Enraged (venting)

Specialties Emergency

Published

OK, I know y'all can relate...

Tonight I received a 23yoM, out drinking and driving, hitting parked cars. He already has 2 felony DUI's on his records.

He fought with fire department on scene (no head injury - he was just a drunk jerk), EMS on scene, police on scene; en route was kicking my medics and the police. He arrives and is still screaming and trying to swing while handcuffed to the cart.

I *tried* my very best to remain calm and therapeutic, but could only tolerate so much of the, "I refuse, you can't touch me, I'm suing you because my dad's a lawyer, and you can't let them take me to jail because I want to go home," while he attempts to swing, swears, and spits. He made mistake number one at that point by grabbing at my hand and squeezing until my hand popped (I filed charge number one at this point).

He smelled so strongly of ETOH it made the eyes water, and of course, he ended up in CT scan.

He fought and carried on over there, getting tazed several times. I ran over and medicated with Haldol and Ativan, but it was like spitting in the wind. Head blocks were gone, c-collar askew, and un-even on the LSB.

For a few minutes he chilled out and I once again explained everything. The CT tech needed his arms above his head, so I explained that I would remain at his side to care for him, and help him hold his arms. He said, "Whatever." (Meanwhile my tech and 5 policemen were on the other side of the glass watching).

I put on the lead, and was helping him hold his arms, and he screamed, "Let go of me you 'effin B*tch!" He then pulled an arm free and punched my chest (mistake number two, and charge number two filed) and face (mistake number three, and charge number three filed).

I lost my cool at that point and completely lost it. I'm ashamed to admit that without thinking, and in order to get away, I punched him very hard and quick 3 times in the chest so he would let go of my other arm (and it worked).

The police were all over him like a cheap suit. I told him that we were done playing the easy way, and he would now be going down the hard road, and told him I was taking him back to the ER to paralyze and intubate him.

He cried all the way back.

I'm just irritated that such a young man is wasting his life an potential and doesn't even care (he could have killed someone!). I'm furious that he thought he had to right to assault me. And I'm even more enraged that I lost my cool and responded the way I did.

Any tips for calming down?

I have never worked in corrections although I once did a volunteer day helping w/adult literacy classes in a state prison setting. Whole different world than a hospital ... totally different level of supervision of inmates and totally different setting designed specifically for command & control, not health care.

I could be wrong, but I read your post to be taking the OP to task for defending herself. Your suggestions included: 1) not working with "this type of patient" and 2) calling security. Again, I could be wrong, but your original post, and your subsequent posting, suggest that the OP is somehow at fault for losing her temper or being prone to violence or something.

So I asked the question: have you ever been assaulted? That is, have you ever been in a situation where you needed to act to minimize physical harm to yourself NOW, not as a hypothetical situation but NOW?

I found your suggestions outrageously naive for someone who has been practicing for any length of time. In the time it took for the 10, 12, 20, or however many steps it took for the police officers and others to get to the OP, she was being punched. This is a real event - not a cartoon where the action gets paused for the OP to call security.

I wholeheartedly agree that this terrible incident could have been avoided if the police had stayed within arms length of the patient (as they do in my facility). But the bottom line is that that did not happen, and the OP took steps to minimize physical harm to herself.

I wonder why they didn't stay with the patient. Did the OP tell them to and give them the lead aprons so they could? Or did she position them outside the room? Did they suddenly get scared and refuse to stay with him?

She can certainly defend herself as necessary. I won't make this point again, as I have stated it several times here already and no one seems to believe I mean it, so no point reiterating it again.

There are other problems, though. First, the pt was cuffed to the cart. If so, he was somewhat controlled. Next, the OP will likely never again, at least I hope she won't, allow herself to be the only one with a pt who is out of control like this. I hope she definitely gets the cops in there with their arrestee. Let them hold his arms over his head. Next, I hope she insists that the doctors anesthetize and tube the pt so all of this becomes moot.

