Coworker physically abusive to patients

[Depressed_RN]

I am a new grad that has been working in the ER for close to 2 months. I have been assigned to a new preceptor and honestly I do not like how he treats the patients. He uses foul language in front of them and even physically assaults them (slapping and digging his nails into them) he claims it is self defense. He has worked at the hospital for almost 4 years and does not appear to be well liked by half of the staff. I want to report him but I am still in my probation period and I fear that they may terminate me if I do. I thought about reporting anonymously but I'm also scared he will put the pieces together and realize it was me!

He is very friendly with the manager, it is really just sickening how he treats some patients. I feel like this is a horrible secret to keep but I feel I have to in order to keep my job

[kbrn2002, ADN, RN]

What you are witnessing is abuse, no way around it. I can also see why you wouldn't be comfortable reporting it to your nurse manager. After all, he's been there 4 years so I find it highly unlikely that nobody has noticed his behavior before you came along. Chances are he is friends with the very manager you would be reporting his abuse to and chances are your report would either go uninvestigated or even worse be discounted and found unsubstantiated, possibly leading to the very retaliation against you that you are concerned about.

The other side of this coin is not only your moral obligation but your legal obligation to report abuse of a patient. You absolutely need to report this. If there is not an anonymous HR Hotline you can call go straight to the state level and contact your ombudsman. The number for the ombudsman is legally required to be posted in a public area in the facility, or you can always look up the contact information for your state online. This might be a better option all around as you can be assured that your complaint can be made completely anonymously and the state does investigate all complaints.

[Kooky Korky, BSN, RN]

I would but again he is friendly with the manager and has worked at the hospital for 4 years. I have only been here 2 months. It may seem silly to most on here but you guys are more likely secure in your jobs. I am brand new to nursing, brand new to the U.S, far away from home and I don't know anyone here. many would never understand my life and the struggles I've been through to understand why I'm so worried of losing my job. When I first made this post I was accused of exaggerating. The person does not know the whole story but yet still basically accused me of making things out worse than they are. Of course no one on here knows whether or not this is even true but it is true to me and it is an issue that bothers me.

It can play out that same way in the workplace, my manager may accuse me of exaggerating, lying or trying to start problems on the unit without any question.

The poster was wrong to accuse you of exaggerating. There is no basis that I can see for such an accusation. Maybe she is trying to give you a way out.

You have had a hard life, you say, and I am sorry for that. You are far from home, have a child or children to support, you are new on your job, new to America. You are very fearful, some of which I understand, but not all of your reasons seem valid. New to America? What's that got to do with not speaking up when you see this mentally ill coworker abuse patients?

Do you know what a nanny camera is? Can you very anonymously plant a couple where this savage's behavior is caught on camera? Doing so probably violates HIPAA - I'm not sure, but wouldn't be surprised.

Frankly, I fear this worker might come after you and hurt you, but you still have an obligation to protect your patients. I think you are guilty, too, of elder abuse, abuse of persons who can't protect themselves if you don't report this behavior.

It's a hard decision, but you don't want to be in trouble by not reporting.

You might try this - the next time you see him maltreating a patient, gently put your hand on his, look him in the eye, and hold that pose until the truth hits him and he stops his assault and battery.

Ask him what he would do if he saw Nurse X do such and such to a patient.

Actually, this guy is probably in need of anger management/psych evaluation because he is battering/assaulting/abusing those who can't defend themselves. Makes you wonder what he's like at home if he's so overt at work.

It might be time for you to look for another job, unfortunately, but don't go without correcting this very serious problem. Find the courage and speak up. I pray God's blessing and protection upon you.

I doubt any nurse is all that secure in his or her job.

[Kooky Korky, BSN, RN]

In some workplace cultures, relationships and politics, "who you know", etc. trumps everything else. I worked in a dysfunctional facility where management routinely hired their relatives and friends. It was a mental health facility, where many of the patients were vulnerable. Some of the technicians were absolutely horrible and had no business working in such a place. However, their aunt / cousin/ niece was a bigwig, and these employees made sure to let everyone know just whom they were connected to. New employees who came in and "made waves" by reporting verbal abuse or patient mistreatment were terminated while still on probation. One female tech was reported by several of her colleagues for patient abuse, but guess what? Her boyfriend, and later, her fiancée, was the facility investigator. No one saw anything wrong with their totally inappropriate relationship. I can understand the OP feeling ambivalent about reporting her preceptor if he is friends with people in high places.

True. She's really between a rock and a hard place. Still, she is a mandated reporter and has brought this situation out in public, so needs to report.

[Kooky Korky, BSN, RN]

Do you have experience with making allegations of a colleague's patient abuse to a manager? I do, they were not gone and out of my life as soon as I made the allegations. In my case, the manager responded "No one has ever complained about the employee before" The manager told the employee what I alleged and listened to the employee's version of events and dismissed my concerns as unsubstantiated. At the time, I was a new employee and the offender was well known to the manager.

What became of the matter?

[canoehead, BSN, RN]

OP, you may want to pick a quiet moment, and a nurse you respect and ask about your preceptor's behavior. Ask, if that is normal behavior on the unit, has anyone ever said anything to him, has anyone reported him, and to who? What became of the report? Is the reporter still around? It will give you more information on what to expect from him and your coworkers/supervisor. It may convince you to report directly to the Board instead of your supervisor. I'd phone the board and pick their brains over the reporting process, and who has access to the file. Can you just be known as "coworker" without him getting your address/personal details? What is your liability if it's just a he said/she said situation? Even more important...has he been reported before?

