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

Specialties Emergency

Published

As a 1yr ms RN going into ED, one of the top things that concerns me is the safety. I'm sure you have seen lots of crazy things that happen at ed, and I'm not doubtful that one of them include violence against staff.

I have heard from others that people bring guns to the ed, sometimes you can get punched, kicked, put in choke holds, wrestled like in the octagon, etc.

In my state, we have a law that makes assaults on ed staff a felony, but I don't think that will stop the real crazies. I already have a bad back for which I go to the chiropractor, and I don't want to get disabled.

I understand that the best thing to happen is just avoid the violence when it's happening, but what if I have a coworker who is 5ft and will surely go to Valhalla if I run away? Or what if I'm cornered and have to fight? I be honest with you, if there's two options, one being a saint and risk being disabled for rest of my life or being badly hurt, and the other being "selfish " and knock the snap out of someone so I can support my family, I will happily put someone to sleep as best as I could with the blessings of Rocky Marciano. This is not really something you would worry too much about in MS setting, so I feel apprehensive about it.

As you all know this is my first ed position and I know I will defend myself and my coworkers in violent situations. So the question is probably this: what is the realistic approach in hitting someone before yourself can get hurt bad in ed? I'm not going to just simply start punching pts but I'm taking about real danger situations where you know it's either do something or get hurt.

Many ED nurses I talk to about this said they had to use "rough" methods to avoid having themselves or coworkers from getting badly injured... Or am I worrying about something that happens very very rarely?

Specializes in Transitional Nursing.

I am trying to see the logic in becoming a nurse, getting hired in an ER, and inquiring as to whether it's acceptable to hit a violent patient before they have the opportunity to hit you.

Why wouldn't you first try diffusing the situation, or work on strategies to avoid getting hit? Wouldn't you think that hitting a violent patient would only make them more violent?

Also, what are the odds that your punch is going to incapacitate said violent patient, provided you WERE allowed to hit them?

Just saying.....

My money is on the drug induced rage.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I am trying to see the logic in becoming a nurse, getting hired in an ER, and inquiring as to whether it's acceptable to hit a violent patient before they have the opportunity to hit you.

Why wouldn't you first try diffusing the situation, or work on strategies to avoid getting hit? Wouldn't you think that hitting a violent patient would only make them more violent?

Also, what are the odds that your punch is going to incapacitate said violent patient, provided you WERE allowed to hit them?

Just saying.....

My money is on the drug induced rage.

Perhaps the OP dwells under a bridge? I'll admit, I fed it. But continuing to uphold an uneducated point of few after multiple experienced nurses -- especially ER nurses -- have attempted enlightenment speaks more to the bridge-dweller than a real nurse seeking information and advice.

Perhaps the OP dwells under a bridge? I'll admit, I fed it. But continuing to uphold an uneducated point of few after multiple experienced nurses -- especially ER nurses -- have attempted enlightenment speaks more to the bridge-dweller than a real nurse seeking information and advice.

I thought maybe the same, and actually would have given credit for some excellent under-bridge-dwelling activities. But, out of curiosity, I reviewed some of her other posts.

She has a pretty unique outlook, and appears to be genuine.

Specializes in Emergency.

Still can't hit first.

Specializes in Emergency, Telemetry, Transplant.
Still can't hit first.

Nor second, third, etc...

Actually, I am quite sure it would be possible to come up with a theoretical scenario in which you could strike a patient and not get in trouble. " He had slashed the knife at me three times, and backed me in a corner...." But, so what?

The question is irrelevant. Laws in every jurisdiction are different, hospital policies and administrations are all different, and who knows how any given hypothetical situation might play out?

I took a concealed weapons carry course, and a guy asked what I thought was a truly dumb question. "If I truly believe my wife or child's life is at stake, would I be justified in using deadly force?" My thought was: If you thought your family was in true danger, why would you care about the law? If you didn't think that, why would you consider shooting somebody?

The same logic applies here: If you thought you had no other option, why would you care? By definition in that situation, you have no other option. On the other hand, if there is another viable option, you need to take it. And, in reality, unless you are really good at it, hitting somebody will make any situation worse. And given the fact that you even asked the question, I am going to go out on a limb here and guess that that it is unlikely you will disable somebody by hitting them.

What has made this such a weird thread is the OPs steadfast refusal to understand the realities being explained to her by folks who have "been there, done that". Why ask the question if you don't want to hear the answer?

I work ER in a hospital with both psych and rehab facilities. Obviously, we deal with volatile patients. The only time I ever considered hitting somebody was a guy who spat at me- and I controlled my reaction. Every other situation, I managed to diffuse, or foresee and manage appropriately.

OP- as a new ER nurse, what you need to look at is building the skills to manage volatile situations. Hitting is not one of those skills.

Good luck.

Specializes in ER/SICU/House Float.

I hate to give you more bad news but the ER is not the only place you will have patients that are violent. I've had a patient jerk me over the rails in MICU 20 years ago. I would of been hurt more had I not relaxed and started talking him down. I was working Surgical step-down had a guy in DT throw a knife at me. I could go on and on. The IV pole hurts like hell avoid if you can ask me how I know LOL There are just some situation that you do the best you can and yell someone to call the code. The think with on the floor you got closed doors and many rounds and there are sometime just you alone doing whatever procedure and **** happens. We had a gunman last summer the e/r doors have safety shut down so he couldn't get in so he started going through the hospital shot 2 before security took him down.