Also, she says that she is totally upset with herself for losing control. So she was perhaps more angry than scared, is how it sounds to me. She knew he was restrained partially and she knew cops and her tech were just outside the glass. Also, it sounds like there was maybe too much talk. It is certainly pointless to explain very much to an upset drunk. Just try once and then do what must be done, without further ado. And certainly don't threaten to "paralyze" him and treat him harshly. That in itself is a battery, I think. Again, I'm no lawyer but that's my guess.

Something else she says - that the pt thought he had a right to treat her like that. Guys, this patient was not thinking about the nurse and how to treat her. She gives him way too much credit. He was drunk. All he cared about was going home. That's it.

Just a word about Corrections. The ratio of guards to prisoners was about 1:100 where I worked. Terrible odds, very, very dangerous setting. You learn to avoid trouble whenever possible and to be nice so someone will, hopefully, help you if things really go south. Also, while health care is not the primary business of a prison, the prisoners have a legal right to health care. That means that the nurse is an extremely important part of the prison setting and is very much involved in the daily routine.

TrudyRN,

I think you are missing out on one very important aspect of all this:

You can't control all variables. Sometimes, things happen and you have to react.

Sure it would have been great, without the benefit of 20/20 hindsight, to realize he wasn't as calm as he looked, or to have insisted the police were in the room. But...it happened...it was violent...lessons were learned. But to sya someone should stop working/helping potentially violent patients because of what happened smacks of holier-than-thou judgementalism.

Come on...you've never been in a stiuation where you acted one way and then later wished you had acted another? I doubt you're as perfect as your judgemental attitude would suggest.

As for the guy being handcuffed and therefore being "restrained". Really. My husband is in law enforcement. One out of control guy, in less than 5 seconds, broke another guys nose and knocked him unconscious WHILE HANDCUFFED AND WITH TWO OFFICERS TRYING TO RESTRAIN HIM (kicked him in the face).

That you think a nurse, who doesn't have the training that law enforement officers have, was supposed to intuit that this guy wasn't going to kill her in the seconds that went by as she was being assaulted is absurd.

And it's great that in psych nursing you turn the other cheek. But I bet you would change your tune if your psych patient tried to rape you, or stab you with a pen (unfortunatly these things have happened, a nurse was raped at a center only a block away from where I live).

She was justified, ethically, morally, and socially justified. Not a court in the land would find her at fault.

You live and you learn. Next time she probably will handle a similar sitaution w/ more finesse. All the more reason she should work with that type of patient in the future.

Specializes in Emergency / Trauma RN.

Hey Folks,

Thanks for an intersting thread for an early morning read. I think this ties in very nicely with the other threads on this forum to do with violence in the ER. (family vs. RN, pt vs. Rn, Family vs. Pt.). I'm an RN practicing in a regional Hospital / Trauma center in Canada. Small town granted (no worries with gang warfare etc.,... thank God), but we do get our share of drunks, addicts, and violent patients and family members. Our legal system might me a little more sane in that defending ourselves against the violent patient later in a court of law is less of a concern perhaps than in the US.

An interesting point was brought up earlier by a corrections RN about preventive practices, not just paralysing and tubing, but I'm thinking more seclusion and physical restraints.

Typically as soon as there is an issue of an intoxicated person becoming violent (pulling IV's, swinging at staff, etc.) the first thing out of the bag of tricks are wrist and ankle restraints. If they are really out of control, then comes the IM injection of vitamins H + A. If the clinical situation warrants further investigations (ie CT head for an assault victim) we will consider the use of rapid sequence intubation for further diagnostics.

A funny thing happened one night shift when we were helping a violent intoxicated person. I had just restrained the patient while waiting for the MD to make their way over to assess them (we still let the docs see sick people first (depending on their CTAS score of course). I was at the nursing desk documenting my interventions, and a family member of another patient approached. She was quite upset that we had violated that persons (the drunk) right's by using restrainets against their will (is there any other way to use restraints ?... don't answer that, not interested.) Of course the drunk didn't like it and was quite verbal about it.

