Policy on ED violence

Ummm... I'm pretty sure it's a crime to threaten to kill someone...

Holy crap... that's ridiculous! Funny, I bet if that same guy walked in the police officers place of work and threatened to kill him or another officer it wouldn't be long before the matter was "taken care of"! Good luck to you... keep safe!

The current ER I work at has a policy on violence as too: What ever happens to the nurse happens to the nurse, we're not getting involved or making policies because we don't won't to cause a scene in our community or file charges against patients we help. I did have one patient that punched a security officer in the nose and fought me as well. And he went to jail when discharged. But it wasn't the hospital that filed charges or gave a dam* it was me picking up the phone and dialing 911 afterwards and saying I want to file charges. The local police here in Nashville will be glad to file charges if you call em.

Every other ER I have worked at, the security officers have always HAD weapons and the authority to arrest. We also always had psych/lockdown rooms and were not afraid to use them for our violent patients...psych or not.

I can't say much for policies...but, you need to beef up the security to protect staff and other patients. Discuss the use of panic buttons in all rooms, having a locked unit, and implementing a 2-visitor/patient rule (visitors must check in at triage and must wear a pass before they are allowed to go through locked doors to the main ED area; obviously this rule can be modified, especially if there's a PNB or critical patient). Discuss the importance of documenting exactly what the patient says (ie "I'm going to come back and kill you all"). On patients who are a threat to themselves or others, we have security 1:1 with them and all belongings are removed and they are searched with a metal detector.

Basically,
Each time they come to the ED we are obligated to provide the MSE (Medical Screening Exam), if no emergency exists, they can be discharged with no further treatment/interevntion.

We'll do this every time they come in - this is federal law (COBRA/EMTALA)

However, should they decide to being to act out, verbally threaten, make overt gestures, become disruptive etc. AND not respond to re-direction, in that they continue to de-stabilize the care area; then we will have them removed.

We have several who have "restraining orders" against them (due to prior behaviors) and all that means is that once they have received their MSE (if they will cooperatievly allow it) then they are to be off the premesis.

To the poster who feels his/her facility does not support them with policies or the ability/support to prosecute; I would say you need to do a couple of things
1) Talk to your board of nursing, specifically make the topic about staff safety
2) Get involved with your local/state Emergency Nurses Association
3) Confidentially talk to your state's labor dept/board

...basically, labor laws REQUIRE your employer to provide a SAFE workplace, free from violence or the threat of violence.

Let me tell you, in my 15+ years, whenever I have heard someone state that their admin doesn't support them - once they have done some of the above steps -OR- gone and spoken with their Director/CNO - things HAVE changed....sometimes it's a mis-perception and it needs clarification.

Bottom line; you employer is legally required to provide a safe workplace. If you really feel it's unsafe and people are in jeopardy, just go get you a first "free" consultation with an attorney who specializes in labor law; they would DROOL at the opportunity to get a hospital to settle a case like that; especially if ANY damages had ever occurred from the facility's failure to act.

Assault is a crime, and does not require physical contact. The physical contact is called battery. As I understand it if you have reason to believe the threatener can and might carry out the threat. Somebody's status as a patient does not change that.

http://legal-dictionary.thefreedictionary.com/Assault

Obligations under EMTALA are widely misuderstood= mboswell summed them up well.

we have had a FF/known and documented drug seeker pull a knife and threaten the life of the RN and the unarmed security guard.

If you actually have somebody in a supervisory position that thinks that what you have described does not constitute a crime, that person is a moron.

http://allnurses.com/nursing-news/mo...lf-414147.html

http://www.thefreelibrary.com/Nurse+...e.-a0203588345

In NM, we have a law that says lower levels of assault (verbal) against a health care worker while performing their duties, are misdemeanors. Assault with threats to kill become a felony, battery is anywhere from a 4th degree felony on up, depending on severity.

Our ER security do not have guns, but do have the whip out type batons. Haven't ever seen them use them. They do respond pretty quickly and take down violent patients.

Local PD shows up really fast when we call, they're great about it.