Um... Can you hit before you get hit?

elkpark · Jul 9, 2014

We have police on the ground not security guards, and staff are always given choice to file criminal charges on pts or family or anyone if physically struck . Happened already last shift. It goes both ways...

I certainly wasn't trying to suggest that it doesn't "go(es) both ways," or that staff members shouldn't file assault charges if they are assaulted by someone in possession of her/his faculties. I'm glad to hear your employer supports that; lots of employers don't. My response was specific to the OP's question about hitting back in an assault, and I've never been anywhere in my career where it was considered acceptable to respond aggressively to an assault, or the fact that one was being attacked was considered a reasonable excuse for doing so. File charges against the individual? Fine. Fight back? No way.

AdamantiteEnigma · Jul 9, 2014

I've worked in ED's for the majority of my career. There has literally only been one time that I've had to do anything past either raising my voice volume, or assist in restraining a patient. I suppose takedowns count as well, yet that is done in a manner in compliance with CPI mandates. Yet even in that one incident, I didn't go any further than using a martial technique to disarm a man with a hunting knife. He attempted to pursue and stab me, and that was a bad idea. Considering the officer response *after* he was disarmed he was much better off just dealing with me. I actually felt really badly for him. Oh, and I got written up over it. That was a terrible shift overall for me. Kote-Gaishi is not your friend at work haha!

Escalations in aggresive behavior happen often in that setting. We are expected to remain calm, professional, and in control. Your co-workers are invaluable in this process. And I've found in my own experiences a showing of solidarity amongst staff that 'this is not ok' is far, far, more effective.

Never allow an escalating person to block your route of escape. And if they do, that is one of many reasons why there is a code switch on the wall, and you have a voice :)

cannul8r · Jul 9, 2014

The ED nurses in our organization are required to take yearly CPI training/refreshers, along with those of us who work in the Mental Health unit and our security guards. Rather than striking defensively, in CPI you are taught maneuvers to avoid, block or escape from a variety of attempted attacks (strikes, grabs, hair-pulling, etc). More importantly, you are taught to focus on de-escalation skills. I think these are essential safety skills for your line of work.

applesxoranges, BSN, RN · Jul 9, 2014

Apparently the guy I replaced was fired for "excessive force." So keep that in mind. Obviously this is just hearsay since I wasn't hired yet. Supposedly the woman kicked another worker in the shin so the fired guy punched her.

Guests · Jul 10, 2014

This thread has diverged a bit from the original question.

Um... Can you hit before you get hit?

The answer is an unequivocal and absolute * NO *

To those who say that you can never use force, do you really mean that if somebody has a forearm to your throat and is punching you in the head, that you are still not permitted to fight back with sufficient force and aggression to permit you to escape? If so, I dispute your assertion.

Likewise, say that a patient has managed to place one of your colleagues in a choke hold... are you asserting that you have no legitimate and defensible recourse beyond trying to verbally de-escalate? "Sir, I understand that you're frustrated at the wait time and the physician's refusal to give you Dilaudid but I must insist that you not murder this nurse."

OP, not only can you not strike preemptively, you may only use what force is reasonable to permit you to escape to safety.

elkpark · Jul 10, 2014

This thread has diverged a bit from the original question.
The answer is an unequivocal and absolute * NO *
To those who say that you can never use force, do you really mean that if somebody has a forearm to your throat and is punching you in the head, that you are still not permitted to fight back with sufficient force and aggression to permit you to escape? If so, I dispute your assertion.
Likewise, say that a patient has managed to place one of your colleagues in a choke hold... are you asserting that you have no legitimate and defensible recourse beyond trying to verbally de-escalate? "Sir, I understand that you're frustrated at the wait time and the physician's refusal to give you Dilaudid but I must insist that you not murder this nurse."
OP, not only can you not strike preemptively, you may only use what force is reasonable to permit you to escape to safety.

I cannot speak to what practices may be in various EDs, but in psych you are never allowed to respond aggressively to aggression. Employers provide training in nonviolent, nonaggressive ways of escaping from choke holds, bites, hair pulls, etc. (and how to assist others from escaping those kinds of holds), avoiding various kinds of kicks and blows, and how to safely (and nonaggressively) restrain individuals who are combative/aggressive, and you are limited to those interventions in the workplace. If you respond aggressively, you will be fired, probably reported to the state for abuse, and can be criminally charged with assault by the client. In the facilities in which I've worked, the ED staff and security personnel have received the same training, and were held to the same standard. Of course, I realize that doesn't mean the same is true everywhere.

But you are taking a big chance by responding aggressively in any way. I encourage the OP and anyone else who has not already had the discussion to find out from your employer precisely what is and isn't allowed (in terms of responding to assaultive behavior) in your specific workplace.

Been there,done that, ASN, RN · Jul 10, 2014

Take up judo, aikido or jiu jitsu. It's a nonviolent redirection of force and uses submission holds (restraining) rather that strikes.

I want to like this,but sheesh.. what does it say about our profession if we have to study martial arts to get through the shift?

MrChicagoRN, RN · Jul 10, 2014

I want to like this,but sheesh.. what does it say about our profession if we have to study martial arts to get through the shift?

Jiu Jitsu, not to sure of, seems more violent to me, and involves more grappling than I think is necessary. Keep in mind, that even if attacked, this is not going to remain 1 on 1, and that others are going to jump in.