I calmly replied "well Ma'am, I'm glad that you spoke up because normally I'd agree with you 100 %, but right now I am more concerned with #1 - my rights not to get punched in the head. #2 - That person is enjoying their rights not to have to deal with an assault charge in the morning after they sober up a bit. And #3 -your husband is enjoying his right to have his NSTEMIt taken care of by the physician before he has to rush over here to deal with their acting out".

She seemed okay with that...

In the past I have tended to want to talk people down, play the peace maker, but after being punched in the head once and losing a couple of hundred dollars in wages I am less sympathetic.

1speed

Specializes in Emergency.

What an enjoyable read this morning!

One question for those who felt compelled to offer the dissenting opinions:

Have you ever worked more than one night shift in an ER? Obviously not!

TrudyRN,

I think you are missing out on one very important aspect of all this:

You can't control all variables. Sometimes, things happen and you have to react.

Sure it would have been great, without the benefit of 20/20 hindsight, to realize he wasn't as calm as he looked, or to have insisted the police were in the room. But...it happened...it was violent...lessons were learned. But to sya someone should stop working/helping potentially violent patients because of what happened smacks of holier-than-thou judgementalism.

Come on...you've never been in a stiuation where you acted one way and then later wished you had acted another? I doubt you're as perfect as your judgemental attitude would suggest.

As for the guy being handcuffed and therefore being "restrained". Really. My husband is in law enforcement. One out of control guy, in less than 5 seconds, broke another guys nose and knocked him unconscious WHILE HANDCUFFED AND WITH TWO OFFICERS TRYING TO RESTRAIN HIM (kicked him in the face).

That you think a nurse, who doesn't have the training that law enforement officers have, was supposed to intuit that this guy wasn't going to kill her in the seconds that went by as she was being assaulted is absurd.

And it's great that in psych nursing you turn the other cheek. But I bet you would change your tune if your psych patient tried to rape you, or stab you with a pen (unfortunatly these things have happened, a nurse was raped at a center only a block away from where I live).

She was justified, ethically, morally, and socially justified. Not a court in the land would find her at fault.

You live and you learn. Next time she probably will handle a similar sitaution w/ more finesse. All the more reason she should work with that type of patient in the future.

Reread her original post and reread what I wrote. You have misunderstood some of what we both wrote. As far as her continuing to work in this setting, I didn't tell her what to do. I suggested that maybe she wants to rethink whether or not to continue to subject herself to situations like this. If she or anyone else chooses to work in the ER and they get hurt, well, they knew it could happen so they accepted the risk. just like cops know and accept the dangerous aspect of their work, just like Corrections nurses, just like Psych nurses.

I am going to contact some lawyers about this, just for my own edification and knowledge. I will let you all know what they say. I never claimed to be a legal expert. In fact, I have stated more than once that I am not an attorney and am not sure whether A&B took place. If I find out I'm wrong, I will let you know. I am also going to talk with some of our local ER managers for their input and let you know what they say.

BTW, wildmountainchild, there are some variables that we do control, such as maybe having the cops in the room instead of outside it, and/or cuffing the pt's hands overhead instead of this nurse trying to hold him still, such as what she said to him and perhaps how she said it, and why no EUA approach was used. The OP herself says she knows she messed up and she is upset with herself for losing control. :uhoh3: :uhoh21:

Please tell me - why am I "judgemental" because I have this particular view? Why can't it just be my view, which is valid as anyone else's? Why is it judgemental to hold an opposing view? Are you not judging me and telling me how awful it is to take a different view? Are you not angry and disgusted with me because I have said somethign you don't like? How is it that YOU are not judging me by disagreeing with me?

As for intuiting anything - it was pretty obvious that the patient was really out of it if he had gotten Haldol and Ativan and had to be Tazed several times in CT. Not much intuition required to know help was needed. Also, he was apparently only cuffed by the legs to the cart, as she was trying to hold his arms overhead herself. Too bad they didn't also cuff his arms overhead, put on a waist restraint, etc.

The feeling I get of all this is that she was angry that he was wasting his life and she tried to talk him down and that approach didn't work. She didn't utilize her resources (the cops, EUA), she got terrified when this drunk person hit her and grabbed her arm and she lost self-control, as she readily states.

