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Discussion

Policy on ED violence

I'm curious to find out how your hospital handles violence against nurses. Recently (within the last several months) we have had a FF/known and documented drug seeker pull a knife and threaten the life of the RN and the unarmed security guard. Two days ago after confronting another known FF/drug seeker (professionally), this patient returned to the ER and threatened to bring a gun and kill the doctor and the nurses(me specifically) involved in the patient care. We have also had a known non-compliant schizophrenic become fixated o n one nurse and began stalking and threatening her. All of these were investigated by the police but to my knowledge no charges were filed because no actual crime was commited.

According to our current policy, we still HAVE to see and treat these patients, regardless of the personal and very real danger to ourselves. Our ED is not equipped with metal detectors, nor is it a locked unit. The doors are locked, but security is lax and all anyone must say is "My sister/brother/parent/friend is in room #9" and in they go. Our triage area has only one exit and it is behind the patient, not the nurse, leaving them essentially trapped.

I know that Emtala states that everyone is entitled to emergency care (to paraphase), but am I wrong in thinking that we should have a zero tolerance policy on accepting patients who have threatened to KILL us if they get the chance? I have been very verbal to my management that as the charge nurse I refuse to let these people through the doors and they will never get the opportunity to harm one of my nurses. The physician in question agrees with me. But upper management is sticking to the motto, "everyone reacts differently to being sick or in pain, some lash out and say things they don't mean."

So I ask, what are your policies, how is it handled? If I can piece together enough real information, maybe I can do a better job at protecting my staff. Thanks in advance for any replies.

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We have the same situation as the original poster...our security isn't "allowed" to touch a patient...they are basically there as a visual cue, with no weapons of any sort on them. Most of them are smaller than me, and I hear they are the lowest paid position in the hospital! We, as the nurses, are the ones taking down patients...luckily I have a lot of guys on my shift so they help take care of that. But when we have had violence in our dept, all we can do is call the police...we pray nothing bad happens as we are not locked down (they say we can't be because we are the one of the main fire exits for the hospital), no metal detectors etc. How do those hospitals who have police, metal detectors etc get those things in place?

We don't have security. I'm the only male RN in the place. We do have a locked unit though. But like someone else said, all anyone has to do is say, "I need to see a doctor." and in they come. We've had people threaten the doctors, the nurses....one guy stood outside the glass backdoors with a shotgun...

One threatened to drive through the hospital...

Our local police are sometimes good about coming to the ER, depends on who is working.

We can't carry any weapons in the ER, I'd feel better if we could pack some heat, or at least a tazer.

  • Author

Thanks to everyone to replied so far. Just so I'm making myself very clear about the situation and not to make it seem like our local PD isn't helpful, they ARE. They always come when called and beleve me, I won't hesitate to make that call if any staff or other patients feel threatened. My concern is; even a 5 minute response time is too long when there may be a loaded weapon involved.

I've read some information about de-escalating tactics and have some ideas about beefing up what little security we have that won't cost too much (because we all now that's the bottom line) some as simple as re-arranging the furniture in the triage room so that the nurse is closest to the door. I have even asked for a limit to visitors (one per patient) and that all visitors must be verified with the charge nurse prior to admittance. I was truly surprised by the amount of nay-saying I got for that. Fellow charge nurses state "we get enough phone calls".

My opinion is, I'd rather take an extra hundred phone calls a night than risk having to make one trauma call for one of my nurses.

As everything, it's a work in progress.

We have had some FF Seekers that have threaten physical harm to the staff, and a few that have cause physical harm. Our hospital has filed a protection in the courts against these people and they are not allowed on the property and have been removed from the property several times by security or the LAPD. Makes me feel good that our hospital has our backs.

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