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Combative/Violent Confused Patients


Specializes in Med-Surg. Has 6 years experience.

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Specializes in Med-Surg, Psychiatric. Has 4 years experience.

I feel for you! I guess it has something to do with wanting a baby very much and if I ever were to fall pregnant and this happened to me, I would be pretty darn upset, too. I would have talked to my charge nurse and see if I could switch pts with someone. I would not normally do this, but if I were pregnant and I had a violent pt, I'd try and switch for safety sake. Though, I would offer to help the nurse willing to switch with me in any way possible. I would just be extra careful, as hard as that may be with a pt. with dementia. Keep a safe distance when they are upset, ask for help when needed, use protective garments.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

Very sad. This is why I am hesitant to post on all nurses.com. It is full of bitter people who seem to enjoy being rude and cold to other nurses. This is pathetic and I would never respond to a comment by disregarding it. I am done posting on this site.

You posted on a public site. Some people agreed with you; some did not. Those that did not agree with you are called "bitter people who seem to enjoy being rude and cold to other nurses." You go on to say that you would never respond to a comment by disregarding it. This right after you bashed elk park for disagreeing with you.

You had a rough experience. Your management was very supportive. I'm sorry you encountered a spitter, but it's not the end of the world. Of you think it is, then perhaps this isn't the job for you.

Now I'm waiting for you to bash me.

I think your management was very generous. I had an 89 year old patient whacked out on anesthesia who was bound and determined to either A) rip his penis off, or B) rip the catheter out of his penis that was causing him to want to rip his penis off. He hit my aide with the call bell, kicked me in the chest, and tore my arm open with his fingernails. He was also spitting at anyone that came near him and tore through not one but 2 sets of wrist restraints. Took 7 people to hold him down to buckle him in to velcros and a lap belt. I threw a 4x4 and a tegaderm over my arm and went to employee health the next day. I realize being pregnant magnifies the situation but I think your management was more than generous. Not sure what part about the situation they didn't give a feces about.

These things happen frequently. If a pt seems off- step away from the bed until you can determine their state of mind.

I am going in on modified duties, meaning I won't have a patient assignment for two shifts. It really upsets me hearing fellow nurses not supporting others because they themselves have had bad experiences. This is what I call lateral violence.

My manager is very understanding and they took this event seriously. She said she would feel the same as me and gave me lots of support. Perhaps elk park is bitter as she never stood up for herself before in the workplace.

What you went through at work does sound pretty terrible! I'm not trying to sound rude, but mocking elk park isn't helping anything. If you got time off, rather than boasting of your ability to 'stand up for yourself' or your great manager, how about showing the same compassion you seek?

Sorry to hear your troubles. Hope you don't have health related problems because of it. I'm generally the kindest nurse on my floor, but if someone gets like that to me, I turn into mr. Not do nice and very direct and to the point with plenty of assertiveness nurse. I don't play that game with those types.

I had pt rip his Iv out, rip tele leads off, refuse meds, drop f bombs left and right at me and the DR, and was refusing care in other ways, plus disrupting the floor so much that pt families were complaining. Dr ordered 1mg of haldol. House sup distracted while I gave it. After several f bombs amd attempts to hit me failed, he finally calmed down and I was able to provide adequate care on him. It's just sad that we have to deal with this.


Specializes in Psychiatric, Geriatric. Has 3 years experience.

I'm sorry this happened to you, violent or combative patients are never easy to deal with. However, I find it AMAZING that your employer gave you ANY time off for this, let alone an entire week?! PAID?! Holy sh*t. Please don't say management doesn't care, because trust me, I have worked at a few different hospitals and seen many patient/staff injuries and I can't believe anyone gave you time off when you weren't actually injured. (Not saying that being spit on isn't scary, or gross, but you didn't sustain any wounds.) We just had an incident where a patient attacked a nurse and knocked out three of her teeth and she was back two days later...