But Judo and Aikido can be excellent exercise, and if used correctly, and most forms only redirects the aggressors' own energy away from the victim. This allows the clinician to make a safe retreat until help arrives. Many people take these less for self defense, more for the sport.

And, you never know what angry person you may come across when you are out and about. Always helpful to know you arenot a sitting duck out there, no matter what you do for a living.

AdamantiteEnigma · Jul 10, 2014

Jiu Jitsu, not to sure of, seems more violent to me, and involves more grappling than I think is necessary. Keep in mind, that even if attacked, this is not going to remain 1 on 1, and that others are going to jump in.
But Judo and Aikido can be excellent exercise, and if used correctly, and most forms only redirects the aggressors' own energy away from the victim. This allows the clinician to make a safe retreat until help arrives. Many people take these less for self defense, more for the sport.
And, you never know what angry person you may come across when you are out and about. Always helpful to know you arenot a sitting duck out there, no matter what you do for a living.

Jui-Jitsu is in fact much more aggressive. I'd recommend it for street defense. But in a work situation one is much more likely to end up jobless and the subject of a civil suit using it. Aikido, which is something I branched into after studying the latter through my 20's, is much more passive. Respectful really by comparison. If one were to study, that's what I'd recommend. What I felt compelled to use to disarm my knife wielding friend was by the book. It just put him on the floor, away from the knife, and in a position for the PD to take over. It's difficult for me to describe it well in words. So here's a visual:

By way of contrast, what I'd studied for years before would have had me disabling a joint, executing a bone break, and/or doing permanent damage to the eyes under the same circumstances.

However I feel it must be restated that something akin to this would be an absolute last resort. In my situation I was fleeing the room and realized he was going to catch me anyway swinging that thing around. Not to mention the obvious safety risk that imposed to anyone within range. I did get in trouble for doing that. And I had to prove during my disciplinary meeting that I had in fact used CPI mandated techniques, and had attempted to escape. That alone saved my job.

Been there,done that, ASN, RN · Jul 10, 2014

Jiu Jitsu, not to sure of, seems more violent to me, and involves more grappling than I think is necessary. Keep in mind, that even if attacked, this is not going to remain 1 on 1, and that others are going to jump in.
But Judo and Aikido can be excellent exercise, and if used correctly, and most forms only redirects the aggressors' own energy away from the victim. This allows the clinician to make a safe retreat until help arrives. Many people take these less for self defense, more for the sport.
And, you never know what angry person you may come across when you are out and about. Always helpful to know you arenot a sitting duck out there, no matter what you do for a living.

Been awhile since I took your previously suggested CPI course. It includes "how to identify at-risk individuals and use nonverbal and verbal techniques to defuse hostile or belligerent behavior. They also learn how to control their fear and anxiety in a crisis or avoid injury when a crisis becomes physical"

I for one, am done with having to learn and apply ANY martial art during my work day.

tarotale · Jul 10, 2014

Jui-Jitsu is in fact much more aggressive. I'd recommend it for street defense. But in a work situation one is much more likely to end up jobless and the subject of a civil suit using it. Aikido, which is something I branched into after studying the latter through my 20's, is much more passive. Respectful really by comparison. If one were to study, that's what I'd recommend. What I felt compelled to use to disarm my knife wielding friend was by the book. It just put him on the floor, away from the knife, and in a position for the PD to take over. It's difficult for me to describe it well in words. So here's a visual:
By way of contrast, what I'd studied for years before would have had me disabling a joint, executing a bone break, and/or doing permanent damage to the eyes under the same circumstances.
However I feel it must be restated that something akin to this would be an absolute last resort. In my situation I was fleeing the room and realized he was going to catch me anyway swinging that thing around. Not to mention the obvious safety risk that imposed to anyone within range. I did get in trouble for doing that. And I had to prove during my disciplinary meeting that I had in fact used CPI mandated techniques, and had attempted to escape. That alone saved my job.

Disciplinary action?! The guy had a knife for jumping Jacks sake! This is why I hate this profession, that though must be angel, do no harm is so ingrained stupidly in the profession that the only defense you have against a guy with gun or knife trying to kill you is telling them "sir I know I might be murdered or disabled if lucky, but I'm really offended by your behavior and won't give you the soda you asked if you don't put that down!"

I always thought from school that it is bizarrely retarded that we cannot protect ourselves from realistic threats of life. Are cops held to same standards like we do? No. A patient with gun or knife trying to kill someone is just as much of a criminal as someone attempting that outside the hospital. And you didn't even punch the guy! Just disarmed him, and disciplinary action... I remember an outrage when one nurse near my town was shot and killed by a pt and brought dismay to community, yet no changes... How long do we endure this?

Guest219794 · Jul 11, 2014

Sorry guys- I am going to let the cat out of the bag.

OP- Of course it's ok to hit somebody first. The more experienced nurses are having fun at your expense.

Every ER has a list of instances in which a preemptive strike is allowed, or even encouraged. This list varies from facility to facility, and you need to become familiar with it.

But the list is not given to new nurses until orientation is over. It's kind of an open secret you would have learned about sooner or later. You will also be taught some one-punch knock out techniques after you finish your telemetry training.