Stop the Silence...Violence Against Nurses

Violence in the workplace is higher in nursing than most other fields of work. What are our rights as nurses? I share my story and some insight for you, as well as free resources. Nurses Announcements Archive Video Knowledge

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"What do you mean they are taking my baby away? I won't let them; I won't let you!" And just like that, she spit in my face.

Spit-In-My-Face

I cared for her during the worst pain she had giving birth, helped her through her heroin withdrawal, educating her how to take care of her new postpartum body, she has now that she became a mother, and she...spit...in...my...face.

At least it was spit and not another gun in the patient garbage can we found last year from the drug dealer father down the hall, or the poor nurse beaten in our dark parking lot because she didn't have any cash to give the hobo on the street.

At least it was only spitting is what I told myself.

I felt ashamed like I did something wrong. Maybe I shouldn't have said or put her in that situation, scared what her friends and family may do to me (who had not one ounce of control over her custody situation).

I wanted to go home that day, but I didn't, and I am not alone in how I was feeling. Nurses accept violence from patients, and it is uncalled for.

Violence Against Nurses

Though the public is not aware, many nurses experience violence within the workplace. It is estimated that within the last year, one in four nurses were physically attacked at work.

Who knew nursing could be such a dangerous job? Patients attack nurses because they are sick, mentally and physically. Sometimes, like the situation I was in, patients become upset with nurses for not giving them the answers they want. Therefore, patients may attack nurses before they can be restrained.

Right now, no federal law for the protection of nurses from violence exist. Some states have taken into their own hands and created their own specifications like programs that teach violence prevention. Though, the American Nurse Association has set out a model bill for states to follow to help develop protection for nurses.

What nursing job is at the most risk?

The nurses in the ED are the ones who are at the most risk for injury. Often, they receive the patients that are belligerent from alcohol intake, off their psych meds, or irate because they are not receiving care fast though. Often times, you will see the hospital security officer stationed in or near the Emergency Room.

Male nurses, in the ED, are at the highest risk for assault from patients. They are often called to help with violent patients, and often do not hesitate to help protect their female coworker.

Why nurses? Well, we are the ones caring for the patients, with the longest and face to face interaction. In 2014, the Journal of Emergency Medicine reported that three in ten nurses were assaulted on the job with "long waits, delayed pain medication, and mental illness being the three leading factors that led to violence," per the Journal of Emergency Medicine.

How to stop violence from patients

There are a variety of de-escalating techniques nurses should try when a patient becomes violent, or you anticipate they will be violent. Oftentimes, patients react because they are mentally ill or irate just as my patient was because she lost custody of her baby.

Preventing violent acts

Beyond the training recommended for nurses, the ANA also recommends:

  • Key areas, like the ED and behavior health centers, should have security guards present.
  • Mock situations practiced to have a clear system for dealing with aggressive behavior before it turns into violence and for summoning security personnel.
  • Keeping the hospital lit at night, inside and out.
  • Always tag the chart if the patient has a violent history.
  • Staffing design to keep nurses together with violent patients, and never to be alone
  • Making sure nurses know whom to call to report the violent incident in their department.

OSHA has also released a 60 page free resource for healthcare workers regarding violence within the workplace: Free Resource

If you want to take a course, the CDC offers a free one for nurses: Free Course

You have to know that it is your right to be safe at work. Be smart about your safety. Take extra courses on violence within the workplace and educate yourself as much as possible. Talk to your director and security officers if you notice a problem that can be fixed.

A great video from YouTube on nurse violence:

rescueninja1987 said:
I have told patients and families on a few isolated occasions that I was going to call the police and file a report, but usually they straighten up after that and I don't actually follow through with it. I got pretty good ad de-escalation working in psych but definitely don't have the "It would never happen to me" mentality. Working in ICU I am more afraid of some idiot trying to punch buttons on a vent or IV pump than I am being assaulted.

It would be nice if machines were either in a container that was locked or had a security system where your thumb or doctors thumb were administrators that could unlock the device so that way no one can temper with it.

