Enraged (venting)

[andhow5]

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?

[obliviousRN]

Many excellent points DusktilDawn

[NurseMMM]

I don't believe most people realize what we have to endure sometimes as a nurse. And be expected to remain emotionally and physically intact after such an incident. Why were you left alone with him to begin with? I hope he rots in jail. And I hope that the hospital administrators supported you in all of this. You were probably looked at as being a liability for them in the long run. Has your employment status changed since this incident is the real question? Are you still working there or did they find a way to belittle you in other ways and get rid of you? Just wondering. I have seen this happen to other nurses that were assaulted by patients. I worked with one nurse who was excellent. A patient threw an IV pole at her. It hit her as well as flying out an 8 story window to the ground where the ER was and almost hit an EMT. She filed charges against the HIV, ETOH patient. He died while hospitalized, by the way. But eventually, they started writing her up. Over stupid things. Like at discharge and the charge nurse would go in to request a patients survey of care. They requested how this particular nurse did her job, etc. And low and behold sooner or later, found some patients to complain over her not emptying his urinal quickly, etc. Or that the IV came out and she stuck me twice without mercy, etc. I believe they interrogated the patients until they found someone to rise up and complain about her, only to write her up to get rid of her. She resigned because of all of the flack she was getting about a year later. It was very sad. She was a good nurse. But a liability for the hospital, I suppose. All because she pressed charges against this crazed man? Who almost killed her as well as an EMT. I hope he rots, you know where. I suppose I have seen too many negative things in my nursing career. This was in 1992. I don't know if she retired or is currently working as an RN or not. But I hope she is better off than what she encountered at our hospital. She didn't deserve to be "weeded" out. She was one of the good ones. If the hospitals feel your a liability and or want you gone, believe me eventually your gone. Whether you are at fault or not. If they don't like you, they find reason's to get rid of you. That's why I always keep it anonymous with reporting incidents. If they find out your a whistle blower, they will weed you just a quickly as if you were a mean nurse to others. It is best to keep yourself protected and remain anonymous.

[TrudyRN]

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?

Thank you for being nicer, Oblivious.

1. She had been hit. He now had hold of her arm.

2. probably

3. agree

4. They were outside the scanner room.

5. I'll take your word for it, never tried to do it or saw it done;

6. She had had enough. She'd been hit thrice, she felt sorry for him and frustrated with how he was living his life and angry that he routinely endangered others, and frustrated that she couldn't really help him much, other than to tend to his immediatel medical needs (which was totally appropriate and necessary and commendable, BTW. It's what he needed right then. The other, the attempts to help him sober up, have to wait.) She says she lost control, which could happen to any of us, including me, and is angry at herself for that.

7. I'm not sure. But am going to find out because I really want to know. What does your hspital ER manager and/or lawyer say?

8. We certainly have to be able to do something to keep safe. When words, humor, and existing physical and chemical restraints aren't enough, physical force might be required. Perhaps it is the type and method of utilizing the physical that we need to look at.

9. I think leg restraints were absolutely indicated for this wild man. I believe they were in use and were keeping him from kicking.

10. Yes, this could happen anywhere. No we do not have to be passive punching bags. Yes, we need a buddy system, an alarm readily accessible to call for immediate help, we each need to know self-defense techniques, we need training in personal assault response and self-protection. We need our employers to stand by us and our legislators, too, and make it legally as hard on those who assault us as it is on those who assault police officers. Yes, I would most assuredly defend myself, too, if I could not escape the setting or get immediate, effective back-up. You didn't ask but I will tell you that I, too, would press charges against someone who assaulted me and, if I got hurt, I would try to sue the employer who didn't protect me by having sufficient Security staff and enough male aides to accompany me when I work with dangerous clients.

Peace.

[obliviousRN]

Again - I apologize for my snottiness - please understand it comes from a place of being in that nurse's position of having a drunk volatile pt physically assaulting me.

so...........................

Here is a direct quote from the OP:

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).

Yes he was holding the nurse's arm, but he had also just punched them in the chest and face. So I would like to remind everyone it wasn't as simple as just holding onto the nurse's arm. Yes at that point the pt was holding the nurse's arm, but was his other arm raised in a fist? Was he suggesting the hitting would continue? Was he moving toward the nurse? Was he trying to get off the scanner table and come toward the nurse? Was he........was he.....etc. There are so many unanswered questions in the scenario, but I still would give the nurse the benefit of the doubt.