As for my being perfect, I never, at any time, have stated that I am perfect. I am a fallible human being, just like anyone else. I'm not sure why you think I said I'm perfect. Reread what I've said. Nowhere in it will you ever see that I said I was perfect.

Trudy -

I don't work in a psych unit. I work in an ER. Therefore, I don't have to take the stand that I can't fight back. And the psych nurses I know are trained in prevention, yes - but if they are being choked by a patient or strangled by a patient, they are not going to sit around patiently waiting for the response team to get there.

Yes, many measures to prevent this could have taken place. Will they next time? One would hope - I can't imagine the OP wouldn't change their practice to ensure their personal safety next time. But the fact is - it happened. Would 4 points have helped? I doubt it - how many people have a way to four point in a CT scanner? I've never seen one. The OP had ALREADY administered the recommended medications with some effect. The patient was INITIALLY calm in the CT scanner and suddenly became violent again.

I'm seriously surprised at your judgmental attitude. Your comments give the impression that the OP was 100% wrong, an abuser, and a batterer. If you want to change someone's opinion or practice, you don't go about it by pointing the finger and branding them with a Scarlet Letter on their chest. I hope this isn't how you treat new nurses who are training under you.

Reread her original post and reread what I wrote. If she or anyone else chooses to work in the ER and they get hurt, well, they knew it could happen so they accepted the risk. just like cops know and accept the dangerous aspect of their work, just like Corrections nurses, just like Psych nurses.

Choosing to work in a dangerous field does not negate your right to protect yourself. My husband is also a police officer. If someone is trying to assault him, he certainly will protect himself and his other officers with physical force if need be.

A dangerous job does not mean you throw your hands up in the air and take the mindset that it's OK for someone to hurt you because you "chose" that line of work.

What an enjoyable read this morning!

One question for those who felt compelled to offer the dissenting opinions:

Have you ever worked more than one night shift in an ER? Obviously not!

Obviously nothing, Mom. I worked ER for 3 years early in my career. And it was even Nights. And, yes, we saw plenty of drunks. And back then it was Thorazine, not H&A, there were no CT scans, and no succ and tubing anywhere but OR. We had to use plenty of restraints and cop strength and male ER aide strength. And we learned not to try to reason with drunks or explain much to them, just do what we had to do.

Never assume someone is wrong just because he dissents.

What really troubles me, though, is that one who dissents is assumed to be anti-self protection and to be inexperienced in the particular setting involved (ER in this case). It is not fun to be the lone dissenter. But that misery is compounded by the closed-mindedness, the offense-taking by those who disagree with me. I wish we could just talk instead of taking offense at dissenters. :o :( :bluecry1: :scrying: :confused: :crying2: :sniff: :imbar :no: :smackingf :cry: :banghead: :icon_sad: :icon_rolleyes: :icon_cry:

Choosing to work in a dangerous field does not negate your right to protect yourself. My husband is also a police officer. If someone is trying to assault him, he certainly will protect himself and his other officers with physical force if need be.

A dangerous job does not mean you throw your hands up in the air and take the mindset that it's OK for someone to hurt you because you "chose" that line of work.

Please show me where I said differently.

Trudy -

I don't work in a psych unit. I work in an ER. Therefore, I don't have to take the stand that I can't fight back. And the psych nurses I know are trained in prevention, yes - but if they are being choked by a patient or strangled by a patient, they are not going to sit around patiently waiting for the response team to get there.

Yes, many measures to prevent this could have taken place. Will they next time? One would hope - I can't imagine the OP wouldn't change their practice to ensure their personal safety next time. But the fact is - it happened. Would 4 points have helped? I doubt it - how many people have a way to four point in a CT scanner? I've never seen one. The OP had ALREADY administered the recommended medications with some effect. The patient was INITIALLY calm in the CT scanner and suddenly became violent again.

I'm seriously surprised at your judgmental attitude. Your comments give the impression that the OP was 100% wrong, an abuser, and a batterer. If you want to change someone's opinion or practice, you don't go about it by pointing the finger and branding them with a Scarlet Letter on their chest. I hope this isn't how you treat new nurses who are training under you.

