Assaulted by a Patient

el · Jan 9, 2001

Sorry to say, but if you are dealing with Psych patients one of the risks is violence. I would say always protect yourself and the staff. Always remember, keep yourself between the patient and the door, use a buddy system if you need to. Block arms and legs even if they are not moving. And remember, if someone bites you, push toward the bite, don't pull away. Keep the room clear of anything that can be thrown or used to hit you with. At least keep these things out of reach. If the patient is that dangerous, you should be able to get security to stay in the room, or restrain the patient. Explain to the family that it is in the patients best interest as they could hurt themselves trying to hurt you. If that doesn't work, explain that you can not allow the patient to endanger the staff, or other patients for all you know. Also, you need to speak with the Manager of the floor, everyone should be on the same page as to exactly what to do if a patient becomes violent or hits the staff. Good Luck.

soundsLikesirens · Jan 9, 2001

I don't know why the family didn't want her to get the IM Haldol - unless it was because they were expecting her to get a sleeping pill???? (don't see the difference, myself...) But obviously, their concern isn't for the staff. Her daughter told me that she struck her. (guess she wanted it to be me.....) I don't know, but I don't feel like we should have to deal with all this. We're short-staffed already, and this just makes it impossible...I finally got tired of feeling with them and started in on my piggybacks - which were LATE...and hanging blood - which was LATE......ALL BECAUSE THEY COULDN'T MAKE UP THEIR (*(&t &)ING MINDS ABOUT MOM..........!!!!!!!!!

soundsLikesirens · Jan 9, 2001

....dealing with them, I meant

mustangsheba · Jan 10, 2001

Hi Sirens: Everything El says. Why won't the family allow this patient to be medicated? Sounds like the doctor needs to have a heart-to-heart with them. Most patients would choose to be medicated rather than hurt another person. If they're psychotic, they see things that we don't see and are afraid so they strike out. What a nightmare it must be for your staff to have a psych ward dropped right in the middle of your regular patient load, which, by the way, is not therapeutic for the other patients. Perhaps one section of your floor could be designated for psych and a psych nurse assigned to that area. All the nurses that are having to deal with this need to document everything and approach management en masse. In my humble opinion, getting hit is not an option.

gholiway · Jan 12, 2001

This issue is not as isolated as people think. I work in a rural hospital and we do not offer psych treatment. In fact you should ask to review your departments scope of services. Admitting psych patients to a med-surg floor is appropriate for Med reasons. These pts are quite difficult but remember that the JCAHO standards for restraint use are very specific when restraints are used for behavior reasons. The geri chair would be considered a restraint in this instance. The Haldol would be considered a chemical restraint especially if the pt. is not on it already. It's tough and you should take the issue to your nursing supervisor. Get the medical staff involved. You should have a violence in the workplace program that addresses just this very thing. Check with your risk manager. QUOTE]Originally posted by soundsLikesirens:

Does anyone know what the law is concerning a nurses' recourse to A. avoid being assaulted by a combative patient and B. one's recourse if assaulted?

I work on a med/surg floor and we typically have 10-11 patients apiece. Lately, we have been getting more and more admissions that seem to be psyche-related. (The psyche unit is closed...for lack of patients, or so I heard). Well they're all finding their way up to our floor....I know you have to have a doctor's order for physical restraints.

But the other night, I had a patient that was combative with a hx of punching nurses and the family wouldn't allow her to be in a geri-chair, they wouldn't allow IM Haldol...they were TOLD by the admitting MD that they would have to stay in the room and take care of her because our floor is short-staffed (it is). Yet they expect us to be in the room constantly and get mad if we aren't (I don't care - let 'em get mad). I'm not worried about that; but I am worried about getting my teeth knocked out by some of these combative, agitated patients.

soundsLikesirens · Jan 12, 2001

As soon as I got to work last night, I was told that the other 2 RNs that were scheduled called in......they pulled an RN off the psyche unit. He told me that the psyche unit will soon be a locked unit - that they were changing it to a locked unit soon, so it ain't gonna be getting any better soon.

