What do you do when a patient threatens harm?

Nurses General Nursing

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So far in my short few months on the floor I've already had a bunch of patients threaten to hit me. Every time I get threatened or yelled at by the public all I can think of is that I'm not getting paid enough to put up with this ****.

What do you do when someone just threatens violence? If I just called security on my ascom who knows when they would show up. But I don't feel the need to call a code since nothing is actually happening & I don't want to make the patient more irate.

Yesterday I was trying to remove a patient's IV (she was being D/C'd). She had paper thin skin & lots of tape. I was trying to go as slow as possible & use ETOH pads & then hand sanitizer. She wasn't good with pain & at one point she said she was going to punch me in the face. What do you do in a situation like that? I just quickly changed the conversation & de-escalated her, then she was fine.

Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Oh and you should ask your employer about CPI training. This includes verbal de-escalation training, some fast easy moves and holds as well as training into you own trigger/behavior which you may be doing unconsciously do that may trigger a patient. If your work doesn't offer it you can find it on the internet and get CEUs as well.

Hppy

I love this advice!!! This is why I love this forum!!! Thank you so much!!!

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Sounds like you did what you needed to do. In all honesty, if someone is threatening violence and I have no reason to doubt they're serious, I leave the room if at all possible. Sometimes I go back in later after the person has had time to settle down. Other times, if it is feasible, I send someone else into the room, especially if they have more authority than me, and let them deal with it. I am at work to care for patients, not be a punching bag, although I am a small person.

Thank you. Yes, I am small as well so I don't want to be mistaken for a punching bag either.

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Everyone has said what to do. As a psych nurse we are always on our guard, but I stress to my fellow nurses who do not work on a designated psych floor that they will deal with psych pt's and pt's who are combative. At least with my specialty I know what I'm dealing with. ALL nurses should assume that a pt or family member could assault you without warning (except those cute little babies), but watch out for mama bears. Nurse abuse is real and under reported. We are expected to deal with it and we do! I am totally sympathetic to aggravated, medicated pt's, but it doesn't give someone the right to be aggressive or assaultive.

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The last 2 hospitals I've worked at "Code Grey" is the code for violent patient/family. In psych we all wear panic alarms and a hit to the button calls the code. Alarms go off all over the unit, security comes running, as well as staff from other psych floors.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Everyone has said what to do. As a psych nurse we are always on our guard, but I stress to my fellow nurses who do not work on a designated psych floor that they will deal with psych pt's and pt's who are combative. At least with my specialty I know what I'm dealing with. ALL nurses should assume that a pt or family member could assault you without warning (except those cute little babies), but watch out for mama bears. Nurse abuse is real and under reported. We are expected to deal with it and we do! I am totally sympathetic to aggravated, medicated pt's, but it doesn't give someone the right to be aggressive or assaultive.

I totally believe it is under reported. That's why I wanted to ask what I should do. I'm use to corrections where there is always someone there to protect me.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
The last 2 hospitals I've worked at "Code Grey" is the code for violent patient/family. In psych we all wear panic alarms and a hit to the button calls the code. Alarms go off all over the unit, security comes running, as well as staff from other psych floors.

I believe it is code grey. I feel like every nurse on every floor should have a panic button. I know psych has a higher chance of getting assaulted but you just never know what you're going to get on any floor. You might get someone who is off their meds or undiagnosed.

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With how you describe what you're doing, if I were in that position, I would probably look at her while doing what you're doing and tell her, "Don't, I'm trying to do my job for you, so you can get out of here and go back to your normal life."

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We really do. I had a conversation with a coworker about it yesterday. I can't tell you how many times a code is called for security. We should be able to carry mace.

There was a patient on the floor who got irate & had a pocket knife. You're telling me I have a whip out my ascom, call a code & wait for security to get there?

It's one thing if a patient is verbally abusive when if someone ever starts to become physically abusive with me, I will do whatever it takes to protect myself. I have 2 little ones at home & I want to go home at the end of the day.

I completely disagree that we should be able to carry mace. It is absolutely inappropriate for a health care professional to use mace in a health care facility. What on earth are you thinking?

When used inside, mace sucks. PD used it once when I was working, and I got itchy even though I wasn't very close.

We should carry Tasers.

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Oh and you should ask your employer about CPI training. This includes verbal de-escalation training, some fast easy moves and holds as well as training into you own trigger/behavior which you may be doing unconsciously do that may trigger a patient. If your work doesn't offer it you can find it on the internet and get CEUs as well.

Hppy

This is great- in theory.

In my experience, courses offered by the hospital seem more geared to reducing liability for the hospital by establishing a standard of care, and training for it.

While some of the principles taught for de-escalation are reasonable, most of the physical techniques taught to protect oneself are useless and potentially dangerous.

The techniques I have been taught could be used to get a 90 y/o LOL to let go of you, and do so without hurting her. Which is nice.

Actually physically defending yourself from a real assault takes hundreds or thousands of hours of practice- not a 2 hour session once a year.

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Specializes in Case Manager/Administrator.

Under no circumstance should anyone ever put up with abuse. Verbal skills can get you out of a lot of situations (I have worked in the prison system). An ability to de-escalate is an art and anyone can learn with trial and error. I agree with all here no abuse from patients, document it all and spell it out if they use the F word then write that out do not use asterisks (F***) because in a court of law they can come up with all words that begin with the letter F...fail, frog, fine, full, flurt, forget, attorney can twist these words back at you so be exact, no sugar coating, it is the truth and as Judge Judy says the truth will be best. If anyone ever hit me I would press charges in a min with exception of Alzheimer's, dementia very young children....bad behavior needs to be addressed I have no problem saying to my patient if you hit me and I will see to it that the law for hitting healthcare professionals is used against you.

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Specializes in School Nursing.
Oh and you should ask your employer about CPI training. This includes verbal de-escalation training, some fast easy moves and holds as well as training into you own trigger/behavior which you may be doing unconsciously do that may trigger a patient. If your work doesn't offer it you can find it on the internet and get CEUs as well.

Hppy

I did an 8 hour CPI course on Wednesday, this training counts toward our nursing CEUs??

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I completely disagree that we should be able to carry mace. It is absolutely inappropriate for a health care professional to use mace in a health care facility. What on earth are you thinking?

When used inside, mace sucks. PD used it once when I was working, and I got itchy even though I wasn't very close.

We should carry Tasers.

Yes, mace can be bad inside. Taser work for me! :D

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