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So I called the police on a patient

Nurses   (3,050 Views 39 Comments)
by JBMmom JBMmom, MSN (Member)

JBMmom has 6 years experience as a MSN and specializes in Long term care; med-surg; critical care.

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MunoRN has 10 years experience.

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7 minutes ago, JBudd said:

If you can be convicted and sent to jail for drunk driving; obviously you can be considered to be liable for drunken assault of a health care worker. 

People don't get free passes for beating up somebody at a bar: "well they were drunk & didn't know any better" isn't going to fly with the bouncer.

They can be charged even when impaired because they made a decision to be impaired.  You're saying because they choose to seek medical help for the symptoms of withdrawl that they are then criminally liable for those symptoms?

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JBudd has 38 years experience as a MSN and specializes in trauma, teaching.

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I never said anything about the ones with DTs (a potentially fatal syndrome, far different than the shakes), they should have been sedated and tubed to begin with.  But when you get brought in, and attack, yes, you are criminally liable.  Very few are actually hallucinating to the point of non-awareness.  

And if you are aware enough to come in voluntarily for symptoms of withdrawal, don't make the decision to attack the person helping you.

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JBMmom has 6 years experience as a MSN and specializes in Long term care; med-surg; critical care.

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14 hours ago, MunoRN said:

I feel like we're all talking about two different things, are we talking about a patient with at least minimal cognizance, or a delirious, hallucinating patient in DTs? 

I've never heard a nurse suggest it would be appropriate to press charges against a patient for the symptoms they are receiving nursing care for.  Caring for ETOH withdrawl patients is not easy by any means, but if a nurse isn't up to the task please decline to care for these patients instead of criminalizing the patient's illness.  

This particular patient was receiving treatment for withdrawal, yes, he was getting benzodiazepines and when alone in the room, did appear to be yelling at people that weren't there. However, he quickly reoriented to reality when staff came into the room. He remembered who I was from the shift the night before without me prompting him. As I said, at first I shook him hitting off as just part of the job, not like it hasn't happened before. However, he was quite lucid enough to remember that he had hit me for the rest of my shift and after enough specific threatening statements towards me and other staff, I decided to call.  By coincidence, when uniformed security officers or a police officer entered the room, the patient was the picture of polite reserved behavior. Only when it was female staff members providing care did he display any of the aggressive behaviors. I've seen plenty of detoxers, it's not that I just wasn't up to the task that night, although I admit it had been a very challenging week to that point. I do not judge my patients, they deserve professional, competent care no matter what circumstances have brought them to my assignment. However, even the police officer that came to take my statement admitted this particular patient is well known to local police and has a history of violence in the community. I know it will most likely go nowhere, but I wanted there to be a paper trail, because next time maybe he won't be full-on detoxing when he hits another staff member.

I completely understand the skepticism, you're quite entitled. It was a judgment decision and I stand by it for the sake of myself and my coworkers.

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TriciaJ has 37 years experience as a ASN, RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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2 hours ago, JBMmom said:

I completely understand the skepticism, you're quite entitled. It was a judgment decision and I stand by it for the sake of myself and my coworkers.

Exactly.  I've had people strike out indiscriminately and later apologize when they were lucid.  Being able to selectively choose a target is a different story.

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MunoRN has 10 years experience.

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17 hours ago, JBudd said:

I never said anything about the ones with DTs (a potentially fatal syndrome, far different than the shakes), they should have been sedated and tubed to begin with.  But when you get brought in, and attack, yes, you are criminally liable.  Very few are actually hallucinating to the point of non-awareness.  

And if you are aware enough to come in voluntarily for symptoms of withdrawal, don't make the decision to attack the person helping you.

"The shakes" is not "far different" from the DTs, tremors are the "T" part of Delirium Tremens.  And as much as we might prefer it, we don't routinely tube ETOH W/D patients.  The "shakes" and the psychosis / delirium / fight-or-flight response originate from the same GABA/glutamate pathway.  

I'm not sure where you're getting that "very few" ETOH W/D patients requiring hospitalization "are actually hallucinating to the point of non-awareness".  

Withdrawl patients often come in at the beginning or before even starting withdrawl, they know what's coming if they've been through it before, I'm not sure where you're getting if they are sufficiently cognizant prior to withdrawls then they are still sufficiently cognizant in the midst of withdrawls.

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MunoRN has 10 years experience.

