Got Beat Up Badly In Face By Patient

MiaLyse, APRN · Mar 2, 2008

It seems like this patient definitely should have lost privileges and an incident report should have been filled out. Also, wouldn't seclusion have been appropriate for at least a short period following the assault?? That's not punishment, that's for safety IMO. Sorry this happened to you.

faithful11 · Mar 2, 2008

It seems like this patient definitely should have lost privileges and an incident report should have been filled out. Also, wouldn't seclusion have been appropriate for at least a short period following the assault?? That's not punishment, that's for safety IMO. Sorry this happened to you.

In the eyes of Patients' Rights, and along the guidelines of CRIPPA...one must be able to substantiate the decision made to PREVENT, DIMINSH or INTERRUPT a behavior which is dangerous to self or others. So, keeping that in mind ---if patient A has just beat up patient B or a staff member, and was yelling and screaming during the attack staff must do something DURING the attack. If the patient beats up someone, then walks away, breathing is even and unlabored no increase, facial expression is calm, tone and rate of speech is even and calm...body is not tense and there are no verbal threats to harm anyone, and heaven forbid they SAY "Oh..i am calm. I will take a voluntary time out". Then, what I am saying is that if you do a more extreme measure (more restrictive, which seclusion, po/im prns and restraints all are) then just be prepared to explain the justification. I do not necessarily agree, I am just saying what we are being forced to adhere to as far as CALIFORNIA dept of mental health. I work forensic psych, and it is verrrry frustrating. Though we may not like it or agree, it is actually punishment to implement something following an agressive behavior, when the attacker is now appearing calm. Key word ,appearing is there on puprose. :angryfire We have a woman who beats the living daylights out of people, then goes into a psychogenic crisis where she is "limp,immobile,verbally nonresponsive and disoreinted"...explain IN A LEGAL DOCUMENT i.e. chart, WHY she is being tied down in 5 pts restraints, when she cannot even stand up (appears anyways....we all pretty much are aware this is her behavior and NOT the real deal).

I am all for patient rights...I just wish the staff were valued a bit more in the eyes of the law and that we had just as many rights and guidelines to protect us when we need it.

I don't try to change anyone's mind either. As long as you can protect YOUR license and YOUR job with the decisions YOU make...so be it. Same for me.

elkpark · Mar 2, 2008

In the eyes of Patients' Rights, and along the guidelines of CRIPPA...one must be able to substantiate the decision made to PREVENT, DIMINSH or INTERRUPT a behavior which is dangerous to self or others. So, keeping that in mind ---if patient A has just beat up patient B or a staff member, and was yelling and screaming during the attack staff must do something DURING the attack. If the patient beats up someone, then walks away, breathing is even and unlabored no increase, facial expression is calm, tone and rate of speech is even and calm...body is not tense and there are no verbal threats to harm anyone, and heaven forbid they SAY "Oh..i am calm. I will take a voluntary time out". Then, what I am saying is that if you do a more extreme measure (more restrictive, which seclusion, po/im prns and restraints all are) then just be prepared to explain the justification. I do not necessarily agree, I am just saying what we are being forced to adhere to as far as CALIFORNIA dept of mental health. I work forensic psych, and it is verrrry frustrating. Though we may not like it or agree, it is actually punishment to implement something following an agressive behavior, when the attacker is now appearing calm. Key word ,appearing is there on puprose. :angryfire We have a woman who beats the living daylights out of people, then goes into a psychogenic crisis where she is "limp,immobile,verbally nonresponsive and disoreinted"...explain IN A LEGAL DOCUMENT i.e. chart, WHY she is being tied down in 5 pts restraints, when she cannot even stand up (appears anyways....we all pretty much are aware this is her behavior and NOT the real deal).
I am all for patient rights...I just wish the staff were valued a bit more in the eyes of the law and that we had just as many rights and guidelines to protect us when we need it.
I don't try to change anyone's mind either. As long as you can protect YOUR license and YOUR job with the decisions YOU make...so be it. Same for me.

The guidelines you are describing are Federal regulations as well as state regulations in most (if not all) states -- restrictive interventions (restraint, seclusion) cannot be used as punishment, and must, in any case, be discontinued as soon as the client is calm and cooperative.