I KNOW Haldol is a restraint...but I had the order for it. And I'm not going to stand there and get beat up....sorry.

leslie :-D · Jan 15, 2001

Sirens.... I, too, work on a highly volatile floor. If the pt. is a threat to self or others, then you should be able to get a 24 hr. emergency restraint until psyche services comes in. Although I'm not aware of any legal recourses, too much staff have been out on medical leaves secondary to workplace violence, family's wishes, MD's lack of cooperation. Document everything, fill out incident's reports and give mgmt. your medical bills. Our first responsibility is to protect the other pts...(to hell with us, right?). OSHA might be able to offer some good input if staff and pts. safety is at risk.

gholiway · Jan 15, 2001

Sirens, don't be sorry for how you feel. It is stressful enough to deal with so called "normal" pts. let alone agitated, combative ones. I agree with El. Use some sort of buddy system. Document and forward your concerns to the risk manager. Restraints are perfectly acceptable in emergency situations. The family can like it or lump it. Give em a choice. The ropes or the needle. Just kidding. But really, family education is needed here. The docs could be more supportive in that area. Hang in there.

Originally posted by soundsLikesirens:
As soon as I got to work last night, I was told that the other 2 RNs that were scheduled called in......they pulled an RN off the psyche unit. He told me that the psyche unit will soon be a locked unit - that they were changing it to a locked unit soon, so it ain't gonna be getting any better soon.
I KNOW Haldol is a restraint...but I had the order for it. And I'm not going to stand there and get beat up....sorry.

buckboomer, BSN, RN · Jan 16, 2001

In Minnesota physical abuse or assault is a felony, to health care workers. I unfortunately know that. I was assaulted, and received a broken thumb on my dominant hand. I missed 2 months of work. I had nothing but problems with Employee Health, the stupid police, and my HMO. I am still waiting for a court date, 3 months later. Even my fellow colleagues have NOT been supportive. Nothing has changed, and I expect little. I was violated, injured though NO fault of my own. What can repay or compensate me for the bother, pain, and inconvenience. I am NOT satisfied with the judicial, legislative or enforce ment of the stupid laws. The best thing I did, I was told, was notifying the police and pressing charges. The company I work for, writes about respect and safety in the workplace. What a joke! Even regular verbal abuse is ignored from the MDs. Nurses are very low on the food chain in Allina Health Systems. Keep me in the dark, and continue to feed me the BS. Underpay me, give me terrible pension benefits, and the crummy schedules. It is hard to come to work, and hear from the patients, get me something to eat, how much longer must we wait, etc, etc. The work environment is very unhealthy. But what are the alternatives, in hospital nursing? Different departments are not good options, either. Beat me, verbally abuse me, and forget stated values. Allina Health System's Mission: Provide an excellent health care experience for our customers. Forget the employees, but provide something else, for "our customers".

ikelly · Jan 16, 2001

Originally posted by soundsLikesirens:
Does anyone know what the law is concerning a nurses' recourse to A. avoid being assaulted by a combative patient and B. one's recourse if assaulted?
I work on a med/surg floor and we typically have 10-11 patients apiece. Lately, we have been getting more and more admissions that seem to be psyche-related. (The psyche unit is closed...for lack of patients, or so I heard). Well they're all finding their way up to our floor....I know you have to have a doctor's order for physical restraints.
But the other night, I had a patient that was combative with a hx of punching nurses and the family wouldn't allow her to be in a geri-chair, they wouldn't allow IM Haldol...they were TOLD by the admitting MD that they would have to stay in the room and take care of her because our floor is short-staffed (it is). Yet they expect us to be in the room constantly and get mad if we aren't (I don't care - let 'em get mad). I'm not worried about that; but I am worried about getting my teeth knocked out by some of these combative, agitated patients.

There are OSHA guidelines re: violence against health care and social service workers.It's a 36 page paper with recommendations for reporting, prevention, education etc. One concern voiced in the report is that violence against health care workers is underreported. Another concern is the perception that violence is part of the job. You need the support of management and your co workers. OSHA suggests that all staff involved in or even witnessing a violent incident should be supported and the incident should be processed with the staff. Victimized employees should be offered

treatment. Trauma-crisis counseling should be offered. This is the ideal.

The OSHA site is: http://www.osha-slc.gov/SLTC/workplaceviolence/guideline.html

Another thing you can do is to have the patient arrested for assault. That's not always possible if the patient is elderly and confused.

Check out the OSHA site. It's very informative and has great referencces. You can use the guidelines to show management that there are things that can be done.

Good luck and stay safe.

Ida