Slapped across the face by male patient

allnurses Guide · 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.

I was referring to jadelpn's post, which I quoted a fraction of at the top of mine. Not sure why you feel I was addressing you specifically.

noyesno, MSN, APRN, NP · 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.

The patient speaks Punjabi. We have a language line and I agree 100% that patients have the right to communication in their native language.

I had not even touched him or tried to assess him. Simply tried to see if I could offer him a simple boost by pointing to the sheet and motioning that we wanted to pull him up. I was waiting for him to give me the okay to do this (by nonverbal cues). Had he not clearly indicated it was okay to boost him with nonverbal cues, I would have then proceeded with the language line but I never got the opportunity, he smack me right there and then.

I agree, I don't think other nurses had been adequately assessing this man's mentation.

noyesno, MSN, APRN, NP · 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

You rock nurse156. XOXO. Thanks for your posts. I know, after it happened everyone was acting like this is just part of the game.

I think I'm going to do a police report. I'm nervous it might negatively impact my job. Can they can fire me for reporting this to the police? Is it a HIPAA violation to tell the police the patient's name? Hmmm...

noyesno, MSN, APRN, NP · 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. 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.

I did not put my hands on the patient, at all. Didn't even pull the bedding. I tried to communicate my intent to boost him nonverbally through motioning. Had he not understood, I would have called the translator but we didn't get that far.

noyesno, MSN, APRN, NP · Aug 10, 2012

By the way, the side of my face he smacked me on is swollen today. According to my eyebrow lady (you know, the lady who waxes my eyebrows), it looks like I had a dental procedure.

CrunchRN, ADN, RN · Aug 10, 2012

I was referring to jadelpn's post, which I quoted a fraction of at the top of mine. Not sure why you feel I was addressing you specifically.

How about because I forgot what I wrote and I thought you were quoting me.....:rotfl:

My apologies for my veiled implication that your reading abilities were perhaps less than desired.

allnurses Guide · Aug 10, 2012

How about because I forgot what I wrote and I thought you were quoting me.....:rotfl:
My apologies for my veiled implication that your reading abilities were perhaps less than desired.

No problem! I have no illusions in that regard, lol. You should see me trying to read the security code on the back of a credit card! Now that's funny! :)

CrunchRN, ADN, RN · Aug 10, 2012

I hear ya. And I was so shocked because I am almost al,ways in agreement with you. Ok, off to get glasses..... :lol2:

foreverLaur · Aug 10, 2012

Yes, I would definitely file a police report. I just wouldn't have high expectations. I had a male patient close fist punch me in the face unprovoked (I said YES when he asked for another Sprite) at work who was alert & oriented x3 and nothing ever came of the police report, unfortunately.

jowangler · Aug 10, 2012

Here's what happened, I'm so upset:
I went into my patient's room to introduce myself. It looked like he needed a boost and the PCT was in the room. I smiled at him and said, "cross your arms," while demonstrating what he should do. Instead of crossing him arms, he took a full swing at me and slapped me across my face as hard as he could. It hurt really bad and even left a mark on my face. I ran out of the room in tears. I filled out an incident report with the manager and we notified the nursing supervisor. They asked if I wanted to go to the ED but I declined.
He did not speak English so it's hard to say if he's completely alert and oriented and everyone just assumes he's confused. I looked at the physician notes on admission and it did say he was alert and oriented times 3. No history of dementia was noted. We called the family and they stated, "he did this all the time at the nursing home." That makes me so angry. Abuse like this should never be tolerated.
Should I have called the police? I've read about nurses pressing charges for things like this. When I mentioned it, everyone acted like I was crazy.
What do you guys think?

Should have called the police, patients don't hesitate to press charges or sue medical professionals. If he was alert and oriented x 3, he knew what he was doing. Maybe he is mad at his family and taking it out on nurses, but it needs to stop!

MeTheRN, BSN, MSN, RN · Aug 10, 2012

I would get a translator in there to assess his orientation and mental status. If he was A+Ox3 GCS 15, I would absolutely call the police. We had a patient corner a nurse and smash her head against the wall while pulling her hair. She had to go to the ED in a neck brace. Once we assessed that he was completely lucid and with it, we called the police. He was arrested after he was discharged. The guy knew what he did, he did it to his wife all the time. The look on his face when he realized he was going to be arrested was priceless and sweet victory for the unfortunate nurse who was my friend.

enworb77 · Aug 10, 2012

noyesno,

Violencelike this should not be tolerated. I've been hit and pinched a few time, but ithas always been by patients or residents who were confused. There are precautions that can be implemented for those we are aware of being confused. For those patients who are A&O X 3 when this happens, you are right to file the incident report with your manager and the nursing supervisor. I might have considered getting an interpreter and having security get involved and talk to him about possible legal ramifications.

Someone earlier mentioned having the physician getting a psych consult. I think this is also a good idea.