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Specializes in MDS/ UR.
TheAtomicStig_702 said:
In a clinic, she was sprayed with lighter fluid and died? Did people just stand around and watch the fire eat away at her skin? No smoke detectors or ceiling things went off? No fire extinguisher nearby? No stop drop and roll? No one tried to put out the fire? She was literally that combustible? When the mentally disturbed patient walked in, did anyone see a big gas container and a lighter in their hand? Or did they just let them waltz on in?

Btw, how did a mentally disturbed patient WALK IN a clinic? Why were they outside to begin with? If they were from another clinic? How did they get passed staff and security?

A quick spray in the face and neck region and ignition- it can be over in a minute.

It is easy to be the arm chair quarterback...

Your words come across real judgmental, I hope I am getting the wrong vibe.

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ArrowRN said:
No it's not over, maybe you never had a 250lbs 6 foot dude run up to you and push you into the wall. That was one of the scariest things I ever been through in nursing. Not just at the actions of the guy but I feared for the rage I had in me when a swore an oath to do no harm. This was not in ED it was on the floor. I got a huge temper and had I not withhold myself I probably would have loss my RN license and punched the hell out of that patient. I was nervous to return to work for several weeks. I find your remarks condescending to say the least. Go tell a rape victim to just "Get over it".

I never swore any oath to "do no harm". That's for doctors and it isn't an oath not to defend one's self. I couldn't begin to recall the number of times a patient tried to hurt me but I do remember one that tried to stab me (I still have the knife).

Condescending is in the eye of the beholder and why does everything go to "rape?" Are we talking about sexual assault here? Clearly a different conversation.

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Specializes in OMFS, Dentistry.

My husband is a paramedic. He had a combative patient rip off his restraints and try to escape the ER. Ultimately my husband is responsible for that patient and the two of them got into it. In the end, my husband tore all ligaments in his knee and was out of work for months. Not only did this patient hurt my husband, but he also hauled off on another paramedic and broke his arm moments later. We live in a state where A&B on an emergency technician will get you 90 days - 2 1/2 years in the House of Corrections or a fine. You know what happened? NOTHING....

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- police

- military

- security

- teaching in inner city

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Specializes in Trauma, Teaching.

In my state assault (verbal) is a misdemeanor, threatening bodily harm or death & physical battery are felonies, when done to a health care worker in pursuit of duties.

I was bitten, my coworkers and I tackled to the floor: Police reports, photos, grand jury and conviction on two counts of battery on a health care worker. My hospital never even suggested that we not pursue it.

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Specializes in Cardiac Telemetry, CCU, ED.
FutureNurseInfo said:
I do agree with the other poster. Just because the hospital you work for has no clear rules/procedures against violence by patients, does not mean you cannot call the police and file a police report against the violent patient.

Unfortunately, most will then find themselves unemployed.

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Specializes in Travel, Home Health, Med-Surg.
Flatline said:
Honestly this sounds like a personal issue, we as healthcare professionals are certainly expected to understand but please do not confuse that with tolerate.

Understand =/= Tolerate

I have called the police on a patient, I have called on the behalf of my nurses, I have seen others call. I am not sure where you are getting this tolerate thing from?

I think nurses tend to shrug off violence to some degree as knowing it is not worth their time (who hasn't) but I do not know about some widespread conspiracy to accept abuse just because we are nurses.

I personally have let things go like being bit by someone confused simply because I got the pleasure of throwing a 4 point restraint on them...plus I had enough charting with q15min assessments and didn't want to fill out anymore paperwork...but I do not think that is what you are talking about, or is it?

If by "personal issue" you mean I would not like being verbally abused, spit on, have things thrown at me etc etc, then yes its personal.

I am not talking about confused/dementia pts etc. (obviously I understand the difference!), I am talking about those who know exactly what they are doing, and do it (violence), because they know they can get away with it. I am glad that not all hospitals allow this culture of violence, but it has been my personal experience (at more than one hospital) to observe this abuse of staff. I don't think that there is some conspiracy (from nurses) to accept violence, I think that they do (accept it) because admin allows the culture to continue, as I stated their responses like...Oh the poor patient... etc, and as others have stated, if staff says anything then bye bye employee.