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7 hours ago, JBMmom said:

This particular patient was receiving treatment for withdrawal, yes, he was getting benzodiazepines and when alone in the room, did appear to be yelling at people that weren't there. However, he quickly reoriented to reality when staff came into the room. He remembered who I was from the shift the night before without me prompting him. As I said, at first I shook him hitting off as just part of the job, not like it hasn't happened before. However, he was quite lucid enough to remember that he had hit me for the rest of my shift and after enough specific threatening statements towards me and other staff, I decided to call.  By coincidence, when uniformed security officers or a police officer entered the room, the patient was the picture of polite reserved behavior. Only when it was female staff members providing care did he display any of the aggressive behaviors. I've seen plenty of detoxers, it's not that I just wasn't up to the task that night, although I admit it had been a very challenging week to that point. I do not judge my patients, they deserve professional, competent care no matter what circumstances have brought them to my assignment. However, even the police officer that came to take my statement admitted this particular patient is well known to local police and has a history of violence in the community. I know it will most likely go nowhere, but I wanted there to be a paper trail, because next time maybe he won't be full-on detoxing when he hits another staff member.

I completely understand the skepticism, you're quite entitled. It was a judgment decision and I stand by it for the sake of myself and my coworkers.

The pathophysiology of ETOH withdrawls can leave short term memory relatively intact, and delusional thought processes can appear fully linear, I'm not sure if that's how you're defining lucid.

The use of mitts however requires that the patient isn't able to be responsible for the decisions they make, if they are capable then you've committed a crime by restraining them, you can't have it both ways, either they have decision making capacity or they don't.  

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JBMmom has 6 years experience as a MSN and specializes in Long term care; med-surg; critical care.

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1 minute ago, MunoRN said:

The pathophysiology of ETOH withdrawls can leave short term memory relatively intact, and delusional thought processes can appear fully linear, I'm not sure if that's how you're defining lucid.

The use of mitts however requires that the patient isn't able to be responsible for the decisions they make, if they are capable then you've committed a crime by restraining them, you can't have it both ways, either they have decision making capacity or they don't.  

So this particular patient was brought in by a family member for being excessively drunk. The patient has no intention of quitting drinking. (I think our hospital does a disservice to people by putting them through a full detox knowing that they will drink as soon as they're discharged. I'm not sure how other facilities work.) As soon as an IV was placed, he would pull it out, it appeared to be an intentional decision, therefor mitts were necessary. Again, since it will likely go nowhere, this is all probably a moot point. I appreciate your time and perspective.

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MunoRN has 10 years experience.

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14 minutes ago, JBMmom said:

So this particular patient was brought in by a family member for being excessively drunk. The patient has no intention of quitting drinking. (I think our hospital does a disservice to people by putting them through a full detox knowing that they will drink as soon as they're discharged. I'm not sure how other facilities work.) As soon as an IV was placed, he would pull it out, it appeared to be an intentional decision, therefor mitts were necessary. Again, since it will likely go nowhere, this is all probably a moot point. I appreciate your time and perspective.

If you've deemed the patient sufficiently unable to be responsible for their own decisions to use restraints to prevent the patient from refusing an IV then it would be contradictory to claim they are actually capable of decision making and can be responsible for their own actions.  

I would be very careful with this in the future, you've submitted a legally binding statement that the patient did have decisional capacity, yet you had them restrained to prevent them from refusing an invasive device even though they have the legal right to refuse that device based on your statement that they have decisional capacity, if that patient ends up getting a lawyer you're potentially screwed.  

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Jail nurse here. My 2 cents. Threats of harm from a patient or attempts to harm self or others by a patient need to be dealt with as 100% serious. Staff safety is just as important as patient safety. If your hospital is going to require nurses to be security guards (by not having in-house security or psych techs available to intervene on strong and aggressive patients) I would use 2 steps: 1. hospital chain of command 2. then call the police. Obviously you are working and paying taxes, and there is some hospital CEO raking it in off the difficult, hazardous, and underpaid work you perform as a nurse. Your personal safety is on the line.

The reality is, only you were assigned to that patient. I have experienced all kind of second guessing from others after an incident. It means nothing: I kept myself and the patient safe. If you really think my ADPIE was professionally incorrect, then ask management for a debriefing. We can pull my charting and the security video (this is jail) and walk through the incident and we can all learn from it. Still havent had a debriefing yet!!

I will use every available resource to keep myself, my staff, and the patient safe if they cannot keep themselves safe or their aggression is escalating. There is no wrong when calling for backup. If you think you need it, you call. Chain of command (charge/nurse mgr/house sup) can either back you up, or your chain of command is broken and you need to back yourself up.

These things are not black or white. Like most of nursing they are a judgement call. In acute care the reality is a lot of detox patients need a sitter, and "there isnt one available". The patient your hospital admitted to the floor. Whom the hospital will bill Medicaid/Medicare and get paid for. The hospital apparently failed to provide sufficient resources to manage that patients medically induced behavioral problem. 

Patient detoxing and making threats, displaying aggression? Yeah we get that in jail. And the patients learn to control their behavior really quick, even with an altered mental status, for a lot of the time, because I have a deputy with a taser standing behind me and 15 more a radio call away. The acute psych term is Show Of Force. Do altered patients get tased? No. Is the altered patient's behavior less aggressive because they see that deputy in the doorway? You bet. It registers even in an altered mind.