Anyway new nurse the e/r usually have a fulltime guard and everyone is working in a close area so help is close by.

Specializes in Emergency, Telemetry, Transplant.
Actually, I am quite sure it would be possible to come up with a theoretical scenario in which you could strike a patient and not get in trouble. " He had slashed the knife at me three times, and backed me in a corner...." But, so what?

Just to play devil's advocate--if a nurse struck a patient, the pt fell, suffered some catastrophic injury (head bleed, whatever), I would think the nurse would have a very hard to justifying his/her hitting the patient when that situation ends up in court.

Specializes in Emergency.
when that situation ends up in court.

I immediately thought of the line "I'd rather be judged by 12 than carried by 6"

Still can't hit first. Anyway, unless you're very well trained & experienced, going against an armed assailant while unarmed yourself is a bad choice.

If you hit a patient, you can pretty much kiss your license goodbye.

Actually, I am quite sure it would be possible to come up with a theoretical scenario in which you could strike a patient and not get in trouble. " He had slashed the knife at me three times, and backed me in a corner...." But, so what?

The question is irrelevant. Laws in every jurisdiction are different, hospital policies and administrations are all different, and who knows how any given hypothetical situation might play out?

I took a concealed weapons carry course, and a guy asked what I thought was a truly dumb question. "If I truly believe my wife or child's life is at stake, would I be justified in using deadly force?" My thought was: If you thought your family was in true danger, why would you care about the law? If you didn't think that, why would you consider shooting somebody?

The same logic applies here: If you thought you had no other option, why would you care? By definition in that situation, you have no other option. On the other hand, if there is another viable option, you need to take it. And, in reality, unless you are really good at it, hitting somebody will make any situation worse. And given the fact that you even asked the question, I am going to go out on a limb here and guess that that it is unlikely you will disable somebody by hitting them.

What has made this such a weird thread is the OPs steadfast refusal to understand the realities being explained to her by folks who have "been there, done that". Why ask the question if you don't want to hear the answer?

I work ER in a hospital with both psych and rehab facilities. Obviously, we deal with volatile patients. The only time I ever considered hitting somebody was a guy who spat at me- and I controlled my reaction. Every other situation, I managed to diffuse, or foresee and manage appropriately.

OP- as a new ER nurse, what you need to look at is building the skills to manage volatile situations. Hitting is not one of those skills.

Good luck.

Heard loud and clear from other experienced nurses... I understand that I will not hit them, yes I understand that part. Obviously I took the course from "can I hit first" to "can I hit to avoid getting killed" in my thread, and if people understand that one can indeed change a vaguely put question into more clear one along the course of discussion, then I think that will do great for everyone, as I am sure every human being on this earth is capable of thinking of/saying a statement and wait and say, "oh wait, I think I meant..." So well, for those who like to have fine prints, you can now consider my question to be "can you hit to avoid getting killed" but I think many people caught on that and answered accordingly to that question, so thumbs up for you gents and ladies.

Although it is probable interjection that some nurses would choose to get stabbed and die of mass loss of blood rather than hitting back, as it can be proven per our evidence-based observation from some of the posts, I have heard loud and clear that it is reasonable in most logical sense to NOT hit someone, maybe just dodge, push/nudge, and run the hell away; which I find highly appeasing tactic in my practice and will resort to if any possible or near death occurrences deviate towards my way. If, however, I am given a scenario wherein I am suddenly cornered by a 200lb man with a machete in his hand ready to strike me, well, maybe using every force I have known or unbeknownst to me would be a natural thing to do than trying to calm him down with a sandwich tray; no concrete answer here but whatever method that will keep me alive, I am probably going to do it; these occasions, however, seem to be rare, so hopefully I will not encounter these kinds of things, especially since I don't see how someone might enter ED with a machete... maybe possible with a switch blade.

I have not seen any violence since I started ED, just some crazy ppl yelling at doctors for not giving them dilaudid, but no guillotine chokes, rear naked chokes, or any full-fledged aggression and exhibition of deadly forces. I cross my fingers as I get ready for tomorrow's shift. ED is really really really an awesome place.

and @Ruby Vee... yes I live under a bridge called single tax bracket. Other than some big guy with beard pointing fingers at me and saying "uncle wants your money", I haven't discovered major discomfort. If you would be generous to maybe drop by and deliver a food cart or fresh ebt card, I will really appreciate it. I live under the bridge next to salvation army on 5th avenue in poverty street in welfare city. I can spare a hot coco if you make it by midnight tomorrow :)

Specializes in Emergency.

OP,

Your original question was about hitting a patient as a preemptive strike due to a perceived threat. The overwhelming response was no. Because that's battery.

You question then morphed into can you hit as self defense and the answer is still no. Not only from the potential for a battery charge but because hitting or punching is the last resort. Fist fights outside the ring are clumsy, brutal and generally wind up as wrestling matches. You keep bringing up being attacked with edged weapons. Going against an armed opponent bare-handed (if not properly trained and experienced) will end BADLY for you. I assume you haven't had the "brought his fists to a knife fight" pt yet. He loses. Every time.

Be alert, aware and never get cornered. That's your best defense.

And if you continuously get cornered, then the purpose of your life could simply to be serving as a warning to others.

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