Keep in mind, everyone, that these rules were not put in place to make our lives difficult; they were put in place as a response to many decades of past flagrant abuse and mistreatment of psychiatric clients.

faithful11 · Mar 2, 2008

The guidelines you are describing are Federal regulations as well as state regulations in most (if not all) states -- restrictive interventions (restraint, seclusion) cannot be used as punishment, and must, in any case, be discontinued as soon as the client is calm and cooperative.
Keep in mind, everyone, that these rules were not put in place to make our lives difficult; they were put in place as a response to many decades of past flagrant abuse and mistreatment of psychiatric clients.

Thank you. :twocents: That's the point I was trying to get across and you also hit on another important aspect which has not been mentioned. People have to think of the proper way (not just ethics here, but the legal aspects as well) to treat and handle patients, because YOU could one day be a patient, or someone you love and care about may be a patient one day. Or has been etc. Again, I do what I know is in alignment with not only the state/federal guidelines, but the hospital Administrative Directives, Nursing Policies and Procedures and the requirements of my state LICENSURE. I am not trying to be brought up for legitimate patient abuse (which if you PUNISH a patient is what you will be doing..abuse) and have to try to explain why I THOUGHT it was okay. :nono: "Oh, well he hit me in the face, and when he walked away calmly and was able to sit and have a rational discussion without making threats, I just thought that SOMETHING should be DONE to PUNISH HIM. I mean, how could he NOT go into restraints? So...we put him in 5 points AND gave him a prn." Have I seen this---sure have. Have I done this---sure haven't. Does it seem unfair at times....sure does. But the law is the law and the rules are the rules. I encourage us all to know what we can/cannot do in certain situations. Because when you are called by licensing/department of justice/your licensing board etc...or even to court...please KNOW what was right and what was wrong. :specs:

MiaLyse, APRN · Mar 3, 2008

In the eyes of Patients' Rights, and along the guidelines of CRIPPA...one must be able to substantiate the decision made to PREVENT, DIMINSH or INTERRUPT a behavior which is dangerous to self or others. So, keeping that in mind ---if patient A has just beat up patient B or a staff member, and was yelling and screaming during the attack staff must do something DURING the attack. If the patient beats up someone, then walks away, breathing is even and unlabored no increase, facial expression is calm, tone and rate of speech is even and calm...body is not tense and there are no verbal threats to harm anyone, and heaven forbid they SAY "Oh..i am calm. I will take a voluntary time out". Then, what I am saying is that if you do a more extreme measure (more restrictive, which seclusion, po/im prns and restraints all are) then just be prepared to explain the justification. I do not necessarily agree, I am just saying what we are being forced to adhere to as far as CALIFORNIA dept of mental health. I work forensic psych, and it is verrrry frustrating. Though we may not like it or agree, it is actually punishment to implement something following an agressive behavior, when the attacker is now appearing calm. Key word ,appearing is there on puprose. :angryfire We have a woman who beats the living daylights out of people, then goes into a psychogenic crisis where she is "limp,immobile,verbally nonresponsive and disoreinted"...explain IN A LEGAL DOCUMENT i.e. chart, WHY she is being tied down in 5 pts restraints, when she cannot even stand up (appears anyways....we all pretty much are aware this is her behavior and NOT the real deal).
I am all for patient rights...I just wish the staff were valued a bit more in the eyes of the law and that we had just as many rights and guidelines to protect us when we need it.
I don't try to change anyone's mind either. As long as you can protect YOUR license and YOUR job with the decisions YOU make...so be it. Same for me.

I agree that if they are totally calm then even seclusion is not appropriate. If they are calm then consequences for their actions should be there such as "time out", offer prn's etc... and then if they won't agree to a voluntary time out then taking away "smoke breaks" or some other consequence is appropriate until they can show they are no longer a threat to others. It doesn't seem like even this was done unless I didn't read the original post thoroughly. Could be my bad.

faithful11 · Mar 4, 2008

Micky--I am not sure if I even read correctly as far as ANY consequences occurring. My bad, as well. In addition to the incident report, there at our facility there would have been notification made to the Department of Corrections watch commander, Hospital Police, Mangement and other folks who have to be notified. The patient would have lost their inter-compound privledges (which means going out on grounds) for 30 days for assaultive behavior...the team would have met to discuss this incident etc. I think it sucks that NOTHING was done in the particular OP incident. I think it also sucks that the job or coworkers didn't even show any support by calling or checking in on her. As others have said, the same is the practice at our facility---workplace injuries REQUIRE A SUPERVISOR TO ESCORT THE EMPLOYEE FIRST TO THE EMPLOYEE CLINIC, AND THEN TO THE OUTSIDE FACILITY IF SO REQUIRED. Who the heck gets beat down then has to struggle to drive to get some aid??!?! That was wrong.

