Hi all, has anyone made a police report against an assaultive patient? Yesterday my coworker was assaulted by an alert and oriented male patient, punched in the face and thrown on the ground. One of our male coworkers helped her up and then the patient destroyed the room, ripped out chunks of the walls, etc. It took 3 deputies to restrain him. He spit all over the deputies.
The deputies encouraged my friend to report to police. The patient is 18 and has a diagnosis of oppositional defiant disorder. Originally came in for overdose, medically cleared for 2 days, but no psych beds available. The psychiatrist kept telling management it wasn't safe for him to be on a medical floor. We often have these strong male patients, and a lot of female staff get injured. Our male coworkers are wonderful and come to the rescue, but sometimes it still happens. Is this just what it means to be an inpatient nurse? Does anyone's hospital have a good way of preventing these incidents?
I didn't know when I signed up for the job that the description included defending myself against large, violent men. I stay in shape, but I will never have a chance against a huge angry man. I am still researching what exactly "oppositional defiant disorder" is. Deputies said we should also report him for property crime. I am usually against sending people to jail, but this pt seems like an actual danger. Everyone constantly de-escalating, we treated him nicely but often had to restrain him, and his behaviors just couldn't be controlled. He tried to attack anyone who went near him. What is the solution for these kinds of patients?
I think it best to not speculate on what may have been appropriate for this specific patient's clinical situation, however I would expect that an MD psychiatrist would be able to come up with a plan to treat dangerous, threatening behaviors therapeutically.
Hi all, has anyone made a police report against an assaultive patient? Yesterday my coworker was assaulted by an alert and oriented male patient, punched in the face and thrown on the ground. One of our male coworkers helped her up and then the patient destroyed the room, ripped out chunks of the walls, etc. It took 3 deputies to restrain him. He spit all over the deputies.
The deputies encouraged my friend to report to police. The patient is 18 and has a diagnosis of oppositional defiant disorder. Originally came in for overdose, medically cleared for 2 days, but no psych beds available. The psychiatrist kept telling management it wasn't safe for him to be on a medical floor. We often have these strong male patients, and a lot of female staff get injured. Our male coworkers are wonderful and come to the rescue, but sometimes it still happens. Is this just what it means to be an inpatient nurse? Does anyone's hospital have a good way of preventing these incidents?
I didn't know when I signed up for the job that the description included defending myself against large, violent men. I stay in shape, but I will never have a chance against a huge angry man. I am still researching what exactly "oppositional defiant disorder" is. Deputies said we should also report him for property crime. I am usually against sending people to jail, but this pt seems like an actual danger. Everyone constantly de-escalating, we treated him nicely but often had to restrain him, and his behaviors just couldn't be controlled. He tried to attack anyone who went near him. What is the solution for these kinds of patients?
I wouldn't try sending him to jail, especially if you have no experience (personal, meaning yourself, not family members, not friends' kids, not your kids, yourself only) with neurodivergency. However, you need to start something to get your facility onboard with better means of handling neurodivergent patients and caring for their own employees. Hell, learn how to start a union (and keep it quiet in the beginning stages) and start one focused on just that.
We’ve had to call the police at one of the hospitals I worked at a few times. We’ve had nurses press charges too. I was even encouraged for verbal threats, management there was extremely supportive to their nurses and they would not tolerate bad behavior. There were signs all over the hospital stating they don’t tolerate abuse.
It is very scary when something bad happens and we can’t defend ourselves. It’s even scarier when the person is completely alert and oriented.
Specializes in Community Health, Med/Surg, ICU Stepdown.
17 minutes ago, Rill said:
I wouldn't try sending him to jail, especially if you have no experience (personal, meaning yourself, not family members, not friends' kids, not your kids, yourself only) with neurodivergency. However, you need to start something to get your facility onboard with better means of handling neurodivergent patients and caring for their own employees. Hell, learn how to start a union (and keep it quiet in the beginning stages) and start one focused on just that.
Can you explain what neurodivergent means? I think I have an idea but want to make sure. We do have a union but so far they haven't been able to accomplish much, although they have tried. Thanks for your reply!
