patient while waiting for the MD to make their way over to assess them (we still let the docs see sick people first (depending on their CTAS score of course). I was at the nursing desk documenting my interventions, and a family member of another patient approached. She was quite upset that we had violated that persons (the drunk) right's by using restrainets against their will (is there any other way to use restraints ?... don't answer that, not interested.) Of course the drunk didn't like it and was quite verbal about it.

    I calmly replied "well Ma'am, I'm glad that you spoke up because normally I'd agree with you 100 %, but right now I am more concerned with #1 - my rights not to get punched in the head. #2 - That person is enjoying their rights not to have to deal with an assault charge in the morning after they sober up a bit. And #3 -your husband is enjoying his right to have his NSTEMIt taken care of by the physician before he has to rush over here to deal with their acting out".

    She seemed okay with that...

    In the past I have tended to want to talk people down, play the peace maker, but after being punched in the head once and losing a couple of hundred dollars in wages I am less sympathetic.

    1speed
    Last edit by one_speed on Dec 17, '06
  12. by   MomNRN
    What an enjoyable read this morning!

    One question for those who felt compelled to offer the dissenting opinions:

    Have you ever worked more than one night shift in an ER? Obviously not!
  13. by   TrudyRN
    Quote from wildmountainchild
    TrudyRN,

    I think you are missing out on one very important aspect of all this:

    You can't control all variables. Sometimes, things happen and you have to react.

    Sure it would have been great, without the benefit of 20/20 hindsight, to realize he wasn't as calm as he looked, or to have insisted the police were in the room. But...it happened...it was violent...lessons were learned. But to sya someone should stop working/helping potentially violent patients because of what happened smacks of holier-than-thou judgementalism.

    Come on...you've never been in a stiuation where you acted one way and then later wished you had acted another? I doubt you're as perfect as your judgemental attitude would suggest.

    As for the guy being handcuffed and therefore being "restrained". Really. My husband is in law enforcement. One out of control guy, in less than 5 seconds, broke another guys nose and knocked him unconscious WHILE HANDCUFFED AND WITH TWO OFFICERS TRYING TO RESTRAIN HIM (kicked him in the face).

    That you think a nurse, who doesn't have the training that law enforement officers have, was supposed to intuit that this guy wasn't going to kill her in the seconds that went by as she was being assaulted is absurd.

    And it's great that in psych nursing you turn the other cheek. But I bet you would change your tune if your psych patient tried to rape you, or stab you with a pen (unfortunatly these things have happened, a nurse was raped at a center only a block away from where I live).

    She was justified, ethically, morally, and socially justified. Not a court in the land would find her at fault.

    You live and you learn. Next time she probably will handle a similar sitaution w/ more finesse. All the more reason she should work with that type of patient in the future.
    Reread her original post and reread what I wrote. You have misunderstood some of what we both wrote. As far as her continuing to work in this setting, I didn't tell her what to do. I suggested that maybe she wants to rethink whether or not to continue to subject herself to situations like this. If she or anyone else chooses to work in the ER and they get hurt, well, they knew it could happen so they accepted the risk. just like cops know and accept the dangerous aspect of their work, just like Corrections nurses, just like Psych nurses.

    I am going to contact some lawyers about this, just for my own edification and knowledge. I will let you all know what they say. I never claimed to be a legal expert. In fact, I have stated more than once that I am not an attorney and am not sure whether A&B took place. If I find out I'm wrong, I will let you know. I am also going to talk with some of our local ER managers for their input and let you know what they say.

    BTW, wildmountainchild, there are some variables that we do control, such as maybe having the cops in the room instead of outside it, and/or cuffing the pt's hands overhead instead of this nurse trying to hold him still, such as what she said to him and perhaps how she said it, and why no EUA approach was used. The OP herself says she knows she messed up and she is upset with herself for losing control. :uhoh21:

    Please tell me - why am I "judgemental" because I have this particular view? Why can't it just be my view, which is valid as anyone else's? Why is it judgemental to hold an opposing view? Are you not judging me and telling me how awful it is to take a different view? Are you not angry and disgusted with me because I have said somethign you don't like? How is it that YOU are not judging me by disagreeing with me?

    As for intuiting anything - it was pretty obvious that the patient was really out of it if he had gotten Haldol and Ativan and had to be Tazed several times in CT. Not much intuition required to know help was needed. Also, he was apparently only cuffed by the legs to the cart, as she was trying to hold his arms overhead herself. Too bad they didn't also cuff his arms overhead, put on a waist restraint, etc.

    The feeling I get of all this is that she was angry that he was wasting his life and she tried to talk him down and that approach didn't work. She didn't utilize her resources (the cops, EUA), she got terrified when this drunk person hit her and grabbed her arm and she lost self-control, as she readily states.

    As for my being perfect, I never, at any time, have stated that I am perfect. I am a fallible human being, just like anyone else. I'm not sure why you think I said I'm perfect. Reread what I've said. Nowhere in it will you ever see that I said I was perfect.
    Last edit by TrudyRN on Dec 17, '06

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