MiaLyse, APRN · Mar 4, 2008

>

I work on an intensive care psych unit and we are lucky if we get 24 hours of lost privileges after assaultive behavior. That used to be the policy but I don't know that it is ever followed anymore... I wish it was though.

Aviationurse · Mar 4, 2008

,MICKEY B and faithful......in our psych unit..there was no debriefing about the incident...all they said was OH...I HEARD U GET HIT? the patient did get transferred to another hosp at 2 am. i did learned later that the patient did hit x2 nurses in another hosp where i used to work before x4 days before my sad incident and patient had to be transferred in our hospital bec pt was in the DO NOT ADMIT LIST in that hosp our hosp is located across the street from there ).... :nono: :nono::nono:that nurse in the previous hosp ended up having MRI and stuff with no visisble injuries and a lot of soreness x1 week.....she said "she wish she had filed legal ff up on patient....i would not have been "hurt "but she dont want to have her home address be known if she filed legal proceedings.....:crying2:

i did file an incident report on the day incident happened but what erks me is that while i was doing the incident report...the cn said "oh ..u dont have to file incident report "..i gave him the dirty look:angryfire....the security said up to now " i dont know why we were not informed about incident bec my dingbat male charge nurse told security in pscy unit staff gets hit most of the time...that aint nothing new...we did not know we have to inform security if staff get hurt bec pt was calm afterward."...:smokin:

AINT THAT SOMETHING????:smokin: my senior charge nurse never gets hurt bec he is always in nurses station doing nothing but flirt with secretary and talk about his wealth....police detective CALLED ME " wants to know if i want to press charges and i told him i have not come to a decision yet"..

i know if i do ...hosp is going to tear up my resume and this action is going to jeopardize my job...i am a foreign nurse grad and my skin color just tells me this....( been in this country 20 plus years) i had multiple specialities before...worked in med surg, hemodialysis , recovery room and am thinking in going to that direction.....:icon_roll:icon_roll

THANKS GUYS FOR THE ADVICE....BTW WHAT DOES CRIPPA MEAN?

i know u would understand plus i am also caught right now taking care of dad with terminal cancer who is skinner than a toothpick and i am his only family/support and i am walking on this cancer path alone . I AM GLAD i GOT U GUYS TO TURN TO FOR SUPPORT /GUIDANCE.. i eat my lunch fast so i can run to medical library and check your responses...THANK U ...THANK U.... :bow: :bow: :bow:

PEACE

bollweevil · Mar 6, 2008

I don't know where you're practicing, but in the several states in which I've practiced psychiatric nursing over the years, a staff member who used anything other than state- and facility-approved intervention techniques (designed to avoid injuring the client while protecting yourself) on a client would be open to criminal charges. You do not have an absolute, unrestricted right to protect yourself (in any way you choose) in psychiatric settings ...

This isn't so. We do have the right to protect ourselves in Psych. No one is required to be a punching bag, even in Psych. The trick is to try to avoid trouble in the first place, to evade, to think fast, to always have a whistle, a horn, a radio, a personal alarm device (even if you must buy it yourself), and be up on how to be safe. It might mean going in a pair to a patient's side, it might mean taking a group of staff with you (a show of force). It could mean getting the patient more properly medicated, it could mean knowing some quick martial arts moves.

