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?
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.
This is straight up negligence on your employer's part.
It also does not sound like his med-psych therapy was being optimized.
I realize it isn't an easy situation when a patient needs a bed that is unavailable, but the answer does not involve putting the patient in with a general population of patients and sending the staff in and just "we'll see what happens."
Administration won't care until another patient is injured. Then, they will throw floor staff under the bus to avoid repercussions
Specializes in Community Health, Med/Surg, ICU Stepdown.
1 hour ago, Hoosier_RN said:
Administration won't care until another patient is injured. Then, they will throw floor staff under the bus to avoid repercussions
Yes, they will ask us why we couldn't "speak to the patient in a calm tone" to "verbally de-escalate" and "prevent physical violence." Next time someone is beating me up I'll be sure to ask them calmly to stop =/
Specializes in Psychiatry, Community, Nurse Manager, hospice.
Psych nurse here. Agree with the PP who said that policy varies greatly, and the culture does also.
But no hospital or agency can forbid you from making a police report.
They aren't really supposed to discourage you either, but they still sometimes do, especially with nonverbal cues.
It's up to the nurse who was assaulted, always.
OP, since this was your coworker, I would suggest that you support whatever decision your coworker makes. That's what people need after something like this happens.
I've been mostly lucky even though as a psych nurse I've been around many, many assaultive patients. I've caught the end of a kick a few times, but I've never been really hurt.
You can take a course in CPI or Handle with Care which will teach you strategies for dealing with agitated patients. While you're taking the class you'll be thinking it won't work, but it actually does.
My former hospital had policies that prevented staff injury. At the time I thought some of them were over the top, but now that I'm working at the state psych hospital where staff are assaulted consistently and regularly, I really appreciate those policies in hindsight.
I learned some things early in my career that I still practice regularly.
For example, I position myself so that a patient is never behind my back and so that I always have a clear path to the exit.
Oppositional defiant disorder is laid out in the DSM5. It's a psych diagnosis for children. The treatment is behavioral therapy. Sometimes parents can be trained to do it, and sometimes the child will need a behavioral therapist who comes to the home and/or school and works one on one with the kid. If it is resolved in childhood the child may develop into a perfectly normal and healthy adult. If not, it can become conduct disorder, which is more serious.
Also, a lot of times a diagnosis of oppositional defiant disorder is made and later we find out that the child is actually on the autism spectrum, or has a sensory processing disorder, or there is some other medical cause.
You mention that the patient had a recent drug overdose, which is significant and points away from oppositional defiant disorder as a cause for the violent behavior.
At any rate, the patient was clearly in psychiatric crisis and out of control.
That does not mean that the nurse who was assaulted should not make a police report. And it also doesn't mean that she should. Her decision to do so, and the empowerment to make either decision is imperative to the nurse's healing from the incident. It's not about what the assaultive person needs. It's about what the victim needs in order to feel empowered and frame the situation in a way that promotes her own well being.
This patient needs more than a criminal charge or lack thereof to get better.
Specializes in Community Health, Med/Surg, ICU Stepdown.
On 8/29/2020 at 5:09 AM, FolksBtrippin said:
Psych nurse here. Agree with the PP who said that policy varies greatly, and the culture does also.
But no hospital or agency can forbid you from making a police report.
They aren't really supposed to discourage you either, but they still sometimes do, especially with nonverbal cues.
It's up to the nurse who was assaulted, always.
OP, since this was your coworker, I would suggest that you support whatever decision your coworker makes. That's what people need after something like this happens.
I've been mostly lucky even though as a psych nurse I've been around many, many assaultive patients. I've caught the end of a kick a few times, but I've never been really hurt.
You can take a course in CPI or Handle with Care which will teach you strategies for dealing with agitated patients. While you're taking the class you'll be thinking it won't work, but it actually does.
My former hospital had policies that prevented staff injury. At the time I thought some of them were over the top, but now that I'm working at the state psych hospital where staff are assaulted consistently and regularly, I really appreciate those policies in hindsight.
I learned some things early in my career that I still practice regularly.
For example, I position myself so that a patient is never behind my back and so that I always have a clear path to the exit.
Oppositional defiant disorder is laid out in the DSM5. It's a psych diagnosis for children. The treatment is behavioral therapy. Sometimes parents can be trained to do it, and sometimes the child will need a behavioral therapist who comes to the home and/or school and works one on one with the kid. If it is resolved in childhood the child may develop into a perfectly normal and healthy adult. If not, it can become conduct disorder, which is more serious.