Where I live, elder abuse reporting is protected, you can not be sued if you make the report in good faith. And nurses must report. I agree with others that you can't just ignore him, a report has to be made. But get information before you do it. Document each incident, and who was there. Check out the area for other jobs. Find out if he's a drinker, if he does karate on the weekends, is he all mouth and no action, what does his car look like, relationship status, and how he's dealt with conflict in the past. Protect yourself, have a plan, and be decided that you will take action if you get blow back from your boss, or will you move on to a better position?

And have someone to talk to. You can PM me, I'm no expert, but I can listen.

[Been there,done that, ASN, RN]

Are you going to allow patient abuse, in order to keep your job? Boggles my mind . You are a patient advocate.

Report this STAT.

[Been there,done that, ASN, RN]

I am not exaggerating, because it is something you may not have experienced does not mean it does not happen. It is easy for you to say to report and live in a cardboard box but I also have a child to think about.

Do you want your child to be abused?

[Anonymous865]

You need to be aware of what the law in the state where you practice requires.

In my state the law requires that you report to the board of nursing/medical board or to law enforcement. Reporting patient abuse internally does not meet your legal obligations.

The law was passed many years ago when some cases were reported in the news of healthcare workers who were suspected of harming patients. The hospitals fired them or allowed them to resign without reporting the suspicions to the state. They moved from hospital to hospital harming patients. One of those cases was Charles Cullen, the nurse who confessed to killing 40 patients in NJ and PA.

Those cases prompted our state legislature to pass a law requiring healthcare workers to report directly to the board or law enforcement. You can report to mangement also, but the healthcare worker is required by law to report to the board or law enforcement.

[Libby1987]

We have a anonymous corporate compliance officer. We are bound to report any fraud or abuse, of anything, and are subject to termination and I imagine reported to the board if we don't. Anyway, they make a point that it's anonymous, to encourage staff to do the right thing. And since you are not exaggerating* and this guy is slapping confused geriatrics I think you should do it immediately.

By the way, I did not "accuse" you of exaggerating, I said I suspect you that are and clarified why I thought it possible. I didn't think you were doing it for effect or any other intentional self serving reason but simply out of new nurse perception. If you're still bothered by it, try putting it to use as an exercise in dealing with questioning by a live person.

ETA, above poster makes an important point, know your state's requirements.

[fawnmarie, ASN]

True. She's really between a rock and a hard place. Still, she is a mandated reporter and has brought this situation out in public, so needs to report.

Yes, I agree that she absolutely needs to report the preceptor's behavior. I just want her to know that I understand her feelings of ambivalence. I think canoehead gave some great advice a few posts back, and maybe the OP could discreetly try to gather information about him. I am being straightforward about what goes on in some dysfunctional facilities. I have had a technician tell me, "Go ahead and report me, I'll just call my sister /aunt/ cousin who is the assistant DON." On one occasion, I did report a recreational therapist who verbally abused and humiliated a very ill schizophrenic patient. I was branded a "troublemaker" for several months after the incident, but I didn't care. I wasn't a brand new nurse or new to the facility, though.

[Kooky Korky, BSN, RN]

I kinda agree the swearing may not be a big deal, I swear myself, I just have never done it in the workplace. I did respond to another post on some things I have witnessed. It is during the day shift and so far it is to patients that are not able to speak.

Even as a student and when I was with my other preceptor, I have never thought to slap a patient. I didn't even know it was allowed, even for defence. I guess I will have to check my facility policy on this.

If you work in Psych, you are not allowed to retaliate. If you work ER or any other area, you can. Still, there are ways to do it that are approved, and ways that are not. Probably things differ from state to state, so find out what's what in your own state.

Retaliate is really not a good word. Protect yourself is more appropriate. In Psych, pts can't be prosecuted, I believe, for violence toward staff. In ER, they can be arrested and prosecuted. I think.

[madricka, BSN, RN]

Oh no, what a horrible position to be in! I remember seeing questionable things as a student but I was absolutely terrified of saying anything.

But please know, this nurse cannot work with patients. It is assault, however minor it may appear to be. And these behaviours tend to escalate over time (maybe because no one said anything?). Maybe the nurse is a great nurse but needs some remedial or disciplinary action? Either way, it's something that needs to be reported ASAP (to employer and BON). If anything, I think the employer would be happy that you came forward since it's a lawsuit waiting to happen (plus, who wants to employ an abusive person?).

As for "necessary" aggressive behaviours with patients... if you are faced with having to take blood or provide other care to a delirious patient or a kicker or whatever the case may be -- ASK FOR HELP! There is never, ever, ever an excuse for striking a patient. "Self-defence"? Unless you are pinned in a corner and being beaten down, it's not "self-defence". I was assaulted by a violent patient a few years ago and sustained permanent nerve damage in my neck and left shoulder. During his care I never once thought to hit him or be aggressive -- I didn't even have restrains on him. My hitting him would not have calmed him down or made him stop what he was doing, it would have likely made the whole situation worse (and I would have felt wretched!).

But I empathize with your situation, not a fun place to be in and I absolutely understand it's a hard thing to do when you've worked so hard to get where you are. But if it was your child was this nurse's patient and he lost his temper? If it were someone I loved who was hit by a nurse, I'd have the police in there! Easier said than done when you have to work with this person, I know.