I've been choked three times, once choked to unconsciousness, hit with various objects, bit, had my hair pulled, had my arms twisted, my hands slammed in doors, etc... Granted, I've worked Psych and Geri, so this comes with the territory, but it's not like psych patients are magically immune to medical problems and psych units generally can't manage patients who are medically unstable, so SOMEONE has to take care of them... it does take a very special person to do my job, take the beating and not lash out back at the patient. :cat:

That being said, if you can't stomach these kinds of situations, finding a specialty that you can abide is in order. What that is, I have no idea, because I hear stories from my nurse friends in nearly every sub specialty that they had "one of *MY* patients" the other day and how wonderful/horrible/funny it was. But surely someone else here can point you in the right direction. OB maybe? Outpatient?

Edited to add: I agree that there should be specialty units for particularly difficult to manage patients, because while I feel most patients with psych issues can be at least temporarily managed on a medical floor, I've worked with levels of psychosis and dementia that need very skilled psych nurses to manage. Many of my patients at the state hospital are nearly incapable of communicating due to psychosis or dementia, AND they have medical complications. For this reason, I recently interviewed with a special med/surge unit for behavioral patients. Hopefully I get it, because I'd love to increase and freshen up my more acute medical skills while still providing care to the patients I find most interesting.

Edited by PSYCHEE

I'm sorry for what has happened to you. Unfortunately, as long you and I work as bedside nurses, we are always going to have to deal with these types of people. When I do have to take care of these individuals, I always ASK if I could do this or that for them; I will ask them if they want this or that medicine before I scan a medication. If they say NO! or say something much worse, I just say "ok" and I walk away. I'll call the family to let them know their family member refused treatment, otherwise the family will report me for "not caring" for their loved one. I hate uncooperative Pts, even if they are confused.

I am sorry you experienced violence from a patient. Objectively, we don't know if that violence was intentional or not, but appearing confused was the first cue to unpredictable behaviors. Being prepared for impulsive behaviors is a skill that is learned in nursing.

Learning how to deal with violent patients is required training as per OSHA and the ANA. Hospitals should be providing training to ALL nurses in how to prevent violence. Unfortunately, the cost of training is the barrier that some hospital's use as an excuse to not train staff. Whether it is CPI, Handel with Care, or MOAB, they each teach verbal deescalation and defense techniques. Based on what your patient had said to you and that he tried to kick you, you should have walked away. Communicated you would be back to check on him. Immediately gotten a coworker, recheck the patient together. I understand the compassion to help him when you believed he was going to vomit, but your personal safety should have been a priority. Increasing distance and not entering his personal space by yourself should have been recognized.

If you have not had violence training then that's a big problem. Management should be requiring it. Floor staff should be using a consistent system to flag violent/ aggressive patients. A system should be in place to alert staff at shift change as to which patients are considered high risk: assault/sexually aagressive behaviors, verbal aggression.

I do find it FUNNY that many posts recommend finding another area of nursing as a solution. It really sounds like, "don't talk about the problem too much, or that's just your problem." Sadly to say, 1/5 new nurses entering our profession are planning to leave within 1 to 3 years. Why is that? Is it because we don't provide them enough training? Are new nurses prepared to deal with violent and aggressive patients and are experienced nurses?

Training to deal with violent and aggressive patients is generally isolated to Psychiatric and ER Nurses. Why is this? Patients are admitted or discharged. If they are admitted they go to the most appropriate bed in the hospital and the floor staff needs to be equipped to safely manage the patients. Patients that are harder to discharge due to violent and aggressive behaviors have longer length of stays. Psychiatric patients who are too violent, are sex offenders (level 3), delevelopmentally delayed, or have TBI's are harder to place as well. They get admitted and the floor staff needs to be able to provide safe care. Learning verbal deescalation and proximity awareness is essential to any aggressive situation.

I don't think you experienced lateral violence from your coworkers. If anything, they were asking for pay for each time they experienced violence themselves. Management should be providing training, yes security. Unfortunately security can't be in all places at all times. That's why the training is essential. Common sense is not common.