Slapped across the face by male patient

allnurses Guide · Aug 10, 2012

I'm so sorry, noyesno. Regardless of the legal aspects here, he violated your space and your sense of safety. It takes a while to get over something like that. Conventional wisdom has been in the past that nurses are supposed to take whatever abuse the patient dishes out. That is changing, and I see it reflected on this board by news stories and nurse's accounts of pressing charges themselves.

If the man was alert and oriented then yes, I would've called the police. So far, I've never been physically assaulted by a patient though, so hopefully someone with direct experience can advise you. ((((noyesno))))

anotherone, BSN, RN · Aug 10, 2012

Sorry that happened to you! I don't know how I would have reacted in that situation. If I knew the pt was completely AO3 I might react differently than if they weren't. but in the community these things don't always matter. Plenty of people in prision are not AO3.

DizzyLizzyNurse · Aug 10, 2012

Not an excuse, but if he was confused and doesn't speak English maybe he thought you were invading his space? IDK it's so tough when someone doesn't speak English.

sauconyrunner · Aug 10, 2012

Yes it hurt. and YES NO ONE should have to feel unsafe on the job.

But the patient also has a right to care given in language he can understand. He is from a nursing home, and there is some sort of history here, as well as some sort of question of confusion. It's pretty clear that No one has been doing an appropriate assessment on

the patient, if you have no idea if he is confused or not. So the assessment with assumptions about the patient has never really been complete as no one seems ot have chosen to find a way to communicate with the patient. How are you assessing for mental status changes? If he was A and O times 3 and is now suddenly swinging at someone, well, that is a change that needs to be reported to the MD, because something has changed.

We have filed many many charges against patients from our Emergency department. These are usually for people who are completely alert and oriented, and had had some warnings. I have been choked by a patient who was strung out on Meth, I chose not to press charges because the pt was not entirely in control of his behavior. I've also been scratched, bitten, spat upon and pushed. It is very upsetting.

I really think you do have a right to be safe at work. But...given the circumstances- you addressed a person who may or may not be confused in a foreign language to him and then physically approached him. I can see why he might have felt like he needed to protect himself.

jadelpn, LPN, EMT-B · Aug 10, 2012

Always be sure to get a translator for your initial assessment. If patient did not understand what it was that you were doing, then reacting physically may be the only way he knows to protect himself from a perceived threat. It is interesting, but I see patients who have been in not so great nursing homes fight for their lives when anyone tries to touch them. Especially if the nursing home was not in this country, who knows what the prior conditions were for this patient. Was this a new admission? Did any other nurse notice that he had a physical reaction to touch? And one doesn't know if one is A&Ox3 unless they can speak the language and assess that. If the patient was in for some sort of infectious process, then they swing away. But you should have been TOLD this prior to you going into the room. If the patient is just a violent jerk who gets off on hitting women, then I would report it to the police. But you won't know that until a translator can assess this with a nurse or the Dr. Otherwise, reactionary hitting or acting out can have a great deal of reasons. Not for a moment did you deserve to be clocked. However, was it intentional, or was it reactionary? The patient should perhaps be medicated if it is a reaction to anyone touching them. Psych consult. In the meanwhile, what is the doctor's suggestion on how to control this patient's behaviors? Transfer to Geri-psych? It is tough to not feel personally vilolated when a patient acts out in a physical way. And I am not suggesting that nurses become puching bags at the whim of jerky, violent, alert and oriented patients. But I have found in my practice, that I don't touch a patient until everyone is well aware of what I am doing and why I am doing it. And with a patient who is confused, agitated, acting out, what can wait until a med to calm the patient can be determined to be appropriate kicks in, and what can not wait, I get more than just my body in the room for assistance.

allnurses Guide · Aug 10, 2012

Noyesno, I've been really disturbed about both your hospital (for looking at you like you're crazy when you mentioned filing a police report), and his family's "he did this all the time at the nursing home" response. To me, their apparent lack of concern reflects a belief they consider healthcare workers as people who should expect to be assaulted as part of their job.

Anyway, I found something New York state has passed into law to address this issue. I hope other states will follow suit. It's called the Violence Against Nurses Law, which makes it a felony to assault a nurse. Two excerpts from an article about this that I found surprisng.

The Violence Against Nurses law went into effect Tuesday, putting nurses into a protected group along with police officers, firefighters and emergency responders. A physical attack against a registered nurse or licensed practical nurse on duty is now a Class D felony subject to a maximum of seven years in prison.

So, up until then, you would be charged if you belted one of those in the jaw, even if you are angry, drunk, on delirious, etc. I have to ask, why have nurses been excluded prior to the present time?

The law applies to physical assault, which includes being spit on, bitten, hit or pushed. It does not include verbal assault. Nurses can press charges against anyone, including patients who are delirious or mentally ill. The bill, Avery explains, covers the basic right to press felony charges. The courts will take it from there.

My opinion now is that I would make a police report. If nothing else, it can go in the statistics kitty for one of the most underreported crimes occurring most likely as we speak.