I think this is applicable to every field of nursing: I nurse with the understanding I may experience aggression from a patient at any time. This does not obligate me to continue to experience it once a particular patient displays it. And I will be a nurse leader by demanding a culture of safety. If patient had a dangerous medical condition, I would get it treated. If they display a dangerous security condition, I will get that "treated". It is my role as a nurse to intervene to keep myself, my patient, and my staff safe. I am a nurse, not a provider. I am obliged to consult for medical AND security orders. It sounds to me like you had to make your own chain of command for security orders because your hospital leadership failed you when consulted. Good for you! Stay safe!

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TriciaJ has 37 years experience as a ASN, RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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1 hour ago, ashagreyjoy said:

Jail nurse here. My 2 cents. Threats of harm from a patient or attempts to harm self or others by a patient need to be dealt with as 100% serious. Staff safety is just as important as patient safety. If your hospital is going to require nurses to be security guards (by not having in-house security or psych techs available to intervene on strong and aggressive patients) I would use 2 steps: 1. hospital chain of command 2. then call the police. Obviously you are working and paying taxes, and there is some hospital CEO raking it in off the difficult, hazardous, and underpaid work you perform as a nurse. Your personal safety is on the line.

The reality is, only you were assigned to that patient. I have experienced all kind of second guessing from others after an incident. It means nothing: I kept myself and the patient safe. If you really think my ADPIE was professionally incorrect, then ask management for a debriefing. We can pull my charting and the security video (this is jail) and walk through the incident and we can all learn from it. Still havent had a debriefing yet!!

I will use every available resource to keep myself, my staff, and the patient safe if they cannot keep themselves safe or their aggression is escalating. There is no wrong when calling for backup. If you think you need it, you call. Chain of command (charge/nurse mgr/house sup) can either back you up, or your chain of command is broken and you need to back yourself up.

These things are not black or white. Like most of nursing they are a judgement call. In acute care the reality is a lot of detox patients need a sitter, and "there isnt one available". The patient your hospital admitted to the floor. Whom the hospital will bill Medicaid/Medicare and get paid for. The hospital apparently failed to provide sufficient resources to manage that patients medically induced behavioral problem. 

Patient detoxing and making threats, displaying aggression? Yeah we get that in jail. And the patients learn to control their behavior really quick, even with an altered mental status, for a lot of the time, because I have a deputy with a taser standing behind me and 15 more a radio call away. The acute psych term is Show Of Force. Do altered patients get tased? No. Is the altered patient's behavior less aggressive because they see that deputy in the doorway? You bet. It registers even in an altered mind.

I think this is applicable to every field of nursing: I nurse with the understanding I may experience aggression from a patient at any time. This does not obligate me to continue to experience it once a particular patient displays it. And I will be a nurse leader by demanding a culture of safety. If patient had a dangerous medical condition, I would get it treated. If they display a dangerous security condition, I will get that "treated". It is my role as a nurse to intervene to keep myself, my patient, and my staff safe. I am a nurse, not a provider. I am obliged to consult for medical AND security orders. It sounds to me like you had to make your own chain of command for security orders because your hospital leadership failed you when consulted. Good for you! Stay safe!

Amen.  It's always easier to second-guess when you aren't there and you can always point to something that someone's written.  However, only the person in that situation is equipped to make the call and it never hurts to err on the side of safety.  The life you save may be your own.

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Leader25 has 35 years experience.

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 I fully support you.The hospital I was working tried to stop me from calling,but security called  police for me ,and helped make a report,offered to remove the culprits if they just looked my way.I was very disappointed in Director of nursing desiring to sweep it under rug,she did the same when doctors got verbal and  physical with nurses too.So glad the witch is gone.Co workers mostly ran the other way,some denied it even happened even when it was right in front of them.

Recently after being informed about ACTIVE SHOOTER protocol[finally]some co workers made our own defense plan using 18 gauge needle,60 ml syringe.I am not take any chances,the hospital does not care about prevention and not enough about post event trauma.

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Here.I.Stand has 16 years experience as a BSN, RN and specializes in SICU, trauma, neuro.

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5 hours ago, MunoRN said:

The pathophysiology of ETOH withdrawls can leave short term memory relatively intact, and delusional thought processes can appear fully linear, I'm not sure if that's how you're defining lucid.

The use of mitts however requires that the patient isn't able to be responsible for the decisions they make, if they are capable then you've committed a crime by restraining them, you can't have it both ways, either they have decision making capacity or they don't.  

Huh??  Violent restraints are a thing.  There are extra hoops e.g. q 4hr orders (I think?), q 15 minute checks vs q 2 hr checks... but they are a thing.  I have never once been told in annual training that they are only used for someone who can’t control themselves— they are used when their behaviors pose a risk to staff.

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