Stop the Silence...Violence Against Nurses

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    Violence in the workplace is higher in nursing than most other fields of work. Have you ever been attacked by a patient? What are our rights as nurses? I share my story and some insight for you, as well as free resources.

    Stop the Silence...Violence Against Nurses

    "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:
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    34 Comments

  3. by   Daisy4RN
    It is absolutely absurd that in this "modern world" this violence is allowed to happen to nurses. You are right that no other profession accepts violence as "part of the job". The move from administration to "customer service" has only made this problem worse. I was told in hospital orientation that there is nothing I could do if a patient assaulted me, this was backed up by the union (yes that's right, the union). While I know that some patients don't know what they are doing many who commit these violent acts do know exactly what they are doing, and do it because they get away with it. This needs to stop!
  4. by   Flatline
    Quote from Daisy4RN
    It is absolutely absurd that in this "modern world" this violence is allowed to happen to nurses. You are right that no other profession accepts violence as "part of the job". The move from administration to "customer service" has only made this problem worse. I was told in hospital orientation that there is nothing I could do if a patient assaulted me, this was backed up by the union (yes that's right, the union). While I know that some patients don't know what they are doing many who commit these violent acts do know exactly what they are doing, and do it because they get away with it. This needs to stop!
    The only people who allow violence against nurses are nurses themselves.

    Your employer and union do not and cannot supercede state and federal laws on assault. I would be surprised if your facility did not have nearly an entire book on the matter in their P&P, you just have to read it.

    Even if they didn't, I cannot walk into your hospital and do whatever I want because there isn't a policy on it. Think about it logically...

    There is a vast difference between LAWS and employer RULES. Know the difference, it is your responsibility to.
  5. by   Daisy4RN
    Quote from Flatline
    The only people who allow violence against nurses are nurses themselves.

    Your employer and union do not and cannot supercede state and federal laws on assault. I would be surprised if your facility did not have nearly an entire book on the matter in their P&P, you just have to read it.

    Even if they didn't, I cannot walk into your hospital and do whatever I want because there isn't a policy on it. Think about it logically...

    There is a vast difference between LAWS and employer RULES. Know the difference, it is your responsibility to.

    I understand the difference between hospital rules and penal codes! It is NOT nurses who "allow" abuse and violence to themselves. Most hospitals and police etc. do nothing about violence, just try to press charges, you get something like, "Oh the patient isn't well...blah blah", nothing happens, or from admin you get "Well what did you say to upset the poor patient, ...blah blah". Most hospitals you actually can walk in and do what ever you want because admin etc. doesn't want to upset the patient and family. This has been my experience at hospitals, do you work in a hospital, maybe yours is more supportive of nurses/staff.
  6. by   FutureNurseInfo
    Quote from Daisy4RN
    It is absolutely absurd that in this "modern world" this violence is allowed to happen to nurses. You are right that no other profession accepts violence as "part of the job". The move from administration to "customer service" has only made this problem worse. I was told in hospital orientation that there is nothing I could do if a patient assaulted me, this was backed up by the union (yes that's right, the union). While I know that some patients don't know what they are doing many who commit these violent acts do know exactly what they are doing, and do it because they get away with it. This needs to stop!
    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.
  7. by   macawake
    Quote from Daisy4RN
    You are right that no other profession accepts violence as "part of the job".
    Many professions are exposed to an increased risk of threats and violence and healthcare is definitely one of them. Others are for example law enforcement, social workers, judges, the military. Perhaps also convenience store clerks? Bank tellers? I'm sure that you agree that other professions also run a risk of encountering aggressive behavior.

    I was told in hospital orientation that there is nothing I could do if a patient assaulted me, this was backed up by the union (yes that's right, the union).
    I'm not a U.S. nurse so I accept the fact that there might be cultural/policy/legal differences at play here, but what exactly did your employer mean when they said that staff "could do nothing" if a patient assaults them? Did they mean that you can't run away if someone attacks you? (in the cases when that's a viable option). Did they mean that you are not allowed to physically defend yourself or a coworker? Or did they mean that you have no legal recourse once an assault has taken place?

    If all of the above apply, that's truly terrible but I have to wonder if that's down to hospital policy and what management wishes in order to avoid negative publicity or if the law actually offers a nurse (or CNA or physician) less protection than it would any other person?

    As I said, I practice in another corner of the world and my experiences may not be generalizable. I would never hit a person with senile dementia or traumatic brain injury who came at me swinging his/her fists but I have caused bodily harm that required medical attention/surgery on a patient who tried to stab one of my ER coworkers. Nothing ever came from that. The coworker who the patient attacked pressed charges, my actions were deemed as self-defense and the patient was subsequently prosecuted for the knife attack.

