Assault against nurses

BonnieSc · Jul 9, 2016

There's a big difference between a patient who punches a nurse in order to hurt her/him and one who is in the middle of alcohol withdrawal! Have you ever taken care of a patient like that? Perhaps it happens some places, but I've never heard of a nurse "pressing charges" against a patient in that condition. I'm not too intimidated to do it, I understand that the patient isn't in control of what he does. Sure, if a person in withdrawal was in, say, a supermarket and punched a clerk, they'd call the police--but actually, what would happen then is that they'd drop the person off in the emergency room of my hospital! And it's likely the person would never be charged with anything, or if they were were, they'd be dropped, person ordered to go to rehab, etc.

But the supermarket clerk has no obligation to the patient. Taking care of people in withdrawal is our JOB. Violence can be one of the symptoms. We dodge fists as best we can and we call for backup and restraints when they're needed. Above all, we try to prevent things from getting to that state with appropriate medication.

Now, that said, there are problems with violence against nurses from people who are aware of what they're doing. It's an ongoing discussion and recently some laws have been enacted. I have gotten surveys on the subject a couple of times--I can't remember if they were from the ANA, the federal government, or what. Here is a recent press release: "http://www.rwjf.org/en/library/articles-and-news/2015/07/nurses-face-epidemic-levels-of-violence-at-work.html"

But although that article talks about how the culture needs to change, it shouldn't just be considered part of the job, etc, which is true--it's not really talking about punitive measures like pressing charges against an incompetent patient, it's talking about how to prevent violence in the first place.

qaz99 · Jul 9, 2016

Start a petition for zero tolerance, get enough signatures for the government to step in?

This is pretty much what has happened in Australia. Paramedics especially were getting assaulted too often. They started a zero tolerance campaign, got the government behind it and now my state has added a maximum sentence of 14 years for abuse against health care workers. There are now various adverts aired on TV and posters around the hospital bringing awareness to the fact it's not acceptable and there will be consequences.

Adverts currently on TV:

Management at my work also encourage good documentation and use of incident reports when a form of assault occurs at work so they can actually do something about it.

nikkole318 · Jul 9, 2016

Yes, I have taken care of too many ETOH patients to count and I've been lucky enough to not get assaulted (yet). I realize that it is part of our job to take care of patients, but it is not our job to take physical abuse. I've witnessed abuse happening from patients who are 100% with it too, which is even more intolerable.

Thank you for the article. I would like hospitals to take measures to prevent abuse from occurring in the first place. Is their medication being managed properly? Have there been any studies to show that ETOH patients should be managed a certain way? Should competent patients sign a waiver to acknowledge the fact that hitting healthcare workers is against the law (I think people forget). What studies have been done to try to determine what prevents violence?

This is such a huge topic, and a controversial one, so I don't even know where to start! I was going to find books to read about addiction, because these patients tend to be the ones who are most likely to be violent. That way I can bring more understanding to the situation.

nikkole318 · Jul 9, 2016

I've actually seen those commercials and they are great. I think that our hospital should have a policy regarding violence, such as incident reports, or at least a guideline that employees can refer to when it happens.

At my hospital, management does absolutely NOTHING about violence against healthcare workers. A nurse in our ER got severely assaulted by a completely competent man who just walked into the ER and apparently wanted to find a woman to beat up. She was so badly injured that she was out of work for months. We don't even have real security. We are a for-profit hospital, so they "save money" by hiring 1 rent-a-cop per shift who gets paid $10/hour.

Horseshoe, BSN, RN · Jul 9, 2016

Sorry, teaching someone that it's "illegal" to hit a nurse is not going to do a damn bit of good if they are in DTs. I can't get on board with you wanting punitive measures in place for people with conditions which render them mentally incompetent. Would you put someone in jail who hit someone while in a diabetic crisis? I've seen them strike out before when their BS is going nuts. I think you might be a tad judgmental here because someone in DTs is seen as bringing it on himself, vs. someone with another condition who does the same thing while mentally unbalanced.

Holding people who are alert, oriented, and mentally competent accountable for their actions is one thing. Pressing charges against people with brain dysfunction who are not in control of their actions is another thing altogether.

verene, MSN · Jul 9, 2016

Holding people who are alert, oriented, and mentally competent accountable for their actions is one thing. Pressing charges against people with brain dysfunction who are not in control of their actions is another thing altogether.

THIS so much. If a person is aware of their actions and intentionally trying to harm others that is one thing to hold them accountable. Most of my encounters with violence have come from end-stage dementia patients. Taking punitive action is complete inappropriate for this population.

Holding the facility responsible may be appropriate in some cases: There is a difference if the hospital has unsafe staffing levels, doesn't provide needed resources, and is indifferent to a high rate of a assault.

However in many instances it is completely inappropriate: figuring out the proper medications and doses takes time, figuring out the optimal way to communicate with a particular patient can take time - the deescalation technique that works wonders on one may not work on their neighbor down the call. What is security going to do with a frail 95 year old Alzheimer's patient who believers strangers have just invaded his house and are trying to stick needles in him? Tackle him and put him in restraints? Should patient seizing from an overdose be arrested when healed because a nurse was bruised by their flailing limbs?

Working in healthcare involves a level of personal risk. Everyday we are exposed to pathogens, intense emotional situations, patient who pose us harm be it through confusion, misunderstanding, or an out of control neurological disorder, dementia, delirium, or mental illness, detox symptoms, not being able to follow directions, or other health issues. There is always a risk of violence and harm to staff. There is much that can be done to mitigate that risk through protocols and effective teamwork between staff, and training in situational awareness and deescalation, but the risk of violence is a known risk that anyone entering this profession ought to be aware of.

BonnieSc · Jul 9, 2016

Have there been any studies to show that ETOH patients should be managed a certain way?

Are you kidding? You say you've taken care of too many ETOH patients to count; what is it you do with them? It sounds like your hospital may be doing its nurses a disservice in a couple of ways... inadequate security and inadequate education.

nikkole318 · Jul 10, 2016

Yeah, I guess it is. I work for a for-profit hospital and they really have done nothing as far as education.

nikkole318 · Jul 10, 2016

Maybe you can help, point me to some good resources.

nikkole318 · Jul 10, 2016

I would NEVER advocate pressing charges against a dementia patient who thinks we are invading his house and sticking him! I'm talking about policies and procedures for those who are either completely competent and assault healthcare workers.

NightNerd, MSN, RN · Jul 10, 2016

While I competely agree that alcoholism and addiction are, at least to some extent, an illness that is difficult for many patients to manage, isn't part of recovery to accept responsibility for what you've done as a result of that addiction? While my heart goes out to people with this particular struggle, I can't help but see some differences between this and the 95-year-old dementia patient.