I've been working in in-pt psych for 12 years. I've definitely had my share of assaults. I file a police report every time and leave it up to the DA to determine the appropriate course of action. I don't factor in whether my patient knows right from wrong when filing a report because it's not within the RN's scope of practice to make that determination. The reason I file a report is to start a paper trail documenting that individual's history of violent behavior so that when law enforcement comes into contact with him/her they can see that there is a history of violent behavior and to proceed with caution. A history of police reports can also help a DA or judge determine the best course of action for the patient in regards to psychiatric treatment/monitoring vs incarceration. At the very least, filing a report sends a message to your patient that violence is not okay. As healthcare workers, tolerating or excusing this behavior only allows it to continue and, at the end of the day, we have to take care of ourselves. I love being a nurse and I love working with the mentally ill but I won't be able to do much good if I'm stuck at home on disability because of an assault.