OK and onward -

Point #4 - police were present in the immediate vicinity. That would be better wording from me. In our scanner, it is arranged so that the "window" that separates the pt from the staff or police or whoever is about 8 feet away and a few running steps. My point is that even with people close by, I would still respond with physical force if someone was (or had just been) punching me.

Point # 6 - I think we will just have to disagree. I'm not sure I can assume all those things about how they were feeling. Yes, they expressed dismay that they "lost it", as I think any of us would. When I say I would physically respond to someone assaulting me, that doesn't mean I would brag about it later or be proud of myself (not saying that is what you are implying - just bringing my thoughts out here). I would definitely be upset that I had to resort to that point and feel sad. But I would still do it to protect myself.

Point #7 - for my assault and my fighting back - my hospital fully supported me in my actions. The risk manager didn't have any concerns at all. My manager was more concerned about my safety than my actions. She was supportive.

Point #10 - please realize that all hospitals are not the same. Staffing at a rural hospital is insane - especially at night. At a rural hospital I've worked at, noc shift staffing was 3 RN's for the entire hospital. 1 in ER, 2 on the floor, another for ICU if we had a pt. The ER had no other staff in it - just the nurse and the doctor (if the doctor was actually inhouse and didn't go home for the night). Police officers at night on duty usually ran about 2 or 3 for the entire county (Very rural, seriously - 10,000 square miles of pretty much nothing but sagebrush and a few people thrown in for good measure).

So - using that scenario................. think of drunk pt in ER - to CT scanner with one nurse, maybe 2 officers (since the other one was probably on the other side of the county), doctor not present, CT tech running computer. Nurse next to pt with lead gown on, which weighs you down and makes it difficult to move anyway. Pt starts to fight- hits you in face, chest, grabs arm (probably took about 1-2 seconds). Police may be coming towards you to help.............. I would still fight back. Really, I would. It takes one punch to knock you out or to permanently damage you. It takes one punch to damage your airway. One punch can happen in the time it takes the police to take a few more steps toward you. Yes.............I would hit the pt to make them stop. The police could take over from there.

NOw I know not everywhere is rural and more people may be present to help, but think about the situation from that viewpoint.

[obliviousRN]

Should add the above post was not meant to be snotty at all - serious talking about the issues.

The apology was for previous posts, not a "sorry, but here I go.... " type thing

[Epona]

wow. i am absolutely mortified and dumbfounded by this. how disgusting it is to be beaten up when trying to help someone. what in the world is wrong with these morons??????

i am getting ready to start rn school in jan. i already decided a long time ago that i was not working in a hospital er dept. or trauma center. this has certainly reinforced this in my head. i am not going to even put myself there. my hat is off to those who do it, we need you, but i just can't fathom being beaten up on the job and the risk is there. that is so awful. here we are nurses trying to help people and they beat us up.

i am so sorry, so very sorry you had to go through this. and could be at risk of loosing your license over this jerk.

i hope this all works out for you. may you find peace and resolution during this time.

take care.... e

[nuangel1, BSN, RN]

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.

yeah that !:yeahthat: very well said and i couldn't agree more.

[TrudyRN]

Again - I apologize for my snottiness - please understand it comes from a place of being in that nurse's position of having a drunk volatile pt physically assaulting me.

so...........................

Here is a direct quote from the OP:

Yes he was holding the nurse's arm, but he had also just punched them in the chest and face. So I would like to remind everyone it wasn't as simple as just holding onto the nurse's arm. Yes at that point the pt was holding the nurse's arm, but was his other arm raised in a fist? Was he suggesting the hitting would continue? Was he moving toward the nurse? Was he trying to get off the scanner table and come toward the nurse? Was he........was he.....etc. There are so many unanswered questions in the scenario, but I still would give the nurse the benefit of the doubt.

OK and onward -

Point #4 - police were present in the immediate vicinity. That would be better wording from me. In our scanner, it is arranged so that the "window" that separates the pt from the staff or police or whoever is about 8 feet away and a few running steps. My point is that even with people close by, I would still respond with physical force if someone was (or had just been) punching me.

Point # 6 - I think we will just have to disagree. I'm not sure I can assume all those things about how they were feeling. Yes, they expressed dismay that they "lost it", as I think any of us would. When I say I would physically respond to someone assaulting me, that doesn't mean I would brag about it later or be proud of myself (not saying that is what you are implying - just bringing my thoughts out here). I would definitely be upset that I had to resort to that point and feel sad. But I would still do it to protect myself.

