Can a Nurse Punch a Patient in Self-Defense?

Nurses General Nursing

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Nurse who punched patient back breached code - HDC

A nurse in New Zealand who reacted to being punched in the head several times by a mental health patient by punching the patient back, was found guilty of breaching the Code of Health and Disability Services Consumers' Rights and ultimately suspended.

At the time, a female patient had been admitted to a medium security mental health facility "due to increasingly changeable mood, psychosis and associated aggressive behaviours." "The patient punched the nurse several times in the head leaving her ear bleeding and her earring torn out."

The nurse in this situation was a new nurse and probably without the experience and training needed to work with such volatile patients. But, even with training and experience, situations happen. Nurses and other healthcare professionals become the target of sudden violence.

While hitting patients can certainly not be condoned, what do you think about acting in such a manner in self-defense? Have you ever been in a situation where you were the victim of bodily injury inflicted by a patient?

It sounds as if this nurse wasn't able to convince the adjudicating body that her actions were the minimum needed for self-defense.

Specializes in NICU, PICU, Transport, L&D, Hospice.

She would have gotten away with it if she was a LEO...

Specializes in MDS/ UR.

Easy to say what we'd do till we are in the situation.

I can find it probable that someone may have to resort to such extreme measures.

There is a lot of violence unleashed on health care workers.

Specializes in SICU, trauma, neuro.

If someone is assaulting me, especially to the point of drawing blood, "angel of mercy" image be darned. I'm not willing to become that poor elderly nurse who was bludgeoned by a pt's foot. I'm going to do whatever is in my physical capability to defend my person. I'd hope it wouldn't be my license that day--I would fight THAT tooth and nail too--but worst case scenario, what good is a license if I am too injured to work? Or too impaired to care for myself? Or even too psychologically traumatized to return to the scene of the crime? I'll say it again, I'm going to do whatever is in my physical capability to defend my person.

Specializes in Pediatrics, Emergency, Trauma.
Easy to say what we'd do till we are in the situation.

I can find it probable that someone may have to resort to such extreme measures.

There is a lot of violence unleashed on health care workers.

This.

I have been threatened; it had been about almost 10 years ago, but it was pt transitioning through dementia stages and threatened to "smash my head against the wall and watch it bleed" mind you he was in a very frightened woman's room; I Have also been propositioned as well, and I still don't know how well it would've been if my communication skills weren't as effective, or if the pts decided to advance on their promises. :eek:

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
"The patient punched the nurse several times in the head leaving her ear bleeding and her earring torn out."
Why in the heck was the nurse wearing earrings in psych? When I worked psych, people knew better than to wear earrings. Furthermore, no one wore stethoscopes around their necks since an unstable patient might use them to strangle staff.

Anyhow, I wouldn't know what to do in the aforementioned situation unless I was actually undergoing an attack from a volatile patient. Therefore, I will not participate in the Monday morning quarterback judgments.

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.
If someone is assaulting me, especially to the point of drawing blood, "angel of mercy" image be darned. I'm not willing to become that poor elderly nurse who was bludgeoned by a pt's foot. I'm going to do whatever is in my physical capability to defend my person. I'd hope it wouldn't be my license that day--I would fight THAT tooth and nail too--but worst case scenario, what good is a license if I am too injured to work? Or too impaired to care for myself? Or even too psychologically traumatized to return to the scene of the crime? I'll say it again, I'm going to do whatever is in my physical capability to defend my person.

Oh I totally agree. I would protect myself and worry about the consequences later.

Why in the heck was the nurse wearing earrings in psych? When I worked psych, people knew better than to wear earrings. Furthermore, no one wore stethoscopes around their necks since an unstable patient might use them to strangle staff.

Exactly. What was she thinking wearing earrings?!?!?!?!?!?!? She was definitely a newbie.

My humble opinion: Our own personal well-being is of the utmost importance. We cannot serve ourselves, much less others, when incapacitated. A physical assailant has broken social code, and the "rules" no longer apply. Self-defense must be not only tolerated, but encouraged by those for whom we work. The psychological woes of a patient are indeed important, and we address them daily; however, at no point are we to accept physical assault. It benefits no one. It is neither therapeutic nor excusable. I am just as compassionate, sometimes even more so, than the next guy or gal... but I will NOT be a victim, nor should you. Ever. Period.

I am not familiar with New Zealand's "Code of Health and Disability Services Consumers' Rights," nor do I care to be. All I know is that accepting a position of RN or any other health discipline is not a surrenderance* of your basic human right to life and freedom from suffering. Review boards may consider your behavior unsavory and perhaps *gasp* bad for business... but you've lived to explain yourself. That's worth something... wouldn't you say?

*I may have created this word. So punch me. ;)

Specializes in SICU, trauma, neuro.

True...not the wisest move there.

Why in the heck was the nurse wearing earrings in psych? When I worked psych, people knew better than to wear earrings. Furthermore, no one wore stethoscopes around their necks since an unstable patient might use them to strangle staff.

I've thrown people to the ground (ETOH/psych/HI) and shoved my knee hard into the back of a guys neck when he tried to rush me after I pinned him down. I wouldn't think twice about knocking a patient out who became violent and attempted to assault me. How is this even a question? Where else in real life would someone allow themselves to be assaulted and not fight back?

I feel like I am a cop with drugs sometimes....

Specializes in Leadership, Psych, HomeCare, Amb. Care.

Here is the whole 33 page report: http://www.nzdoctor.co.nz/media/3410719/12hdc01008.pdf

A few observations.

It gives us the events, but not really giving us a vivid picture. It appears that there were some performance issues that were not formally followed up with in the past. The nurse insisted on giving the IM emergency medications even though she had just been assaulted. This was the first time she had been assaulted and admitted she overreacted.

The report acknowledges the right to defend oneself in an attack, but they felt Nurse B went beyond that. The nurse was taught deescalation, which was not followed. The documentation was sketchy, saying the patient was verbally abusive, but did not describe what was said. Me, I will document any threats or insults verbatim and un censored to convey paint an accurate picture.

It appears she overreacted, which was unfortunate. From the report, it sounds like the worst punishment came from Nurse B herself.

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