Abuse in Nursing

[stickit34]

I am honestly at the breaking point with this topic.

Why is it so acceptable for nurses to be abused at work? By patients and families, co-workers, physicians, etc.? I'm speaking mainly with patients and their families in this topic. The patients are allowed to hit us, spit at us, punch us, verbally abuse us, etc. and we can never do a damn thing about it. I'm usually told, "Well, that's the nature of the job." Since when is that an excuse?! Why are we not allowed to protect ourselves, and even allowed to press charges if we so choose? I'm so confused, and really this is making me hate my job because I have to deal with this at least once a week if not more. If this is "the nature of the job", then count me out.

Any opinions, comments? Help a girl understand here.

[friggasdistaff]

My question is why is verbal abuse acceptable? I understand people seeking medical care can be upset, but it is NEVER acceptable to verbally abuse anyone. We teach children that it is unacceptable to speak to each other in a hateful or rude manner, why shouldn't we expect to adults to behave respectfully?

[AdamantiteEnigma]

I'm so glad that there are people who also agree it isn't right! It gives me hope :) I like the idea of signing consent forms, because then the patient really knew that they were responsible for their actions.

For me alone, I've been punched in the stomach, pinched hard enough to break skin, grabbed and yanked, threatened and spat at. And that's not even counting the times I've had my butt slapped and pinched. I even had a patient grab my crotch! And I swear I am not a mean person at all!

The craziness we see at work!

Wish I worked with ya. I earned the nickname of anti-perv in my old hospital for my willingness to take these patients and shut down that nonsense. Personally, I blame the blue movie industry for this bizarre phenomenon.

Also, I'd drag in a co worker to witness someone attempting to do things like this. Witnessed inappropriate, assaultive behavior is worthy of 4 point restraints.

[Chisca, RN]

Health care is a dangerous profession. The incidence rate for violence against health care workers is more than triple the rate for all of private industry, according to the Bureau of Labor Statistics. From 2003 to 2009, eight nurses were killed on the job in the United States, and 2,050 nonfatal assaults occurred.

Tennessee has changed it's laws to make assault on a healthcare worker a felony. More states need to do this.

Assaulting health care workers about to draw steeper fines in TN | The Tennessean | tennessean.com

[Here.I.Stand, BSN, RN]

My question is why is verbal abuse acceptable? I understand people seeking medical care can be upset, but it is NEVER acceptable to verbally abuse anyone. We teach children that it is unacceptable to speak to each other in a hateful or rude manner, why shouldn't we expect to adults to behave respectfully?

Oh it's not! I will definitely call people out when they're behaving badly toward me or the CNA. I've even told pt's "I'll come back when you've gotten yourself together." Sometimes when my gut tells me this person is acting out of frustration (as opposed to just being a butt) I will say, "Yelling is not going to solve the problem. I can't help you like this." But I won't just be a verbal punching bag in the name of customer service, or because of some perceived excuse for bad behavior.

But aside from telling people to knock it off, there's not as much to actually do about it. We can call security, put on 4-point restraints, etc. for physical attacks, but we don't have one for the tongue.

(Although a couple of times I'll admit to doing a mental happy dance when the dr. said "We're going to intubate." lol)

[PMFB-RN, RN]

We had a recent, out of control young patient in the ER. His main diagnosis turned out to be ETOH intoxication, but he was brought in as altered mental status. He attacked another nurse and myself, started to have a major temper tantrum in the room, tried to intimidate us by looking at everyone's badge and saying that he had 'connections' (read, gang connnections), and that he would have us killed.

We called a code grey, got about 15 people in the room, got a spit mask and leather restraints. We eventually called the police. The police officer said that there was no point in pressing charges because the prosecutor's office didn't pursue things like this. That PO'd me. No back up from the governmental officials! Jeez!

Wow, once again I would like to know what state this is, so I can stay far away. In my state health care workers, including nurses, are a protected class. In the eyes of the law hitting a nurse is exactly the same as hitting a police officer.

Our hospital's policy is to call police and purse criminal legal action against anyone, patient, family, visitor, staff or whatever who uses violence again our staff.

[IChooseThisWhy]

Add my vote. Assaulting a healthcare worker in the workplace, when done by a patient in their right mind, should be a felony. We all work very hard to show respect to our patients, and to make the hospital experience safe for them.

I recently had a alert and oriented patient throw an object at my face. I'd only been in the room about 3 minutes when it happened, and the reason he gave to my charge nurse later was that he "just wanted to sleep".

The patient was awake when we entered, and we were doing bedside report. If I had not instinctively moved out of the object's path, I'd be typing this with one eye right now. The object shattered on the wall instead of my face. We left the patients room, then.

What bothers me most is that I called my charge nurse right after and told her I didn't feel it was safe for me to care for the patient. How can you take care of someone when you know that if you need to be close to them they may try to mutilate you or worse?

I made sure my charge nurse knew I was very concerned that if I had to still give this patient care, he might well have given another try at putting my eyes out. But, the charge nurse didn't reassign the patient. She was resistant to my even notifying the doctor.