Also, a lot of times a diagnosis of oppositional defiant disorder is made and later we find out that the child is actually on the autism spectrum, or has a sensory processing disorder, or there is some other medical cause.
You mention that the patient had a recent drug overdose, which is significant and points away from oppositional defiant disorder as a cause for the violent behavior.
At any rate, the patient was clearly in psychiatric crisis and out of control.
That does not mean that the nurse who was assaulted should not make a police report. And it also doesn't mean that she should. Her decision to do so, and the empowerment to make either decision is imperative to the nurse's healing from the incident. It's not about what the assaultive person needs. It's about what the victim needs in order to feel empowered and frame the situation in a way that promotes her own well being.
This patient needs more than a criminal charge or lack thereof to get better.
Thank you for your reply! He was 18 and had diagnosis of ODD but psychiatrist said since he is 18 and so violent it is now conduct disorder. I need to do more research! My friend did file charges and patient is in jail for now. I went to visit her and she is doing OK. thanks for the great advice!
Thank you for your reply! He was 18 and had diagnosis of ODD but psychiatrist said since he is 18 and so violent it is now conduct disorder. I need to do more research! My friend did file charges and patient is in jail for now. I went to visit her and she is doing OK. thanks for the great advice!
You can research ODD if you want to gain knowledge, but I wouldn’t take it into consideration when deciding to report or not. It doesn’t matter. Thug’s defense attorney can choose to use it as a defense if they want... YOU (or the victim) don’t need to make that determination.
Specializes in Community Health, Med/Surg, ICU Stepdown.
40 minutes ago, Workitinurfava said:
One would think that the hospital would assist in helping the nurse file the charges seeing it happened at work.
Actually, they tried to get her to file a citizen's arrest. They made it seem like they were helping her, but then we found out it's so if the patient sues someone for sending him to jail he can only sue her, not the hospital. Great back up...
I was assaulted by the same patient, on two separate occasions when I worked in an outpatient dialysis unit. After the first incident, management basically told me to avoid him as much as possible (really???). Several months later he back-handed me across the face. I was early enough into my second pregnancy that nobody except my husband knew I was pregnant at the time. When I filed a police report, two officers told me that being assaulted was, in their opinion, a hazard of the job... The patient was discharged from our clinic after the second assault. The clinic manager told me that if it was going to happen, she was thankful it was me, because she would have been bailing any other staff member out of jail, as anyone else would have probably retaliated instead of picking themselves up off the floor and walking away. This was 17 years ago...
Specializes in Community Health, Med/Surg, ICU Stepdown.
2 hours ago, TGHolman said:
I was assaulted by the same patient, on two separate occasions when I worked in an outpatient dialysis unit. After the first incident, management basically told me to avoid him as much as possible (really???). Several months later he back-handed me across the face. I was early enough into my second pregnancy that nobody except my husband knew I was pregnant at the time. When I filed a police report, two officers told me that being assaulted was, in their opinion, a hazard of the job... The patient was discharged from our clinic after the second assault. The clinic manager told me that if it was going to happen, she was thankful it was me, because she would have been bailing any other staff member out of jail, as anyone else would have probably retaliated instead of picking themselves up off the floor and walking away. This was 17 years ago...
WOW!! I am so sorry that happened to you. And you brought up something I've also wondered about, whether nurses who fight back in self defense can be sued by the patient that attacked them. I guess if the patient did something but then stopped and the nurse then retaliated it might not be OK? But if you're being attacked and need to defend yourself I think you should be able to without fear of legal action. I didn't know things like that happened in the outpatient environment too =/ thanks for sharing
Specializes in Mental Health, Gerontology, Palliative.
On 8/27/2020 at 4:38 AM, Wuzzie said:
It isn't. That is the prosecutors job.
We have similar issues, patients commit a violent assault. The police go "this patient is under the mental health act' and refuse to progress the charges. Although it is improving, we are starting to get some patients through the courts for their actions. Once watched a patient king hit another patient in the head, when I asked if the patient would be charged I was told 'they are under the mental health act'. This patient knew exactly what they were doing, so much so they told another patient what they planned to do.
OP you should definately pursue criminal charges, especially if the patient has been deemed to be competent. Violence against healthcare workers needs to stop
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JKL33
7,039 Posts
Negligence already noted in my first reply.