Battery: Defending yourself against a combative patient

[rhkenji]

I was on my new work orientation today and the topic of restraint and battery was discussed at the end of the day.

I totally understand that we CANNOT touch a patient without permission and the a patient has the right to refuse to be touched or cared for or the nurse can be charged with battery.

Now, I get that.. but I didn't know that in cases that we are getting battered ourselves, we are also not allowed to "push" a patient back or hold them to stop them from hitting us. How true is this? I know this is orientation, and this is probably hospital policy. But are we really not allowed to defend ourselves?

I asked what I'm suppose to do, the instructor just said "run. call security. lock yourself somewhere.. even your co-nurses are not allowed to hold a patient to help you", "security, EMTs and MDs on the other hand, CAN by law"

California, Los Angeles area

[MMC.RN]

What type of nursing are you doing? As a forensic psych RN, we are specially trained to protect ourselves from combative patients and can defend ourselves by going hands on and as long as we use approved techniques we are covered. I am assuming this is not true in your case...

[rhkenji]

What type of nursing are you doing? As a forensic psych RN, we are specially trained to protect ourselves from combative patients and can defend ourselves by going hands on and as long as we use approved techniques we are covered. I am assuming this is not true in your case...

We are a mix of med-surg, tele and ED nurses. I will be working in the ER

[Here.I.Stand, BSN, RN]

I would need to see a law expressly forbidding one person from protecting herself. I have never in all my years of nursing seen, nor been told, that we can't use reasonable force to protect ourselves. How is it battery for an RN, but the exact same act acceptable for an MD? That makes no sense. Battery is battery. There's nothing special about medical school or EMT school which qualifies one to block a punch, while nurses are practicing outside our scope if we block the same punch.

Plus, I would think we open ourselves up to greater liability for running, if the pt fell and got hurt, or pulled out a chest tube or ETT or central line... because the RN ran away rather than touch that pt.

We hold pts down all the time. If they are combative, we use 4 point restraints. We have a behavioral code which is responded to by security and psych RNs, and they will also restrain pts who are putting staff at risk and interfering with treatment. Heck our ED will do what I like to call a behavioral intubation -- pt is so combative that they need large amounts of Ketamine, and therefore are intubated to protect their airway. Do they hold the pt down to keep him and the staff safe? You bet!! Or even just with routine cares such as changing linens, the nurse who is holding the pt on his side while the other nurse tucks the sheets, the nurse supporting the pt will also hold his hand down so he can't hit.

[emtpbill, ASN, RN, EMT-P]

I cannot see any policy that specifically states you are not allowed to defend yourself from being attacked. That would open a facility up to major lawsuits.

As a medic before starting nursing school I have many times had to "control" a patient who would try to become physical with me. It is amazing how someone can control another just by a few arm placements on an attackers arm and simply by pushing or pulling.

While I don't condone violence sometimes it's necessary to control a patients movements to avoid from being the injured party. Once the patient is controlled sufficiently security or others can assist in maintaining order and restraint.

[cherryelle07]

I worked with individuals with Intellectual Disabilities for quite awhile. Violent behaviors were common. We were not permitted to defend ourselves persay, but we were able to take measures that allowed us to get away and to safety which included blocking and breaking grips. We were not allowed to restrain unless permitted by a doctor or the individual's behavior consultant. We also have BSPs and ISPs to follow. Also if an individual was deemed a violent, we were not allowed to be with them alone. They were always double staffed so that there was always someone around to call the for help. But this was always in group homes or the community, not a facility.

[LadyFree28, BSN, LPN, RN]

I work in a ED, and when there is a combative pt, whether they are under the influence of in a psychiatric crisis or both, security is called and all hands are on deck-I recall a pt lunging for their parent and the physician behind her gave a defensive stance and prevented the pt attacking their parent; we then placed the pt in four points and I have and IM Haldol and Benadryl and kept it moving and the pt safe.

My ED work is primarily Peds, so when a kid lashes out, I prevent them from hitting me; when procedures are medically necessary and for safety, best believe that measure are in place to allow me to keep the pt and me safe; maybe that constitutes at your job as battery, but in my setting-

[rhkenji]

thats what they said. let security handle the patient, they are allowed to: nurses then can put restraints (chemical, physical), but we cannot and not allowed to hold a patient down.

[purplegal]

In order to hold/restrain a patient, we must have a doctor's order. We have a Behavioral Emotional Response Team that specializes in calming these patients down in the hopes that restraints aren't necessary, and, if they are, can be applied in the most humane way possible. At the same time, it seems ridiculous that we would not be able to protect ourselves at all. Our lives are just as important as any patient's.

[rhkenji]

I asked about that, she stated: "the law sees the nurse in the position of power every time, even in a situation where the nurse defended him or herself against a patient"

[txbornnurse]

Sounds all nice and neat with security but most of my work sites did NOT have security available so we used a combination of verbal interventions, blocks to include how to safely push someone more than arms' length away. Yes we had to have a doctors order for a physical restraint but if the situation warranted the use of a restraint to prevent harm to patient and/or others we could obtain the order after the fact.

I truly doubt what the instructor told you is backed up by the criminal code. It sounds like the facility is trying to minimize their liability in a civil action. Personally as a nurse who has sustained broken bones as a result of assault by a patient I will do whatever is reasonable to protect my self and let the chips fall where they may. I might get fired but if I did I can promise you I would pursue redress against the facility.

YMMV

[djh123]

It can be dicey. Somewhat late one night a couple of years ago, one of my residents got very angry/combative and I ended up holding up someone's chart in front of me - to deflect punches that he was threatening to throw but luckily it didn't quite get to that - and was yelling at him (no bosses/mgt. were around) to go away, and it finally worked. I've also been threatened by at least a couple of other residents. You have to be aware.