Point #7 - for my assault and my fighting back - my hospital fully supported me in my actions. The risk manager didn't have any concerns at all. My manager was more concerned about my safety than my actions. She was supportive.

Point #10 - please realize that all hospitals are not the same. Staffing at a rural hospital is insane - especially at night. At a rural hospital I've worked at, noc shift staffing was 3 RN's for the entire hospital. 1 in ER, 2 on the floor, another for ICU if we had a pt. The ER had no other staff in it - just the nurse and the doctor (if the doctor was actually inhouse and didn't go home for the night). Police officers at night on duty usually ran about 2 or 3 for the entire county (Very rural, seriously - 10,000 square miles of pretty much nothing but sagebrush and a few people thrown in for good measure).

So - using that scenario................. think of drunk pt in ER - to CT scanner with one nurse, maybe 2 officers (since the other one was probably on the other side of the county), doctor not present, CT tech running computer. Nurse next to pt with lead gown on, which weighs you down and makes it difficult to move anyway. Pt starts to fight- hits you in face, chest, grabs arm (probably took about 1-2 seconds). Police may be coming towards you to help.............. I would still fight back. Really, I would. It takes one punch to knock you out or to permanently damage you. It takes one punch to damage your airway. One punch can happen in the time it takes the police to take a few more steps toward you. Yes.............I would hit the pt to make them stop. The police could take over from there.

NOw I know not everywhere is rural and more people may be present to help, but think about the situation from that viewpoint.

It sounds very problematic and not the type of setting I was picturing, being a city girl myself and used to big teaching hospitals. Heck, those nurses better keep pepper spray handy.

[Altra, BSN, RN]

It sounds very problematic and not the type of setting I was picturing, being a city girl myself and used to big teaching hospitals. Heck, those nurses better keep pepper spray handy.

Could pepper spray use be considered assault/battery? Just curious ... Or is it just more palatable in your mind than taking physical action? Might the assailant pause long enough to fish the pepper spray out of your pocket? I suppose it's possible.

I wouldn't recommend it, though, as the entire department would then have to be decontaminated. Probably not the thing to do.

There is no way to restrain a patient to a CT scanner table - you need a bed frame or something similar.

Again ... the OP had to deal with a physical assault NOW ... she was being punched NOW.

I also strongly disagree that this is an issue solely of ER, corrections and psych nurses. Just ask any med-surg floor nurse. Where do you think violent patients go after their brief stay in the ER?

[Jo Dirt]

First, stop wasting your time thinking about him. He's made his choices and now he has to live with them.

Second, are you upset that you punched him? Your actions seem reasonable to me since you said that you were trying to get away to prevent him from further assaulting you. How many times do YOU think you should allow yourself to be punched before you become proactive in your safety?

And shame on your ER doc. Any patient that has to be tazered to be CT'd should have immediately been paralyzed and intubated.

You've had a huge adrenaline rush tonight. You're going to think about it a lot. Time will make it better.

When you tell this story at work, leave out the part about punching him. While your peers that have stood there on the line with you understand the dynamics of what happened, there's always going to be that ONE who will put you at fault and try to take your license if they can.

YOU HAVE EVERY RIGHT TO PROTECT YOURSELF!!!

Too many nurses take the abuse and suffer, they even think it is some kind of obligation. No way!

Don't be hard on yourself. There is absolutely no reason to take being abused.

[RunnerRN, BSN, RN]

"If you're fighting for your life, it becomes another story. Although that would not hold up in psychiatric nursing where, no matter what, staff are not allowed to lose their cool."

THE ER IS NOT A PSYCH WARD!!!!! Our goal is not to establish a therapeutic setting so Mr Alkie can figure out why he drinks. The OP was working to make sure he did not have a possibly life threatening injury. And I really don't feel that telling this pt to "calm yourself or we will paralyze you and put a tube in your throat" was battery/threatening. It was simply a nurse explaining the possible consequences of his actions.....act like a human being or we will force you to.

Again, when I go to work, I go to help people - but not at the expense of my safety. Hindsight is always 20/20, and I'm sure the OP will act differently in the future. But she acted appropriately for the given situation and issues.

[Daywalker]

Don't sweat it. He won't, and you were defending yourself. Our facility won't handle patients like that until they have come down enough to be docile.