What do you do when a patient threatens harm?

  1. So far in my short few months on the floor I've already had a bunch of patients threaten to hit me. Every time I get threatened or yelled at by the public all I can think of is that I'm not getting paid enough to put up with this ****.

    What do you do when someone just threatens violence? If I just called security on my ascom who knows when they would show up. But I don't feel the need to call a code since nothing is actually happening & I don't want to make the patient more irate.

    Yesterday I was trying to remove a patient's IV (she was being D/C'd). She had paper thin skin & lots of tape. I was trying to go as slow as possible & use ETOH pads & then hand sanitizer. She wasn't good with pain & at one point she said she was going to punch me in the face. What do you do in a situation like that? I just quickly changed the conversation & de-escalated her, then she was fine.
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    About OrganizedChaos, LVN

    Joined: Aug '13; Posts: 7,895; Likes: 19,976

    61 Comments

  3. by   elkpark
    Quote from OrganizedChaos
    What do you do in a situation like that? I just quickly changed the conversation & de-escalated her, then she was fine.
    That's what you do.
  4. by   ruby_jane
    And document. In quotes. "Patient said she would punch me in the face." And document what you did to de-escalate (which was really good, BTW).

    In the example you gave, pt was leaving but maybe she'll be back.

    Also make sure you're aware of where you are in relation to the door every time, and do your best to be closer to the door than your patient is. This is more of an ambulatory nursing thing but a quick exit may be your friend.

    Is that going to help you not get hit? Nope. Probably someone's going to swing at you. It's happened once in the 10 years I've been a nurse. And if it comes to it - yell for the code. That's going to get people where you are if you're really in danger.
  5. by   OrganizedChaos
    Quote from ruby_jane
    And document. In quotes. "Patient said she would punch me in the face." And document what you did to de-escalate (which was really good, BTW).

    In the example you gave, pt was leaving but maybe she'll be back.

    Also make sure you're aware of where you are in relation to the door every time, and do your best to be closer to the door than your patient is. This is more of an ambulatory nursing thing but a quick exit may be your friend.

    Is that going to help you not get hit? Nope. Probably someone's going to swing at you. It's happened once in the 10 years I've been a nurse. And if it comes to it - yell for the code. That's going to get people where you are if you're really in danger.
    Thank you. I just wanted to make sure I did the right thing. I'm new to floor nursing & it's a huge adjustment to me.

    It's really a shame we have to put up with all of this harassment whether it be verbal or physical. I was treated with more respect by INMATES when I worked in corrections!!! I got more please/thank you/you're welcome/yes ma'am/no ma'am. It just turns my stomach to see how everyone is treated.
  6. by   Crush
    Quote from ruby_jane
    And document. In quotes. "Patient said she would punch me in the face." And document what you did to de-escalate (which was really good, BTW).

    In the example you gave, pt was leaving but maybe she'll be back.

    Also make sure you're aware of where you are in relation to the door every time, and do your best to be closer to the door than your patient is. This is more of an ambulatory nursing thing but a quick exit may be your friend.

    Is that going to help you not get hit? Nope. Probably someone's going to swing at you. It's happened once in the 10 years I've been a nurse. And if it comes to it - yell for the code. That's going to get people where you are if you're really in danger.
    Exactly what ruby jane said. Document, document, document. Utilize good verbal de-escalation. Know where the closest escape route may be. If the patient has threatened you once, be sure a co-worker knows you are heading in there again. Doing all the above is not a guarantee of not getting hit/assaulted though but it is good prevention.
  7. by   LonghornChic
    If de-escalation doesn't work then I assess their mental status. If they are pretty oriented and know what they are doing then I say "since you know what you are doing then I should inform you that hitting a nurse is considered a felony". I ususally get an apology afterwards and make sure to document that interaction. We let ourselves get abused too much.
  8. by   OrganizedChaos
    Quote from Crush
    Exactly what ruby jane said. Document, document, document. Utilize good verbal de-escalation. Know where the closest escape route may be. If the patient has threatened you once, be sure a co-worker knows you are heading in there again. Doing all the above is not a guarantee of not getting hit/assaulted though but it is good prevention.
    That is very true & is such a shame. Thank you!
  9. by   OrganizedChaos
    Quote from LonghornChic
    If de-escalation doesn't work then I assess their mental status. If they are pretty oriented and know what they are doing then I say "since you know what you are doing then I should inform you that hitting a nurse is considered a felony". I ususally get an apology afterwards and make sure to document that interaction. We let ourselves get abused too much.
    We really do. I had a conversation with a coworker about it yesterday. I can't tell you how many times a code is called for security. We should be able to carry mace.

