Got slapped by pt. Staff splitting. Need feedback.

[wonderbee]

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.

[RN2begin]

Can a psych nurse press charges against a patient for assault?

Absolutely. However, patient is most often found incompetent to stand trial and the charge is dropped. This does not mean that you shouldn't do it. Outside the hospital, similar assaults would not be tolerated, so if the goal is to discharge patients back into society, why not maintain some "real world" action=consequence. I know I am preaching to the choir...but just my $.02.

[RN2begin]

Can a psych nurse press charges against a patient for assault?

Sorry, I agree with administration on this one. You took someone that was already unstable and aggitated them.

If someone told me, "I don't want you for a nurse", the last thing that I would tell them is that "I am their nurse for the day and that isn't going to change."

You lost the battle and the war as soon as you said that.

Not to be mean, but it was a very disrespectful way to treat a patient. Remember, they are there to get well, not win a popularity contest.

You dismissed her feelings as invalid...every question that I have ever taken on an exam, when something along those lines comes up, it's aways the wrong answer.

I must respectfully disagree with you. This patient obviously has axis II deficits that cannot be met by changing tx providers on a whim. In fact, it is the WORST thing you can do. She assaulted a nurse. She was not assaulted by a nurse. Unfortunately administration and exam questions have much in common in that both are completely disconnected from the realities of frontline psychiatric care.

[wonderbee, BSN, RN]

I must respectfully disagree with you. This patient obviously has axis II deficits that cannot be met by changing tx providers on a whim. In fact, it is the WORST thing you can do. She assaulted a nurse. She was not assaulted by a nurse. Unfortunately administration and exam questions have much in common in that both are completely disconnected from the realities of frontline psychiatric care.

Cluster B, Axis II. MR is mild. Very manipulative. Knows just what she is doing. Giving in to her is not the correct therapeutic choice. We choose our battles with our Axis II's. This is definitely one that needs to be confronted. She is not on forced meds. She can refuse her meds. She will strike out rather than verbally refuse.

Psych nursing is unlike any other kind. Need to walk a mile in the shoes of a psych nurse before one judges.

[medsurgrnco, BSN, RN]

Yes, psych patients need to learn to deal with boundaries. But psych patients lose many rights, and also need to have some degree of feeling in control and being able to make choices. Pick your battles.

[PsychRNOhio]

If the client is considered competent, file criminal charges.

People with personality disorders act out by choice.