He had hold of her arm, not her neck. And the Psych nurses I know are trained to evade. Some are martial artists.

I'm not concerned about percentages. I replied to her post. I said that MAYBE she would want to consider a different area and that MAYBE she had A&B's the person - I was not and still am not sure how the law would view what she did when she (admittedly) lost self-control. I know nothing about fingerpointing, branding letters of whatever color on whatever body part.

I hope you are kind to new nurses, too. And we old gals wouldn't mind some love, either. :o

OK - you're right. Let's talk and not argue and I apologize if I came off as harsh and angry.

This may all end up that we will have to agree to disagree, but here are my points:

1. the nurse was being hit by a patient

2. the hitting was going to continue unless they did something to stop it

3. the nurse's safety was endangered

4. police were present in the CT scanner

5. pt's are difficult to restrain in a CT scanner unless they are restrained chemically

6. initial gut reaction of nurse was to hit back to keep themselves safe (my interpretation of the situation)

7. I don't feel this was assault or battery as the nurse was responding to a violent patient

8. I don't feel it is wrong for a nurse to respond with physical force if they are being physically assaulted by a pt.

9. Would holding down someone's leg when they are kicking you constitute assault if we consider this in the overall scheme of things?

10. I don't feel that working in a dangerous area means that you should accept the fact that you will be assaulted or that you should think about working elsewhere if you don't want to be assaulted. This situation actually could have happened on the floor also - think pt with high ETOH admitted for traumatic injuries. Wakes up the next day and becomes angry and violent on the first nurse that walks in to assess him and starts grabbing them or hurting them. This pt punched her in the face. As a floor nurse, I would also try to get away from the pt and if that entailed hitting them to get them to release me or to quit hitting me, yes - I would do that.

Yes, measures could have been taken to "hopefully" prevent the situation. But I'm looking at the angle of "it happened - what do I think now?". I don't think the OP assaulted the patient (my opinion). I think the OP protected themselves as they best knew how in that moment. That 1 to 2 second moment. That's such a quick, quick, moment. Boom - 1, 2 it's over.

So while I agree with the whole idea that prevention would have gone a long way (as in almost any area of healtcare, life, etc), the face is that I believe a nurse has every right to respond with physicial force if they are being assaulted.

Thoughts?

If she or anyone else chooses to work in the ER and they get hurt, well, they knew it could happen so they accepted the risk. just like cops know and accept the dangerous aspect of their work, just like Corrections nurses, just like Psych nurses.

And if one perpetrates violence towards a health care professional THEY SHOULD ACCEPT THE CONSEQUENCES. There will be consequences if one assaults a cop, there usually is not if they assault a health care professional.

Hit a cop and charges will be pressed irregardless of what your under the influence of, unlike cops however, facilities and nurses themselves are reluctant to press charges. A cop carries a weapon(s) and handcuffs and will use them without hesitation which may cause one to think twice before assaulting a cop as opposed to a nurse, nurses do not carry weapons, in fact in order to even use restraints a nurse has to follow a set policy. A cop wouldn't hesitate to press charges and will be backed up by their superiors AND peers, in fact it's not unusual for nurses who want to press charges to feel coersion not to from their superiors AND sometimes their peers. A cop won't hesitate to defend himself if necessary and are trained and prepared to, a nurse will often hesitate to defend themselves and are usually inadequately trained (if trained at all) simply because unlike a cop, we are not educated from day one to deal with it. Dealing with violence and violent offenders IS part of a cops job, violence towards nurses is a worplace hazard that is not being dealt with effectively. Assault an office and you will be held accountable irregardless of what your under the influence of, assault a nurse and chances are you won't be held accountable irregardless of circumstance.

I disagree that one should consider violence towards their person as part of the job. Violence towards nurses is not strictly limited to those that work in ER, Psych, or Corrections. It's become a pervasive problem in all areas of nursing. It's time that health care facilities and nurses themselves become more proactive in preventing violence in the workplace.

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