God forbid we let them do anything and everything they want. They should be losing privileges for misbehavior and the like. We have to keep control.

bollweevil · Mar 6, 2008

,MICKEY B and faithful......in our psych unit..there was no debriefing about the incident...all they said was OH...I HEARD U GET HIT? the patient did get transferred to another hosp at 2 am. i did learned later that the patient did hit x2 nurses in another hosp where i used to work before x4 days before my sad incident and patient had to be transferred in our hospital bec pt was in the DO NOT ADMIT LIST in that hosp our hosp is located across the street from there )....:nono::nono:that nurse in the previous hosp ended up having MRI and stuff with no visisble injuries and a lot of soreness x1 week.....she said "she wish she had filed legal ff up on patient....i would not have been "hurt "but she dont want to have her home address be known if she filed legal proceedings.....:crying2:
i did file an incident report on the day incident happened but what erks me is that while i was doing the incident report...the cn said "oh ..u dont have to file incident report "..i gave him the dirty look:angryfire....the security said up to now " i dont know why we were not informed about incident bec my dingbat male charge nurse told security in pscy unit staff gets hit most of the time...that aint nothing new...we did not know we have to inform security if staff get hurt bec pt was calm afterward."...:smokin::smokin:WTF?
AINT THAT SOMETHING????:smokin: my senior charge nurse never gets hurt bec he is always in nurses station doing nothing but flirt with secretary and talk about his wealth....police detective CALLED ME " wants to know if i want to press charges and i told him i have not come to a decision yet"..
i know if i do ...hosp is going to **** on my resume and this action is going to jeopardize my job...i am a foreign nurse grad and my skin color just tells me this....( been in this country 20 plus years) i had multiple specialities before...worked in med surg, hemodialysis , recovery room and am thinking in going to that direction.....:icon_roll:icon_roll
THANKS GUYS FOR THE ADVICE....BTW WHAT DOES CRIPPA MEAN?
i know u would understand plus i am also caught right now taking care of dad with terminal cancer who is skinner than a toothpick and i am his only family/support and i am walking on this cancer path alone . I AM GLAD i GOT U GUYS TO TURN TO FOR SUPPORT /GUIDANCE.. i eat my lunch fast so i can run to medical library and check your responses...THANK U ...THANK U....:bow:
PEACE

Do you really think your appearance keeps you from having rights? I think you should file a complaint anyway with police. Speak with their chief of detectives. Go to the top.

As for your charge nurse, make a list of his behavior for a week and send it to his boss. Use times and dates. He sounds like a total jerk and needs to be brought down a peg or two.

elkpark · Mar 6, 2008

This isn't so. We do have the right to protect ourselves in Psych. No one is required to be a punching bag, even in Psych. The trick is to try to avoid trouble in the first place, to evade, to think fast, to always have a whistle, a horn, a radio, a personal alarm device (even if you must buy it yourself), and be up on how to be safe. It might mean going in a pair to a patient's side, it might mean taking a group of staff with you (a show of force). It could mean getting the patient more properly medicated, it could mean knowing some quick martial arts moves.
God forbid we let them do anything and everything they want. They should be losing privileges for misbehavior and the like. We have to keep control.

I think maybe you didn't read my post carefully. Of course we (in psych) have a right to protect ourselves -- what I said was that we don't have an absolute, unrestricted right to protect ourselves, in any way one might choose. I made that statement in response to your suggestion that the OP learn karate. We have a professional obligation to respond to clients within established ethical and legal guidelines.

In my state (and probably in yours, also) using anything other than facility- and state-approved intervention techniques (like the karate you suggest) would not only get you fired, but investigated by the state for possible abuse of clients, possibly disciplined by the BON, and open to criminal charges.

I am certainly not advocating anyone being a "punching bag" in psych settings, or allowing clients to "do anything and everything they want," and I agree completely with everything you said about avoiding physical confrontations except the karate. It is always best to be alert and proactive, and avoid/prevent situations getting physical in the first place. I would even agree with the idea of studying karate to simply improve your balance, reflexes, etc. -- but if you are talking about actually using karate techniques against a client, again, that would be illegal in my state and, I would guess, in yours, also.

PMHNP10 · Mar 6, 2008

thanks guys for the reply...my head /eye still hurts..i am peace loving and instead of going thru the TIME AND ENERGY of finding alawyer...ill just used that time to find another job and quit.....

I really hope and IMPLORE you to PLEASE PLEASE PLEASE file a report with your local police dept at a bare minimum. From what you are saying, complacency is commonplace on your unit. By not acting, you are adopting the beliefs of the unit you despise. Just remember that until something is done, these attacks will continue to occur; and eventually the end result will be far more grave for one of our fellow nurses. You could be instrumental in putting an end to this problem.

I'm glad you weren't really injured, now do what you can to help ensure others who follow won't be put in a situation worse than yours.