    The point I'm trying to make is that I would be surprised if the law doesn't allow you the same rights. I understand that an employer can apply pressure hoping the possibly unwanted bad PR will just disappear, but I can't imagine that they can infringe upon your legal right to not be criminally assaulted. That said, as healthcare workers we have to accept a certain level of risk. If we know that people are affected by disease processes that make them less than rational/in control of their actions, our best course of action is in my opinion to utilize many of the strategies mentioned by OP.

    We need training in how to identify behavior patterns that signal an increased risk of an impending violent attack, we need to be good at de-escalating volatile situations and be aware of our positions in the room and in relation to the patient who might pose a risk. I hold employers responsible for providing the necessary training and it should include "refresher" courses on a regular basis as needed, especially for those healthcare staff who work in environments most prone to threats and violence.


    Edit: Oops. I took forever writing this response (blabbing on the phone at the same time ) and I just noticed that there have been several posts made after the one I responded to.
  8. by   Daisy4RN
    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).
  9. by   Flatline
    Quote from Daisy4RN
    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).
    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?
  10. by   Here.I.Stand
    Quote from Daisy4RN
    I was told in hospital orientation that there is nothing I could do if a patient assaulted me,
    Yeah no...that doesn't work for me, and it shouldn't work for you either. They cannot prevent you from calling 911, going to the police or the DA, or going to the media if needed. I live not too far from a well-publicized case of assault against nurses, so doubt that the hospital would want THAT kind of publicity -- the employer who cares nothing for occupational safety...against the most trusted profession, no less.
  11. by   GeminiNurse29
    I work with forensic psych patients and a lot of geriatric psych/demented patients. In forensics, they're all there Bc they committed some horrible crime, assault, or murder or something. While you have a greater chance of being seriously injured on a maximum security unit, there's more options like seclusion, restraints, and more staff usually. On a minimum or medium unit, it's more rare. And frankly, the geriatric unit is more physical than all the other units. Guys have assaulted staff, admin is reluctant to use restraints (Bc you know, "old" people don't know what they're doing), and they don't get locked down so patients are wandering around at all hours of the day or night. And sadly, the population is getting younger so you get these people who are middle age, not just frail little old ladies, and they have the physical strength. If nursing or techs get assaulted, we fill out an incident report and go from there (usually just to cover medical exams, justify time off). If patients assault doctors or rehab though, they get shipped out to the maximum units. Yeah, nurses aren't high on the pecking order. Admin reasons that it's a psych hospital and people are mentally ill. Some frankly are just @$$holes and criminals and belong in prison.

    I paln to get out as soon as possible.
  12. by   offlabel
    Silence? What silence? Like there is some big secret about working in the ER or other unpredictable patient care areas? What, someone sees an opportunity to cash in on BLM-esque tactics for political gain? Save it. And how does bullying in nursing have anything at all to do with the video examples (with dramatic music) of lunatics suddenly coming out of no where and terrorizing a bunch of nurses? Separate issues entirely.

    Be a grownup, know the risks of where you work and manage them like a professional. The era of power through victimhood is over. Get over it.
    Last edit by offlabel on Mar 25
  13. by   ArrowRN
    Quote from offlabel
    Silence? What silence? Like there is some big secret about working in the ER or other unpredictable patient care areas? What, someone sees an opportunity to cash in on BLM-esque tactics for political gain? Save it. And how does bullying in nursing have anything at all to do with the video examples (with dramatic music) of lunatics suddenly coming out of no where and terrorizing a bunch of nurses? Separate issues entirely.

    Be a grownup, know the risks of where you work and manage them like a professional. The era of power through victimhood is over. Get over it.
    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".
  14. by   Beldar_the_Cenobite
    I believe I read somewhere that nurses do have the right to a safe workplace. In the even that any employee is harmed should be protected by security. Something a medical workplace involving patients should have. If they don't, they're putting at risk a list of things within the facility besides nurses being beaten such as medical records, potential hostage crisis, weapons manufacturing using certain drugs or illnesses extracted from patients to create biochemical weapons, patient safety is at risk, etc. Families will want security for the facility if something happens to them. At any time I feel endanger of my life I'll either raise my voice or force my way to a phone and call police. Violence and mistreatment should not be part of the job. Quality of patient care shouldn't be watered down so low to the point that being beaten is okay. I'd file a complaint with Dept. of Labor and Human Resources. To me, violence in the workplace is the equivalent of a domestic violence in the home. Same thing.

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