Slapped across the face by male patient

[noyesno]

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?

[jadelpn, LPN, EMT-B]

The nurse had no way of knowing what this patient's reaction was going to be. But the patient did not speak English, therfore the nurse had no way of assuring that the patient knew what she was going to do. Pulling someone up in bed "because they look like they need to be" is not an urgent situation as it was described by the OP. Perhaps it was if this patient was sliding down in bed to the point of feet touching the footboard, then let's get it done but follow protocol first. The nurse was done a HUGE dis-service by the fact that no one bothered to tell her that the patient acted out physically--and again as I stated in every post there's a difference in my opinion of a patient being a jerk and violent cause they are a jerk, and someone defending themselves cause they don't understand, invasion of personal space, or delusional. I am not suggesting for a moment that anyone "derserves" to be hit. Nor am I saying it is anyone's fault, without all of the facts that's hard for anyone to say for certain. But patients do act out for a number of reasons. It is an injury, it hurts, it sucks, and should never have happend. But as nurses, we need to protect ourselves. And making sure any patient knows exactly what we are going to do goes a long way to protecting ourselves as well as the patient. I used battery as an example. I never said that the nurse should or would be charged with battery. But it is the same type of scenario. What if the patient said "nurse did not tell me in my language what she was doing, she crossed her arms, I did not know, and thought she was going to hurt me. I had never seen her before, and had no clue who she was or what she was doing, I was just protecting myself". Because quite frankly, he did not know these things if a translator was not used, or perhaps he did, but we have no way of knowing that, and neither does the OP. Legally, we have to use a translator for every interaction, every time. And although extreme, this is a good example of why. Now it is a "he said she said" and even if the patient is a big violent jerk who hits women for the heck of it, the communication issue is a huge issue on trying to prove it. However, I am not attemping to be judge nor jury--and I think there's a communication gap between shifts if this OP went in blind, which seemingly is the case.

[nursel56]

....... duplicate post snuck in here

[nursel56]

Legally, we have to use a translator for every interaction, every time.

That's the first I've ever heard of such a law. Is it a state law? Seems like it would be difficult to function in an environment like that with so many interactions a nurse has with her patients every shift. If she was just checking an IV, passing a tray, picking something up she forgot to take out on her last visit, etc. She could be adding orificenic to his IV, he may believe a dinner roll is a hand grenade and lash out, etc. Seriously, it just seems like if somebody has an abnormal thought pattern, just about anything could seem like a threat requiring one to defend themselves, because even if you don't speak English, to believe the nurse is going to attack you is not rational.

I do get your points here, however my opinion would still rest on what the OP herself has stated - having read through all of her posts in this thread several times and having no reason to doubt her truthfulness, noting the general opinion by other nurses on this thread, and the rationale for the NY law, which addresses the difference between a jerk and a demented person from a legal standpoint. . . much as it nauseates me to use the phrase, we'll have to "agree to disagree".

[SuzieeQ]

This is not okay, and the family just states "he did this all the time at the nursing home" as if it is no big deal. Nice of the family and nursing home to let the ER know about his aggressive behaviour!

[forbidden2know]

i'm frustrated with some of these posters, it feels like some have the attitude that they're are no consequences

for those patience's that hurt others, so naturally it will keep happening over and over until something is done about it, or someone

is held reliable.

[ComeTogether, LPN]

It's really hard when you get abused by a patient. Even harder when they're not demented. I'm going to assume and I advise you to do as well that he was not alert and oriented. It's not ok irs certainly hard to tolerate but it does happen. This is unfortunately part of the job sometimes. No it's not what we signed up for its not fun but I'd he was confused and couldn't speak English didn't know hat you were going to do I wouldn't look at it further. Lesson learned, informed consent couldn't be obtained. Next time you'll take someone in wih you. I have been bitten punched kicked out in a headlock etc etc. they were all demented and I knew and know they weren't themselves. Perhaps their minds were somewhere else, a bad memory of he past. I just try to put myself in their shoes. Afraid confused and not able to understand what's happening. They don't want to be touched they just want to be left alone but we can't do that I'd they need care. I find that I'd they are indeed demented sometimes singing helps. Xoxo. Sorry for your situation.

[netglow, ASN, RN]

No. Sweetie :hug:.

I say you talk to the cops. Make a report.

Look. Noyesno (and the rest of us) understands what's what. We know after checking chart after all this stuff, if we feel we were assaulted still. There is either an immediate explanation and acknowledgement of AO in the hole, or, of absolute intention to do harm. She knows which one, we all do as soon as it happens. The family? Of course they say "he does it all the time". It's assault that they are being informed of... lots of bad people out there.

The job? Seriously No, that hospital is a crappy hospital (you know that I know) ...Get the cops to take a pic of your face. Probably bruising up right about now.

You "what if" people, are only worried for the stress of the fall out. Yup, it's true that people most likely to remain in abusive jobs/relationships try to RATIONALIZE abuse. You all need to sit down and think on that one a while. Think about it right now, before you go to work or go home (for some of you). People who rationalize stuff like this become targets. Even I can see it on your face that it's OK to treat you like crap.

[jadelpn, LPN, EMT-B]

No. Sweetie :hug:.

I say you talk to the cops. Make a report.

Look. Noyesno (and the rest of us) understands what's what. We know after checking chart after all this stuff, if we feel we were assaulted still. There is either an immediate explanation and acknowledgement of AO in the hole, or, of absolute intention to do harm. She knows which one, we all do as soon as it happens. The family? Of course they say "he does it all the time". It's assault that they are being informed of... lots of bad people out there.

