Assault against nurses

[nikkole318]

Recent discussions with coworkers about some unfortunate events inspired me to write this post. At the hospital where I currently work, there was a patient who was going through Alcohol DT's who punched one nurse in the chest and a nursing assistant in the face. He barely grazed the nursing assistant's face, but he did knock her glasses off of her face, breaking them. This was a fairly large male patient, first punching an older woman and than punching a small 110 pound girl. I get really upset when I hear about violence against nurses and would like to do something about it. First, neither nurse pressed charges against this patient. I think both of them were a little bit afraid to, because it "just isn't something you do." I just cannot grasp how healthcare workers are intimidated into not pressing charges. If a man showed up in any other establishment, he would immediately be arrested, alcoholic or not. How can I help to change this culture? Second, I would like to bring awareness to this situation. Hospitals should be required to hold assault perpetrators accountable for their actions. By letting people get away with hurting healthcare workers, it sends the message that this behavior is acceptable. Third, I would like to work with legislators to help make laws that will actually make changes. Can someone point me to some resources?

[verene, MSN]

I would NEVER advocate pressing charges against a dementia patient who thinks we are invading his house and sticking him! I'm talking about policies and procedures for those who are either completely competent and assault healthcare workers.

I may have misread your initial post then - I came away with the impression that you were advocating to hold all patients responsible for harm against healthcare workers. Not just those who are competent and out to cause trouble.

I think a lot of it comes down to the hospital having standards for worker education and for how to handle patients who are competent but out of control. The hospital I worked at most recently used CTI training for employees for deescalation and self-defense. We also had a security team that was very good - most were retired police officers, and all were given extensive training on how to be security in the hospital environment. They were really integrated into the bigger healthcare team particularly in high risk places like the ED. This hospital also had policies about when to call police in, and we had an agreement with our local police department that we could request a courtesy visit where the police wouldn't come to arrest anyone but would make themselves a visible presence in the facility.

At a prior facility I worked at we had the ability to contract with out of control residents- we'd have a discussion with them about appropriate behavior and what was inappropriate and write up a contract with them including consequences for acting out and potential rewards for exceptional compliance. Consequences did include calling the police for intervention (and charges if warranted), eviction from housing, or more minor consequences like not being allowed to go on facility field-trips.

We also had a great relationship with our local police precinct which I think made a big difference on the few occasions staff did call for assistance. The police knew our staff, knew our residents, and we knew most of them. If a crisis point hadn't been hit yet we could call non-emergency and ask a crisis intervention officer to come out and mediate things.

Non-police/security team wise I think there is much to be said for teams that work together. In both facilities I knew I could trust my coworkers to have my back if a patient became escalated. If ever I was worried about a potentially violent patient I could have an additional staff member (or 4) come with me to the room. Sometimes deescalation took swapping out staff shifting around patient loads so the CNA and/or nurse who didn't trigger the violent response in the patient were providing care.

Sometimes though it's just a mess and you have to put staff safety above that of the patient. If the patient wouldn't die/ incur serious harm from us not providing care, we wouldn't provide care while they were violent, and would wait for them to calm down before trying again. There was quite a bit of documentation to follow for this but our facility allowed it when all other options were exhausted.

[nikkole318]

I disagree with your first sentence. I think that when people are in the hospital, there are very much out of their element and the stress of being there along with being ill or injured makes them more likely them to act out in ways they would NEVER act out in other situations. For lack of a better word, they "forget" that the people helping them are humans and that, especially if they are competent, they are to be held accountable for their actions. I think a "reminder" that assaulting healthcare workers is illegal would help.

[MunoRN, RN]

In general I don't think it's appropriate to put someone in jail for symptoms of a medical condition. It's important to understand "DT's", specifically that the "D" stands for delirium, since that is a defining symptom of this condition. Your suggestion that we should just explain to the patient that assaulting staff is illegal assumes some degree of rational thinking on the part of a patient in DT's, which typically just doesn't exist in that state.

[nutella, MSN, RN]

In one hospital where I worked they had a code for psychiatric emergencies - a patient getting violent or in danger of qualified to call a code psychiatric emergency. The idea is to get the power to the bedside because it automatically triggered a psych CNS, security, pharmacy and the nursing supervisor to appear. It also triggered an immediate review of the patient condition and medication. The psych CNS would work with the resident or psychiatrist in creating a plan to prevent further events.

It had a lot of advantages with security coming up asap.

I have seen wheelchair fly in the hallways, nurses getting bitten and punched, patient spitting and so on and forth.

Perhaps your institution can implement something similar?

Getting the extra support and making the hospital aware of what is going on was helpful. I can not count the times security had to hold down a patient so I could administer a chemical restraint im.

In addition, Crisis Prevention Training is helpful to teach staff to recognize situation that are escalating earlier and how to act and diffuse.

I have also found that when a patient is in withdrawal or severe delirium it is best to medicate on the early side and not to wait until everything is escalated.

[Horseshoe, BSN, RN]

I would NEVER advocate pressing charges against a dementia patient who thinks we are invading his house and sticking him! I'm talking about policies and procedures for those who are either completely competent and assault healthcare workers.

In your OP, you specifically referenced a patient in DTs, and went on to insinuate that the nurses should have pressed charges. People in DTs are NOT "completely competent."

[Horseshoe, BSN, RN]

While I competely agree that alcoholism and addiction are, at least to some extent, an illness that is difficult for many patients to manage, isn't part of recovery to accept responsibility for what you've done as a result of that addiction? While my heart goes out to people with this particular struggle, I can't help but see some differences between this and the 95-year-old dementia patient.

When they are in DTs, they are not using alcohol; they are in a physical crisis during which they have little to no control over how they react. While I believe policies should be in place to minimize harm to caregivers in this situation, I think it would be completely inappropriate to ask them to take accountability for any acts that occurred while in DTs.