Stop the Silence...Violence Against Nurses

Violence in the workplace is higher in nursing than most other fields of work. What are our rights as nurses? I share my story and some insight for you, as well as free resources. Nurses Announcements Archive Video Knowledge

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"What do you mean they are taking my baby away? I won't let them; I won't let you!" And just like that, she spit in my face.

Spit-In-My-Face

I cared for her during the worst pain she had giving birth, helped her through her heroin withdrawal, educating her how to take care of her new postpartum body, she has now that she became a mother, and she...spit...in...my...face.

At least it was spit and not another gun in the patient garbage can we found last year from the drug dealer father down the hall, or the poor nurse beaten in our dark parking lot because she didn't have any cash to give the hobo on the street.

At least it was only spitting is what I told myself.

I felt ashamed like I did something wrong. Maybe I shouldn't have said or put her in that situation, scared what her friends and family may do to me (who had not one ounce of control over her custody situation).

I wanted to go home that day, but I didn't, and I am not alone in how I was feeling. Nurses accept violence from patients, and it is uncalled for.

Violence Against Nurses

Though the public is not aware, many nurses experience violence within the workplace. It is estimated that within the last year, one in four nurses were physically attacked at work.

Who knew nursing could be such a dangerous job? Patients attack nurses because they are sick, mentally and physically. Sometimes, like the situation I was in, patients become upset with nurses for not giving them the answers they want. Therefore, patients may attack nurses before they can be restrained.

Right now, no federal law for the protection of nurses from violence exist. Some states have taken into their own hands and created their own specifications like programs that teach violence prevention. Though, the American Nurse Association has set out a model bill for states to follow to help develop protection for nurses.

What nursing job is at the most risk?

The nurses in the ED are the ones who are at the most risk for injury. Often, they receive the patients that are belligerent from alcohol intake, off their psych meds, or irate because they are not receiving care fast though. Often times, you will see the hospital security officer stationed in or near the Emergency Room.

Male nurses, in the ED, are at the highest risk for assault from patients. They are often called to help with violent patients, and often do not hesitate to help protect their female coworker.

Why nurses? Well, we are the ones caring for the patients, with the longest and face to face interaction. In 2014, the Journal of Emergency Medicine reported that three in ten nurses were assaulted on the job with "long waits, delayed pain medication, and mental illness being the three leading factors that led to violence," per the Journal of Emergency Medicine.

How to stop violence from patients

There are a variety of de-escalating techniques nurses should try when a patient becomes violent, or you anticipate they will be violent. Oftentimes, patients react because they are mentally ill or irate just as my patient was because she lost custody of her baby.

Preventing violent acts

Beyond the training recommended for nurses, the ANA also recommends:

  • Key areas, like the ED and behavior health centers, should have security guards present.
  • Mock situations practiced to have a clear system for dealing with aggressive behavior before it turns into violence and for summoning security personnel.
  • Keeping the hospital lit at night, inside and out.
  • Always tag the chart if the patient has a violent history.
  • Staffing design to keep nurses together with violent patients, and never to be alone
  • Making sure nurses know whom to call to report the violent incident in their department.

OSHA has also released a 60 page free resource for healthcare workers regarding violence within the workplace: Free Resource

If you want to take a course, the CDC offers a free one for nurses: Free Course

You have to know that it is your right to be safe at work. Be smart about your safety. Take extra courses on violence within the workplace and educate yourself as much as possible. Talk to your director and security officers if you notice a problem that can be fixed.

A great video from YouTube on nurse violence:

I believe I read somewhere that nurses do have the right to a safe workplace. In the even that any employee is harmed should be protected by security. Something a medical workplace involving patients should have. If they don't, they're putting at risk a list of things within the facility besides nurses being beaten such as medical records, potential hostage crisis, weapons manufacturing using certain drugs or illnesses extracted from patients to create biochemical weapons, patient safety is at risk, etc. Families will want security for the facility if something happens to them. At any time I feel endanger of my life I'll either raise my voice or force my way to a phone and call police. Violence and mistreatment should not be part of the job. Quality of patient care shouldn't be watered down so low to the point that being beaten is okay. I'd file a complaint with Dept. of Labor and Human Resources. To me, violence in the workplace is the equivalent of a domestic violence in the home. Same thing.

1 Votes
GeminiNurse29 said:
Guys have assaulted staff, admin is reluctant to use restraints (Bc you know, "old" people don't know what they're doing), and they don't get locked down so patients are wandering around at all hours of the day or night.

Admin is reluctant to use restraints? I thought it was doctor order to use restraints, not administration who sound like people who push pencils and file papers and don't have anything to do with patients except records...

1 Votes
Flatline said:

I have called the police on a patient, I have called on the behalf of my nurses, I have seen others call.

Has this proven effective?

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Hostile work environment lawsuits should be filed for every single occurrence. The only thing that will make them pay attention is if its going to cost them money or gain them bad publicity. Admin could not give a single crap if nurses get beat up.

1 Votes
TheAtomicStig_702 said:
Admin is reluctant to use restraints? I thought it was doctor order to use restraints, not administration who sound like people who push pencils and file papers and don't have anything to do with patients except records...

I clarify: admin is reluctant for us (and I mean supervisors and managers and higher ups not on the floor) to seclude or restrain a geripsych patient and get the order for it. It's always "why didn't you try xyz..." um we did, obviously it didn't work.