    There was a patient on the floor who got irate & had a pocket knife. You're telling me I have a whip out my ascom, call a code & wait for security to get there?

    It's one thing if a patient is verbally abusive when if someone ever starts to become physically abusive with me, I will do whatever it takes to protect myself. I have 2 little ones at home & I want to go home at the end of the day.
  10. by   hherrn
    Quote from ruby_jane
    And document. In quotes. "Patient said she would punch me in the face." And document what you did to de-escalate (which was really good, BTW).

    In the example you gave, pt was leaving but maybe she'll be back.

    Also make sure you're aware of where you are in relation to the door every time, and do your best to be closer to the door than your patient is. This is more of an ambulatory nursing thing but a quick exit may be your friend.

    Is that going to help you not get hit? Nope. Probably someone's going to swing at you. It's happened once in the 10 years I've been a nurse. And if it comes to it - yell for the code. That's going to get people where you are if you're really in danger.
    Good points. But, when you use quotes, what goes between the quotation marks is exactly what was said:
    Rather than "Patient said she would punch me in the face." , use patient stated "I am going to punch you in the face."


    Also- distinguish between bad behavior in which there is no actual threat, and real danger, and act accordingly. As a fit 180 lb man, my level at which I am concerned for my safety my be different from somebody else's. But, my safety comes first. By a long shot.

    Threatened by a visitor or family member? Call security. If security is ineffective or non existent, call the police.
  11. by   elkpark
    Quote from OrganizedChaos
    We really do. I had a conversation with a coworker about it yesterday. I can't tell you how many times a code is called for security. We should be able to carry mace.

    There was a patient on the floor who got irate & had a pocket knife. You're telling me I have a whip out my ascom, call a code & wait for security to get there?

    It's one thing if a patient is verbally abusive when if someone ever starts to become physically abusive with me, I will do whatever it takes to protect myself. I have 2 little ones at home & I want to go home at the end of the day.
    Be aware that if you "protect yourself" using any techniques or weapons outside of what hospital policy approves, you are opening yourself up to possible criminal charges, as well as discipline from your employer.
  12. by   Sour Lemon
    Quote from OrganizedChaos
    We should be able to carry mace.
    Well, that's a rather entertaining thought! I respond to threats based on how credible they appear to be. Sometimes, I simply ignore the threat. Other times, I leave immediately and return with a full show of force, if need be.
  13. by   Horseshoe
    Quote from OrganizedChaos
    We really do. I had a conversation with a coworker about it yesterday. I can't tell you how many times a code is called for security. We should be able to carry mace.

    There was a patient on the floor who got irate & had a pocket knife. You're telling me I have a whip out my ascom, call a code & wait for security to get there?

    It's one thing if a patient is verbally abusive when if someone ever starts to become physically abusive with me, I will do whatever it takes to protect myself. I have 2 little ones at home & I want to go home at the end of the day.
    What kind of "code" would you be calling? Does your facility have a "code green" or some such that reflects a threat made against your person?
  14. by   Here.I.Stand
    First, I would remove myself out of their striking range and attempt to verbally de-escalate.

    My hospital has a behavioral emergency code, which is responded to by security and psych charge nurse. Our security staff carry tasers, and the RN brings a set of 4-point leathers.

    Security RUNS when these are called.

    If I were in immediate, life-threatening danger -- e.g. hands around my neck -- I would do absolutely anything to protect myself. My husband has black belts in both kung fu and taekwondo, plus went through RoK army training, and he taught me some serious self-defense techniques... but I'm not above fingers in eyes or a knee in the groin.

    If that same person was doing that same action on the street, I would react exactly the same in the hospital.

    Legal trouble? People are allowed to protect ourselves -- if the assailant is killed the victim isn't charged with murder, right? Besides, Maslow's Heirarchy people. My need for survival is more than my need to avoid a courtroom.

    BUT, my hospital requires "run, hide, or fight" as part of our annual required training. The "fight" option is last resort, but if we need to we fight to prevail (or something to that effect.) Methods -- per hospital's training video -- include throwing heavy and sharp objects. I guess they don't want us to be another St John's?

    I do NOT recommend calling a code, unless hitting that button is all you can do. Again, if pt strangling me so can't scream but in reach of the button. 1) the vast majority of violence is not immediately life threatening. We don't need the pharmacist and chaplain and the legion of med students who typically come running to the code; nor do we need the crash cart or heavy LUCAS device. 2) It sounds like this is a frequent occurance on your unit. If each results in a code being called, I can see this becoming a boy who cried wolf situation.

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