Has this happened to you???

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So in order for me to explain this situation, I must first tell you about a situation with a pt, we'll call him TheCrazy.

In out ER, TheCrazy is a frequent flier, always comes in with either complaints of chest pain or SI. Well, 2 weeks ago I took care of him and was very aggressive and rude (more so than normal), bordering on homicidal.

Well the bordering on turned in to full blown homicidal when he decided to throw an IV pole at me for relaying the message that he wouldn't be getting dilaudid for his earache. Before he threw the IV pole at me he started yelling he was going to "get me on the outside" and knew where to find my silver car (what's scary is I really do drive a silver car :trembles:), then he threw the IV pole. TheCrazy got arrested and taken off in a police car and hooray the day was saved!

Fast forward to last night when who do I walk in to find waiting to be seen by his nurse? TheCrazy of course! I hope he saw the anger (not underlying terror) when we made eye contact where I quickly turned around and told my charge nurse I refused to take care of him for fear of my well being. The only way I would agree to take care of him is if he was handcuffed to the bed, or sedated with diprovan. I was told that neither of those options were plausible (clearly not getting the sarcasm) and that I would have to "suck it up". I refused, and ended up getting WRITTEN UP! Please tell me someone else agrees with me that this is ludicrous?

Oh let me describe TheCrazy to you, imagine a 6'3, 200lb ex-convict or ex-military type of guy. Did I mention I'm a 5'7, 135lb girl, and while I am stronger than most people expect, the only hope I would have in a battle with TheCrazy is that I'm fast and fairly agile.

I really just posted this to vent because I'm still fuming from my first write up.... Because I was scared for my safety!

Hope everyone has/had/will have a pleasant night at work :) BE SAFE!

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Specializes in Emergency.

I'm sorry that happened to you. I think it was unreasonable of your charge to not reassign the patient if you felt unsafe, and it sounds like you had reason to feel that way. I have never been in that position but I would hope that my co-workers would be supportive. Anyhow, I don't think you did anything wrong (for whatever the support of an anonymous person line is worth). :)

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I agree that it is ludicrous. But I wonder about your approach to the charge nurse regarding the matter. But if I am to practice what I preach which is to give coworkers, colleagues the benefit of doubt, you are totally right to be upset.

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I would have refused to sign the write up and took it up the chain of command. Even if it meant cc the CNO with a copy of the police report.

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Specializes in CAPA RN, ED RN.

I am sorry this happened to you. We do not need to tolerate violence when we are administering care. Kudos for involving the police with the earlier incident. This guy sounds like a risk no matter who is taking care of him.

I will not endanger myself so I take precautions when dealing with a potentially violent patient. I will not enter the room unless a security officer is present. I also document a risk assessment almost immediately so I can back up my request for the services I need. I am not easily intimidated but I can see how personal this was for you.

I think it was insensitive of the charge nurse to do a power play but I try not to second-guess many charge nurse decisions. However I document my requests to charge nurses and supervisors (not on the pt record) so if there are recurring problems I can show what my requests and actions have been. I encourage you to think of all the options you have since this pt is a frequent flyer and you may encounter him again.

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Specializes in ER.

You'll get a better response from your charge if you approach her in a calm manner. When she hesitates, give her some realistic options, like getting a security guard to standby through the visit, or trading rooms with someone. If she hesitates, sometimes giving 5 minutes so she can sort it out as far as department needs go will result in a better response.

Some patients threaten everyone that walks in the room, and at that point you need to call security and suck it up, because everyone is in the same boat. Administration needs to be aware of that type of patient so you can get a unified care plan going, and appropriate consults.

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Thank you all for your support! I'm glad it's not just me that believed it seemed crazy. I did actually talk with both my nurse manager and nursing supervisor and they agreed with my point. They have chosen not to put the write up in my file but to just call it a verbal warning.

I'm wondering if its because my charge nurse is a large man and my nursing manager/supervisor are both women? Hmmmm...

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You'll get a better response from your charge if you approach her in a calm manner. When she hesitates, give her some realistic options, like getting a security guard to standby through the visit, or trading rooms with someone. If she hesitates, sometimes giving 5 minutes so she can sort it out as far as department needs go will result in a better response.

Some patients threaten everyone that walks in the room, and at that point you need to call security and suck it up, because everyone is in the same boat. Administration needs to be aware of that type of patient so you can get a unified care plan going, and appropriate consults.

I did offer those options, he said it was impossible to make that happen (in his defense we were swamped, but IV poles to the face is where I draw the line!)... I was pretty shaken when I saw TheCrazy so calming down would have been good... Oh well! I'll remember that in the future!

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Specializes in ED.

We have recently have had an increase in violent patients. One nurse is currently out with several broken ribs as a result of an attack, and another nurse recently had a patient threaten her with a weapon. Both patients were arrested. I have developed a zero tolerance for violent patients. I always make sure is security is there when dealing with them and I make sure to document their behavior. New York state has passed a law that makes it a second degree felony to assault a nurse while he/she is performing her duties. It falls in the same category as assaulting a paramedic, fireman or cop. The nurses in my department are serious about reporting violent patients and visitors. There is no excuse, and no, mental illness is not an excuse. You should look into the laws of your state. Also, as a charge nurse, I would never assign a nurse to a pt that has assaulted them in the past.

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Specializes in ER, progressive care.

If I am dealing with a violent or potentially violent patient, I always make sure I have one of the police officers by the door or in the room with me.

Sent from my iPhone using allnurses.com

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From what was stated:

- Yes, you should have been reassigned

- Did you write/file "objection of assignment" form? (not sure if you are Unionized - CNA)

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Specializes in Cardiac, ER.

We have a few frequent flyer crazies as well. Our security is always present, and they carry guns!

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