Got slapped by pt. Staff splitting. Need feedback.

[wonderbee, BSN, RN]

I got slapped by a pt. at the med window. Pretty hard too I might add. She took a dislike to me for no particular reason she can articulate and I can't fathom. Her consequences were wing restriction. While on wing restriction, I brought her a PRN for agitation. Of course she was verbally abusive and told me she wanted another nurse. I told her I was her nurse today and that wasn't going to change. She could choose to take her meds or not take her meds. The choice and the right was hers. I was professional and kept my cool with her.

What do you think happened? The charge nurse told her she would assign another nurse to administer her meds. Every nurse that went in there to give her her meds listened to a tirade of how she hated me. I felt that she was rewarded for her bad behavior, and this set up a staff splitting situation. Now she thinks she can get what she wants by misbehaving and worst, physical aggression against staff.

There are two schools of thought here that came up. 1. The goal is to get the meds in the patient and stabilize so let's get another nurse. The other is 2. The patient was successful in her staff splitting and has learned that physical aggression works to her benefit.

I'd like to know what others think.

[PMHNP10]

yep, she split y'all; too bad; what was her admitting Dx (other than the Axis II)? you set limits and either she should conform or she will have a rough go of it; giving in to patient demands reinforces bad behavior; who's to say whe wouldn't have eventually agreed to take the meds; and if she doesn't and her behavior continues to escalate, and if redirecting, removing from milieu, etc. don't work, then maybe it's time for you to medicate her whether she likes it or not

[aloevera]

typical borderline....I don't agree with the charge nurses's actions to give her another med nurse....frankly, I am very surprised that she would do that....I agree with psychRN03..now the pt. knows she can play the nurses...not good...should have not changed med nurses and if escalated, do what we do....medicate !! she would have tried a differenct tactic next time...now she thinks she has succeeded,

just my opinion....

[Thunderwolf, MSN, RN]

Interesting, physical aggression= wing restrictions

Hugs to you.

[wonderbee, BSN, RN]

This patient has since slapped one of the docs and pummeled another patient. Still no locked seclusion. We're lost. Who are the ones not playing with a full deck here. The patients or the staff?

[inthesky]

this is really wrong; im so sorry that you are dealing with it. I can't believe that whom ever is in charge is allowing the patients to be unsafe!! I don't know what you do when your workplace takes no one's safety into consideration, but I would not want to work there.

this patient belongs in jail, in my opinion. You don't get to assault others just because you are mentally ill.

[Little Panda RN, ASN, RN]

RNKittyKat,

I am sorry to hear about what you are going through. This is the exact reason I left where I was working. Management did not take staff abuse seriously. One nurse I worked with was actually punched in the face and another one was ambushed had a blanket thrown over her, name badge taken and then slapped across the face by two adolescents and nothing was done.

I refuse to work in an enviornment like that. I do hope and pray that things get better for you.

Heres sending hugs your way!!!

[Vito Andolini]

Wow, I'm not a Psych expert but I'm surprised that an attack on other patients and a doctor changed nothing. What does your manager have to say as to why such violence is tolerated? Maybe if the manager got hurt, things would change.

[Thunderwolf, MSN, RN]

Ditto, Vito.

Poor management on this unit.

[wonderbee, BSN, RN]

I've put in my request to go into the casual pool. Very casual. Yes, I have to agree that management is poor to nonexistent. I think a lot of it is attributed to working short. It's easier and less time consuming to send a patient to his/her room than fill out a slew of paperwork for restraint/seclusion and have to find additional staffing for close obs. Management and I and all of the nurses disagree on what is considered safe staffing and working short. I think we're always working short. Now they're going to be working even shorter. Too bad.

[oldladyRN]

I am so sorry that this happened to you. She definitely split staff, no question about it. Your manager was in the wrong and her behavior was reinforced by allowing her additional interaction with other nurses.

Where I work, here's what would have happened: Mary Smith (aka Slappy) would have approached the med window, told me what a sorry b*&^% I was and gave me a slap. The staff would have then placed her in a restraint (because she had already demonstrated the fact that she was a danger to others) and she would have had to de-escalate while in the restraint (which can go on for a maximum of only 15 minutes) as well as commit to safety and better behavior. If she continued to struggle and/or was unable to make these commitments, she would been transitioned to the restraint chair for a maximum initial term of 4 hours.

With patients having a personality disorder, consistency is vital. You were correct in telling her that you were her nurse and that that was not going to change just because she threw a fit. If she had already slapped you and had been placed in the hold, her meds probably should have been administered IM. Once a patient is in any sort of restraint, the game changes. PO meds are no longer an option, as far as I'm concerned. Now they're playing big-boy ball. I can no longer justify letting someone get bitten or spit on just to make sure that Slappy has options and all of her rights.

Where I work, restraints and seclusions are a lot of computer work too, but it is worth it in the long run. We all feel a lot safer because the patients know that we won't allow them to hurt us, themselves or others. I don't mean to imply in any way that restraint is used as punishment, but slapping can and will lead to more violent behavior unless it is dealt with swiftly and consistently.

Best wishes to you.

oldladyRN

[3Angels]

Had a pt 2 weeks ago who picked up the phone in the day room and started to throw it at me..then picked up a chair...he went to seclusion escorted by 3 police officers for assault threat he had already been medicated x2 with no result, stayed in seclusion for 2 hours yelling and cursing then fell asleep..seclusion over pt then reformed his behavior as he realized he would have consequence for his actions. We are attempting to teach these clients how to function in society--it unacceptable to slap or harm another person. This is the first seclusion we have had at our facility in 3 years. Pts are aware made aware of consequence for actions when they arrive on the unit and we enforce them both for our safety and the safety of our other clients. Bet there would be a change in attitude if the person being attacked was the person making the decisions....So sorry you had this experience hope it does not happen again.