nurses attached by patients

caregiver1977 · Jul 19, 2011

I teach our behavioral dyscontrol safety class for the hospital I work for, and part of that class covers exactly this topic.
It is a felony offense to assault any healthcare worker on-the-job. I do not know if this is a state law or federal, but I imagine numerous states besides PA also have this protection.
Starting the paper trail begins at work, by calling security, filing incident reports, and discussion with your director and legal team. My hospital supports the pressing of charges against anyone who assaults anyone on our property. The risk managers will even help when someone speaks with police.
Consider the reputation your employer would receive if they were unable to hire staff due to not putting basic civil rights protections in place. What would the "customers" think if they knew that you had to work in a place that condones violence. If your job would cover up a crime, they need to be reported to OSHA, JCAHO, and the BBB. They are also likely to be found responsible if any civil lawsuits would be brought. It's a risk most places can't afford to take, though some may just need a friendly reminder to help them make the right decision. No hospital wants to advertise "Come to Our ED/Unit/Clinic/etc., where you can beat up the staff!!!"
Filing a report with the police is appropriate. When I worked in psychiatry with patients who were involuntarily committed for being a danger to themselves or others, charges were successfully filed when the patient had assaulted staff. Even though they were deemed "incompetent" for the time being by the medico-legal process, they were still accountable for their actions.
My biggest advice is this, though - don't hit back, and go to the ED and get checked out. It is very difficult to support a claim that you were attacked if you continue to work like nothing ever happened. Even if they clear you to resume work, you have another document stating that you had sustained or suspected bodily harm.

Question????

I have a friend who used to have seizures (I wasn't living in the same city at the time with her so I never eye witnessed any of this) and while recovering from the seizures would tend to become very violent. This was NOT her normal nature at all, and she would barely remember events right before the seizure and sometimes wouldn't remember much the rest of the day after the seizure, she wasn't purposely trying to hurt anyone. She once told me that she woke up in the back of an ambulance after a seizure, had no idea that she had had a seizure, and tried to attack the EMT/paramedic staff because she thought she was being kidnapped. Should charges be filed against such a person? Isn't that a little unfair? Her medicine was finally changed and she hasn't had such a problem in years. I would hate to think she would have had to fight charges, with all the inconvenience that goes with that, because of something she couldn't help. Can't something else be done for such people.

Of course, people who want to hit healthcare workers because of frustration and think they can get away with it, that is another story.

blamejoe · Jul 19, 2011

not to be a complete @$$ about it (because I do sympathize with your friend's condition. I know of situations where people with seizure disorders have been arrested, tasered, etc, because there were these kind of behaviors during or immediately after the seizure), but I have to ask...

... fair to who? Is it fair to the EMT who wanted to go home unharmed that day but wasn't able to? Is it fair to the person who might be frightened to return to their employment because now they realize sometimes it's ok for "sick people" to attack them? Fair to people who did not know that this stranger they were trying to help could become violent, while that stranger DID know the symptoms of their seizure disorder? (What if the reason wasn't a seizure disorder, but a personality disorder? What if the attack was from fear and misunderstanding, like the situation it sounds as though you are describing?

I could list a multitude of "justifications" here; the truth is all outburst have a reason behind them. Discretion is to be had, but my point to the OP is that if you feel you are the victim of a crime, there are laws that protect you EVEN if that crime happened in a healthcare setting. District Attorneys, Judges, and Juries get to decide, along with victims and patient-perpetrators of crime, how far it goes from there.

**No one should be a victim because we choose to help others in need**

caregiver1977 · Jul 19, 2011

You make some very good points, and I don't think that anyone should be a victim because they help others in need. I don't know if it is always appropriate to file charges on a person who truly CANNOT help what they are doing. Having charges filed and getting arresting can have far reaching consequences. Correct me if I am wrong, and feel free, but people are arrested to punish them; not help them. This is why I asked "can't something else be done." I am not saying that a healthcare worker should say "oh well, she gave me a broken nose, but tomorrow's another day!"

These incidents did prompt my friend, her family, doctor, etc. to look into different medications and the problem was solved. BTW, she even understood when she woke up in restraints at the ER. People with my friend's kind of problem already avoid people and certain situations enough because they may be misunderstood (few of the ones I know DO NOT want to be transferred to the ER if they have a seizure--unless in status-- because of how they have been treated there), then they have to live in fear of being arrested for something they can't help?

caregiver1977 · Jul 19, 2011

Let me clarify a little...

I understand that you can't ignore violence no matter who it is from, even from someone like my friend with her condition. But I don't see how her actions were the result of negligence (as if she wasn't taking her medication or something then that would be her fault). I feel what she was doing was cause for a better look at her condition and treatments, but wasn't criminal.

At the same time, had she damaged someone's property in the process she probably would have been held responsible for that. I would just hate to see someone, for example, get arrested at their job or in front of their kids and have to take off work for court dates for something they couldn't help and may not even remember (and I am not talking about people who abuse drugs and alcohol). But then again the assaulted health care worker may be losing job time and other things because they are hurt. I just don't know.

blamejoe · Jul 19, 2011

I will clarify also. I have been assaulted several times at work and have never once pressed charges of my own, despite having been seriously injured (with scars) more than once. But not everyone thinks like me, and keep in mind many of my peers are women who work in a building with unlocked doors where strangers are expected to roam 24/7. That is why there is the option to press charges. I support that option, though I might never take it.

However, there have been "normal" patients who have raised the fist to me who thought they could "act out" and only changed their mind when I informed them that they were in fact threatening to commit a felony against me. There is also the fact that one study found that 9% of violent acts reported to EMS/EDs were the result of hypoglycemia. And I would challenge that an alcoholic withdrawing and seizing who becomes aggressive is, at that time, just as unable to control their behaviors as an epileptic going through the same type of seizures. (Negligence aside, if the alcoholic were permitted to drink, s/he'd probably avoid that seizure and the resultant assaultive behavior). The issue about healthcare workers getting assaulted is quite complex, and there is usually a psychiatric or physiological component every time.

On the other hand, there are programs like CCM, which is our training program for my health network. The majority of our program is about assessing the situation and determining the reason for the behavior, and when it comes to it Safe physical interventions, instead of immediately jumping to conclusions and acting in a way which will likely lead to more injury or combativeness. Neuro staff are very familiar with violence associated with seizures. VA hospital staff are aware that sounds from equiment like MRIs can trigger flashbacks. Psych staff are aware that proximity and powerlessness can trigger outbursts. Geriatric units occassionally encounter aggressiveness during "shower time" from people who survived the Holocaust so they stay cognizant of these triggers. So I guess one solution is for your friend, and those like her, and those who love her, and people like me who teach programs like this, is to advocate awareness.

It will take time, and I wish everyone the best of luck should they choose to advocate along with me. But there are many facets of society who need to be informed, and I think the only way to make sure only "criminals" get charged, and not people suffering from illness, is if we permeate our entire society with Awareness. Quite the task!