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Daisy4RN said:
If by "personal issue" you mean I would not like being verbally abused, spit on, have things thrown at me etc etc, then yes its personal.

Seeing as Flatline's post was in direct response to your previous post...

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I also realize that many other people/professions are at risk, but I think that, in general (with exceptions like police etc), nurses are supposed to tolerate and "understand" that the patients are just sick etc (therefore cant control themselves) ...and other professions do not tolerate this behavior (spitting on the OP etc).

... I'm guessing that's not what Flatline meant at all. Few people want to be spat on, verbally or physically abused or otherwise assaulted.

I think that what Flatline meant, and what I know that I mean, is that the idea that nurses are supposed to tolerate violence is a construct of your own making.

Several posters, myself included, have argued that we don't feel like we have to tolerate assaults, and we don't. I don't believe that you have to tolerate it either.

Quote
I am glad that not all hospitals allow this culture of violence, but it has been my personal experience (at more than one hospital) to observe this abuse of staff. I don't think that there is some conspiracy (from nurses) to accept violence, I think that they do (accept it) because admin allows the culture to continue, as I stated their responses like...Oh the poor patient... etc, and as others have stated, if staff says anything then bye bye employee.

Is it an actual common occurrence that a nurse first gets assaulted, then exercises his/her legal right to notify law enforcement regarding the assault/battery and subsequently gets fired? Is this something you are afraid could happen or have you actually experienced this? Personally, I don't understand why anyone would take that lying down. I would raise absolute hell if my employer did that to me or anyone I worked with.

Now I'm lucky in that I live and work in a country were you can only be terminated for cause, but I'm willing to bet that even in countries with more "employer-friendly" laws, employers avoid bad publicity like the plague. If an employer fires a nurse because s/he was assaulted, raise a stink. Employers, just like most people, only do what they think they can get away with. Make the option of firing a nurse the least appealing one for them. If they don't understand that assault and battery is illegal, even when perpetrated against healthcare professionals, they may need to be reminded about that fact.

I don't think the root of the problem is the culture of the respective hospitals we work for (even though I admit that it's preferable to work for a supportive employer), the solution to any problems you feel you have with tolerating violence in the workplace lies with you and your coworkers. You have that power. My advice is that you use it.

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Daisy4RN said:
If by "personal issue" you mean I would not like being verbally abused, spit on, have things thrown at me etc etc, then yes its personal.

I am not talking about confused/dementia pts etc. (obviously I understand the difference!), I am talking about those who know exactly what they are doing, and do it (violence), because they know they can get away with it. I am glad that not all hospitals allow this culture of violence, but it has been my personal experience (at more than one hospital) to observe this abuse of staff. I don't think that there is some conspiracy (from nurses) to accept violence, I think that they do (accept it) because admin allows the culture to continue, as I stated their responses like...Oh the poor patient... etc, and as others have stated, if staff says anything then bye bye employee.

By personal issue I mean that your own victimhood, failure to act, and ignorance has not just allowed but encouraged any culture of acceptance that you have seen. Are you telling me you were witness to multiple violent crimes at multiple facilities? Did you call the police in these occasions? If the answer is no then you are the culture of acceptance.

The hospital is an employer, they are not your mother, they are not the police, they are a company...that's it.

If you are a victim of violent crime, or see someone else become a victim, then it is your duty to pick up the phone and make the call to the police. Lets wear our big girl/boy pants.

Violence supersedes policy any day. Federal Law>State Law>Local Law....waaaaay down the list below the instructions on your mattress tag are facility policies.

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Specializes in Travel, Home Health, Med-Surg.

Like I said, I am glad that there are hospitals etc that do not allow the abusive/violent culture. Just because you haven't experienced a workplace like that doesn't mean that they do not exist, and its not as easy as you may think to "act", this is not ignorance. Maybe you should not judge until, as they say, you walk a mile.... I guess we agree to disagree.

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