The job? Seriously No, that hospital is a crappy hospital (you know that I know) ...Get the cops to take a pic of your face. Probably bruising up right about now.

You "what if" people, are only worried for the stress of the fall out. Yup, it's true that people most likely to remain in abusive jobs/relationships try to RATIONALIZE abuse. You all need to sit down and think on that one a while. Think about it right now, before you go to work or go home (for some of you). People who rationalize stuff like this become targets. Even I can see it on your face that it's OK to treat you like crap.

I don't even know how to respond to this. HUGE difference between an abusive patient who attacked this nurse for who knows what reason with intent, and the patient who lashes out due to who knows what reason to anyone and everyone who attempts to touch them. I am not a bit concerned about the stress of the fallout, but the miscommunications that any nurse go in uninformed to any patient that has even had a hint of lashing out physically (and if at the nursing home this patient did this "all the time" then THEY need to be held accountable for not informing anyone of this) or the nurse who goes into a room for the first time with a non-english speaking patient and attemt to care for them when they do not consent or are uninformed. There are many sides to the same issue, my attempt was to present another side from years of experience in psych, in acute care, in the field...as a CNA EMT and now LPN. And be well assured that NO one treats me like crap, my husband doesn't hit me nor do I think that hitting is OK. No one derserves to be hit.(and note that this patient has a history of hitting--anyone--not specific to this nurse) And to personalize with statements such as "targets" is just incorrect. This goes to court and the nurse says "yes, I did attempt to care for this non-english speaking patient without a translator, I did not get his consent, I do not know if the patient understood what I was attempting to do, and via the medical record, he was alert and oriented" is setting this nurse up for a mess. Far different story if there was a translator, nurse said, I am going to pull you up higher in the bed, patient ok's that, and when attempting to do that he hauls off and slugs her--THEN I would say file away!! To do otherwise could put the nurse in a much worse light than what she ever intended. So it begs the question--what happend to this patient? Was a translator able to get a reason why this patient lashed out? How did they handle it on the floor? Was he A&O? Did he have a change in medical condition that caused delerium? Was he able to be medicated so that this did not occur again? Or did it end up being "I don't like females, I don't like nurses with blond hair, I refuse to be touched...." what was the outcome of all of this?

[jadelpn, LPN, EMT-B]

That's the first I've ever heard of such a law. Is it a state law? Seems like it would be difficult to function in an environment like that with so many interactions a nurse has with her patients every shift. If she was just checking an IV, passing a tray, picking something up she forgot to take out on her last visit, etc. She could be adding orificenic to his IV, he may believe a dinner roll is a hand grenade and lash out, etc. Seriously, it just seems like if somebody has an abnormal thought pattern, just about anything could seem like a threat requiring one to defend themselves, because even if you don't speak English, to believe the nurse is going to attack you is not rational.

I do get your points here, however my opinion would still rest on what the OP herself has stated - having read through all of her posts in this thread several times and having no reason to doubt her truthfulness, noting the general opinion by other nurses on this thread, and the rationale for the NY law, which addresses the difference between a jerk and a demented person from a legal standpoint. . . much as it nauseates me to use the phrase, we'll have to "agree to disagree".

It is our facility policy, so I mis-spoke when I used "legally" but our expectation with no exceptions is that we have to use a translator every time, every interaction. And with a language line, it is not as bad as it seems.

And yes, I think a great deal of you, and enjoy your posts and experience. We will agree to disagree on this one, as usually, I agree with you 100%.

[netglow, ASN, RN]

Here is the difference between you and me Jade, I don't give a flying _________ if the patient doesn't speak english. And you know what I don't give another flying one what ethnicity he is. Noyesno did not touch the patient and got hit. You don't need a translator as much as you might think for so much of life and human interaction. You still are assuming all sorts of stuff including pathology about the patient, that noyesno did not relay to you.

BTW, noyesno is not any kind of ditz. She's a cool head and an intelligent nurse.

[DizzyLizzyNurse]

Even if this is the case, it doesn't justify assault.

I never said it did. I'm just talking about next time dealing with someone who's a different gender, language, and culture. Maybe he didn't understand and was confused to boot. Not saying it's ok to hit someone, but just an explanation.

[jadelpn, LPN, EMT-B]

Here is the difference between you and me Jade, I don't give a flying _________ if the patient doesn't speak english. And you know what I don't give another flying one what ethnicity he is. Noyesno did not touch the patient and got hit. You don't need a translator as much as you might think for so much of life and human interaction. You still are assuming all sorts of stuff including pathology about the patient, that noyesno did not relay to you.

BTW, noyesno is not any kind of ditz. She's a cool head and an intelligent nurse.

I am not suggesting that noyesno is a ditz. I am suggesting she was set up in a situation that should have been relayed to her, but was not. I am also suggesting that people don't just haul off and smack someone as a general rule, unless they are a huge a**, or something else is going on. However, unless one understands each other, no one can assume a thing. And it would not be in a good place to say "nope, no translator, nope, no consent, nope haven't a clue if he understood me or not". Cause even as*hol**s who hit women for sport are pretty devious in the "it was self defense" department. And unfortunetely noyesno would be in a mess. So netglow, you may not give a flying _______ that the patient did not speak the language, but there are many sides to a situation. And if there were a translator, and if noyesno obtained consent and then noyesno got hit, then she would be in a better position to press charges. I do not know noyesno, nor you, nor anyone else in this situation--so to personalize this doesn't help anyone learn from this as an aha moment. No one deserves to be assaulted, and unfortunetely in this situation no one was looking out for each other to relay that information.