Hurt a nurse, go to prison under new law - Times Union

jadelpn, LPN, EMT-B · Aug 10, 2012

Noyesno, I've been really disturbed about both your hospital (for looking at you like you're crazy when you mentioned filing a police report), and his family's "he did this all the time at the nursing home" response. To me, their apparent lack of concern reflects a belief they consider healthcare workers as people who should expect to be assaulted as part of their job.
Anyway, I found something New York state has passed into law to address this issue. I hope other states will follow suit. It's called the Violence Against Nurses Law, which makes it a felony to assault a nurse. Two excerpts from an article about this that I found surprisng.
So, up until then, you would be charged if you belted one of those in the jaw, even if you are angry, drunk, on delirious, etc. I have to ask, why have nurses been excluded prior to the present time?
My opinion now is that I would make a police report. If nothing else, it can go in the statistics kitty for one of the most underreported crimes occurring most likely as we speak.
Hurt a nurse, go to prison under new law - Times Union

The family may not have a clue why the patient reacted the way that he did. I think there's a HUGE difference between an intentional violent attack, and someone acting out due to what could be many many reasons. What is known is that this person did not speak English. The doctor said he was A&O on admission, but what were the other nurses experiences? And lastly, how embarrasing for the patient if they have no control over their thought proccess or actions when they recover from their UTI, sepsis, or get medicated for a psych disorder. If they are deemed incompetent or incompetent at the time of the incident, how in the world can one expect to send a delerious patient into prison for 7 years???? Nurses always need to expect the unexpected. Assess, assess and assess again. Carefully and fully explain what they are doing and why they are doing it in the actual language that the person speaks. Imagine if you were not well, in a foriegn country in a language you did not know, and a nurse started speaking to you saying who knows what and then crossed your arms in a restraint type fashion?? Or started pulling back the bedding to do--what exactly? You wouldn't have a clue, and react to protect yourself. Actually, what the nurse did in this situation could be considered battery. Putting your hands on a patient without their consent is considered so in some states. Seems like a huge miscommunication with nasty consequences. Hence why translators and patient permission and assuring that the patient understands is so important.

CrunchRN, ADN, RN · Aug 10, 2012

I would ask the doc to order a psych consult so maybe it can be determined if their are legitimate issues or not. If so then I wouldn't do anything except formulate a plan of care to avoid that kind of thing with the knowledge learned.

If he was just being a jerk then file away.

allnurses Guide · Aug 10, 2012

The family may not have a clue why the patient reacted the way that he did. I think there's a HUGE difference between an intentional violent attack, and someone acting out due to what could be many many reasons. What is known is that this person did not speak English.

What if he killed her or left her in a coma? Should he get a pass then, too? I mean, if assessing and getting a translator was all noyesno needed to do better, she must've forgotten a step somewhere, so -- you have to be consistent. The point with the family was not why he did it, it was that he did it, again, and again, again at the nursing home. Maybe if the nurses there had done something about it earlier the whole thing could've been avoided.

Anyway, I'm satisfied the good people of New York made the right decision in this case. If you read the link I provided you will see that it encompasses a number of prevention and awareness strategies as well as the teeth in the law. Here is how I see it ...

On the one hand you have a hearing where a judge looks at all the facts of the case , and then decides what to do about it. He has many tools at his or her discretion. He does not automatically toss a mentally ill person in jail for 7 years. The penalties for throwing trash on the freeway are pretty stiff, too, but it's doubtful you'll be seeing people in prison for littering. Evaluating competency would also be done by the court, not the doctor.

On the other hand you have a group of people (nurses) who do not have the same protections as other professionals the same man may encounter along the way, who are just as (if not more) at risk as the nurses are. The same person doing the same thing to a paramedic that he does to the nurse, is held accountable in the first instance and not in the second. Why is that OK?

Imagine if you were not well, in a foriegn country in a language you did not know, and a nurse started speaking to you saying who knows what and then crossed your arms in a restraint type fashion??

I'm imagining it now, and I'm pretty sure I wouldn't slap the nurse in the face, even if I interpreted the crossed arms as something like "we're going to put you in a straight jacket" which is I guess what you meant by crossed arms as a restraint type fashion?

Or started pulling back the bedding to do--what exactly? You wouldn't have a clue, and react to protect yourself. Actually, what the nurse did in this situation could be considered battery.

I don't think she ever touched the guy, or where are you seeing that she pulled back the covers?

CrunchRN, ADN, RN · Aug 10, 2012

Nurse156,

What I said was not was it a language barrier, but was this patient demented/psychotic etc..... need to find out and if so then yes it would be handled differently and he would be approached differently.

I wasn't condoning giving him a "pass" in any way, shape, or form. You might wish to re-read what I said.

Lynx25, LPN · Aug 10, 2012

You deserve safety at work, however, HE deserves an interpreter. How could anyone have even done an accurate assessment on him, if no one is speaking his language? You don't know anything about him.

I've been slapped in the face, bitten, spit on, and one demure little old lady snapped a piece of wood off the wall and attempted to shank me with it. HOWEVER, I work in LTC, and would never press charges on these people because they all have some sort of dementia or other issues going on.

People who are alert and oriented however, do NOT get a pass. Just as they can file complaints about the staff, we can also file complaints about our patients. I've only done it once, and it had a very positive outcome.