Specializes in Community Health, Med/Surg, ICU Stepdown.
16 minutes ago, AlwaysLearning247 said:
We’ve had to call the police at one of the hospitals I worked at a few times. We’ve had nurses press charges too. I was even encouraged for verbal threats, management there was extremely supportive to their nurses and they would not tolerate bad behavior. There were signs all over the hospital stating they don’t tolerate abuse.
It is very scary when something bad happens and we can’t defend ourselves. It’s even scarier when the person is completely alert and oriented.
Thank you for your support! Our management does come talk to assaultive pts, but not consistently, and not upper administration, ever. Also the doctors and managers often "bargain" with patients to stay and receive treatment. Then they tell us "OK, pt agrees to care now." Then we go back to the room to do something and they are violent again. So frustrating. I think they should be kicked out, after the rules are clearly established and reinforced. I get that some are too critically ill to kick out, but then they should be restrained chemically and/or physically, and I think a deputy should be called to go in the room with us. Because our hospital loves to "avoid" restraints and heavy sedation.
I still knock my violent etoh withdrawal pts out with tons of Ativan, and they are on monitors. No bad responses yet, just put on a little O2 sometimes. They expect us to "verbally de-escalate", and "use a team approach". As in all 5 nurses on our small unit hold a pt down to change them while they kick us. And all other pts on the floor unattended. Unsafe in so many ways. I am desperately looking for a new job, but hard during covid. Thanks again for your reply ?
Can you explain what neurodivergent means? I think I have an idea but want to make sure. We do have a union but so far they haven't been able to accomplish much, although they have tried. Thanks for your reply!
Anyone who isn't neurotypical is neurodivergent. ODD, ADHD, autism, anxiety, depression, schizo, all of those and so much more qualify people as neurodivergent. If you want to try influencing your facility towards better care for both employees and neurodivergent patients and neurodivergent employees, I highly recommend doing a bit of even just basic research (try Youtube-searching "neurodiversity," even, as a starting point). Neurodivergency and disability go hand-in-hand, so definitely check out the affects of both on people, as well as legal rights in association (definitely start out with the basics of learning about neurodivergency and disability first, though, so you know what you're learning about). Even if your union hasn't accomplished much yet, coming in informed can gain you a lot in terms of making progress with their help. They're definitely the first people you should talk to if your facility isn't listening.
Psychiatry is a specialty where there is a high rate of workplace violence. I have found the expectations for dealing with a violent incident differ by the facility I have worked at. Currently, I work in an environment where assault on staff is taken seriously and the campus police take a report. As a NP, I am sometimes asked if a patient has capacity-in short understand the consequences of decisions- after an assault. There is nothing stopping you from filing a police report and a court will determine the patient's competency when charges are brought. Competency and capacity are two different concepts and as a RN you are not responsible for determining either. If you report the incident it may establish a pattern of behavior in the court system that leads to court ordered mental health treatment/counseling/medication. In this way you ultimately may be helping the patient.
Propose a case conference with the treatment team to better address the patient's behaviors while on the medical floor-involve the physician, nurse, team lead, social work. Ask for psych specific deescalation training from your manager if overflow from the psych unit is a common occurrence (SAMSHA, CPI, Handle with Care to name a few). Larger hospitals have code teams including a behavioral health code. Psych specialists usually come to these codes to assist. If the culture of your workplace regarding violence is not one you like, be apart of the change.
I think it best to not speculate on what may have been appropriate for this specific patient's clinical situation, however I would expect that an MD psychiatrist would be able to come up with a plan to treat dangerous, threatening behaviors therapeutically.
No. You should always speculate on what would have been appropriate, otherwise the same mistakes might continue in the future. In this case, it was administration's negligence.
Given the constraints of the current health care system, lack of mental health beds and lack of insurance coverage for mental health diagnoses please share with us what was done wrong in this situation and what you feel should have been done again in this situation.
.thumb.jpeg.99f2e6bf68e7749cbc77be28d62de6a1.jpeg){kind=small}
LibraNurse27, BSN, RN
972 Posts
Ahh that still sounds terrible though. So sorry that happened to you, and I hope your thumb has healed