(The doctor had to know because a major behavior change can be a symptom, so I did notify them. They didn't respond)

Shouldn't I have the right to not have to take care of a patient who has just tried to put my eyes out? Being forced to keep the patient made me feel that I was of no value to the charge nurse, or the hospital. Its not right, its not safe. If he had done that to me out on the street, I'd of called the police. Why is it OK to be attacked without cause while caring for a patient?

[banterings]

I think that you have to look at each situation. The football player needing the LP: I have been inebriated in my younger days, but I still realized that I would not want a LP under any circumstances. Our bodies are hardwired with "fight or flight." To a patient having procedures against his will, regardless of his state of ming and YOUR intentions to save his life, he still perceives it as an assault on his person.

Before all the stories of the guy with 2 bullets in him refusing treatment, look at how the patient is perceiving the situation.

Furthermore many ED protocols only serve to agitate the patient and escalate the situation:

"It's Time to Stop Strip Searching Psychiatric Patients" by Dinah Miller, M.D., Clinical Psychiatry News, April 2012

"Woman Forcibly Stripped by Male Guards Sues Beth Israel Hospital" New York Association of Psychiatric Rehabilitation Services

The latest citations at Arbour HRI were prompted by unannounced inspections in September and October, after a woman was forcibly strip-searched when she was admitted Sept. 4 ; last month Fowler called it “a very serious human rights violation.”

Instead of assigning an employee to monitor the patient until she agreed to be searched and dressed in a johnny, in accordance with hospital policy, the patient was restrained physically and with medication. She was stripped, with little regard to her privacy, inspectors found.

“There were many staff members, male and female, involved in this situation including but not limited to the maintenance staff,” inspectors wrote. Source: Boston.com

As to the use of restraints (WARNING, this video may be disturbing to some):

Video Shows Struggling Mental Patient Die In Restraint

Girl, 16, dies during restraint at an already-troubled hospital

DEADLY RESTRAINTS: PSYCHIATRY’S ‘THERAPEUTIC’ ASSAULT Source: Citizens Commission on Human Rights (CCHR)

The Citizens Commission on Human Rights (CCHR) is a nonprofit mental health watchdog, responsible for helping to enact more than 150 laws protecting individuals from abusive or coercive practices. Since 1969, the Citizens Commission on Human Rights (CCHR) has investigated and exposed deaths resulting directly from a psychiatrist’s “care.” As one of its first investigations, CCHR documented 100 unexplained deaths in California’s Camarillo and Metropolitan State hospitals. One 36-year-old man was found dead face down in a bed where he had been shackled with leather restraints. A grandmother was found dead in a hospital closet two weeks after the staff informed the family that she was missing.

I understand the need for safety of the staff, but you need to look at each situation and your facility's procedures. There are other nonprocedural factors too, such as time constraints and being rushed. Just because you do not feel that you have the time in a busy ED to "talk someone down," explain what's happening to them and why, and get consent from them does not justify labeling them in imminent danger and an exception to the informed consent rule.

I would rather be punched than charged with homicide.

The person who acts like a spoiled jackass, there is no excuse for them. Not that I justify or advocate it, but perhaps they just need a good smack.

The person who was just informed they have a terminal condition may be in one of the stages of grief (anger). They may just need someone to listen to them.

Just as with anything in life, it can become a slippery slope. Have we all not had a bad day and not been as nice as we could have been? I am NOT saying that I have all the answers, but I have found that if you treat people with respect, dignity, and have empathy for them, you can diffuse the situation.

Consider the extreme:

Nurse in Italy accused of killing 38 'annoying' patients

[icuRNmaggie, BSN, RN]

Add my vote. Assaulting a healthcare worker in the workplace, when done by a patient in their right mind, should be a felony. We all work very hard to show respect to our patients, and to make the hospital experience safe for them.

I recently had a alert and oriented patient throw an object at my face. I'd only been in the room about 3 minutes when it happened, and the reason he gave to my charge nurse later was that he "just wanted to sleep".

The patient was awake when we entered, and we were doing bedside report. If I had not instinctively moved out of the object's path, I'd be typing this with one eye right now. The object shattered on the wall instead of my face. We left the patients room, then.

What bothers me most is that I called my charge nurse right after and told her I didn't feel it was safe for me to care for the patient. How can you take care of someone when you know that if you need to be close to them they may try to mutilate you or worse?

I made sure my charge nurse knew I was very concerned that if I had to still give this patient care, he might well have given another try at putting my eyes out. But, the charge nurse didn't reassign the patient. She was resistant to my even notifying the doctor.

(The doctor had to know because a major behavior change can be a symptom, so I did notify them. They didn't respond)

Shouldn't I have the right to not have to take care of a patient who has just tried to put my eyes out? Being forced to keep the patient made me feel that I was of no value to the charge nurse, or the hospital. Its not right, its not safe. If he had done that to me out on the street, I'd of called the police. Why is it OK to be attacked without cause while caring for a patient?

Call the code for a violent and out of control person. No one will fault you.

Whether or not he is alert and oriented is irrelevant; he is dangerous.

Your charge nurse is clueless. Shame on her for hiding under the desk.

We do not get paid enough to deal with this by ourselves. This is a matter for the house supervisor and security. Use your resources.

And go get the AMA form ready so they can walk him to the door.