1 Votes
Specializes in ED, psych.
Daisy4RN said:
It is absolutely absurd that in this "modern world" this violence is allowed to happen to nurses. You are right that no other profession accepts violence as "part of the job". The move from administration to "customer service" has only made this problem worse. I was told in hospital orientation that there is nothing I could do if a patient assaulted me, this was backed up by the union (yes that's right, the union). While I know that some patients don't know what they are doing many who commit these violent acts do know exactly what they are doing, and do it because they get away with it. This needs to stop!

"Nothing I could do if a patient assaulted me, this was backed up by the union" -- um, no. Maybe I'm a lucky gal, but I'd be finding another place of employment if there was truly "nothing I could do."

I'm in adult inpatient psych, major hospital. I'm all of 5'1, 100lbs soaking wet. I've been through 3 days of crisis intervention and another 2 days of CPI so far (almost done with orientation). We have security at the front door of our unit. We've been down staffed recently, which hasn't been awesome, and an increased census as well. That being said ... while there have been some scarier moments, I haven't been afraid for my safety. And if I were to be assaulted (and believe me, it's happened to other staff in the past), there are steps in place to deal with it head on and not push it into some deep dark corner by administration.

This is actually one of the reasons why I chose this unit: staff longevity ... good safety protocol that has been continually updated through the years to keep up with the times.

Believe me, "customer service" follows many professions. I had a parent try to hit me when I was a teacher (to be fair, she was drunk; when she came in the pick up line and I found her to be slurring her words and reeking of alcohol I stopped her from taking her child and we managed to take her keys), and another parent stalked me and a speech/language pathologist for several months. I've seen servers at restaurants get groped/sworn at and just generally treated pretty rudely, DCF/DSS workers get treated pretty badly as well. These professions are generally more tolerant of abusive behavior, at least from my own anecdotal observations. A lower paying waitress? A DCF worker entering someone's home who really doesn't want them to be there? It happens, sadly enough. And people aren't surprised when it does, are they? It's any profession that deals with the public sector combined with a horrible lack of support, empathy, and sometimes even clear cut rules from either admin and the public (or both).

However, what you do with this is up to you. My hospital has clear cut rules that follow the law. If yours doesn't, you still have the law.

1 Votes

OP, while the ED is certainly dangerous, you apparently have no idea how dangerous a psych ward can be.

And since psych patients might be on Med/Surg, Tele, or ICU or wherever in a hospital, the danger is also in those areas.

1 Votes
macawake said:
Many professions are exposed to an increased risk of threats and violence and healthcare is definitely one of them. Others are for example law enforcement, social workers, judges, the military. Perhaps also convenience store clerks? Bank tellers? I'm sure that you agree that other professions also run a risk of encountering aggressive behavior.

I'm not a U.S. nurse so I accept the fact that there might be cultural/policy/legal differences at play here, but what exactly did your employer mean when they said that staff "could do nothing" if a patient assaults them? Did they mean that you can't run away if someone attacks you? (in the cases when that's a viable option). Did they mean that you are not allowed to physically defend yourself or a coworker? Or did they mean that you have no legal recourse once an assault has taken place?

What they meant was that we could not haul off and slug the person. We had to confine our response to the techniques we'd been taught and authorized to use. If you are a black belt in Tae Kwon Do, you must not use that skill. you must only follow, as one person called it, CPI. You can involve coworkers and use chemical and physical restraints after exhausting all non-physical approaches and techniques.

If a pt spit on me, as described by the OP, I would have talked to her and let her know that I was dismayed, after caring for her through the labor and delivery. I also, depending on her response, apologetic or not, would have seriously considered doing a police report. I'd have possibly changed assignments, too. And I'd have let her know that what she did was assault/battery and that I would bring police in if she ever did anything like that again, anything physical. She can say things but she had better not ever touch me again. An employer would not condone me involving police or letting a patient know that I would not tolerate future physical violence.

1 Votes

I have told patients and families on a few isolated occasions that I was going to call the police and file a report, but usually they straighten up after that and I don't actually follow through with it. I got pretty good ad de-escalation working in psych but definitely don't have the "It would never happen to me" mentality. Working in ICU I am more afraid of some idiot trying to punch buttons on a vent or IV pump than I am being assaulted.

1 Votes
Specializes in Oncology/hematology.

Two weeks ago, a mentally disturbed patient walked into a community clinic, sprayed a nurse with lighter fluid and set her on fire. She died.

Apparently, he was upset about adverse effects of his flu shot. He came in to complain about it a few times.

Tragic.

1 Votes
Specializes in Nurse Health Writer / Author.
Certifiable said:
Two weeks ago, a mentally disturbed patient walked into a community clinic, sprayed a nurse with lighter fluid and set her on fire. She died.

Apparently, he was upset about adverse effects of his flu shot. He came in to complain about it a few times.

Tragic.

Oh my gosh...that is horrible :(

1 Votes
Certifiable said:
Two weeks ago, a mentally disturbed patient walked into a community clinic, sprayed a nurse with lighter fluid and set her on fire. She died.

Apparently, he was upset about adverse effects of his flu shot. He came in to complain about it a few times.

Tragic.

In a clinic, she was sprayed with lighter fluid and died? Did people just stand around and watch the fire eat away at her skin? No smoke detectors or ceiling things went off? No fire extinguisher nearby? No stop drop and roll? No one tried to put out the fire? She was literally that combustible? When the mentally disturbed patient walked in, did anyone see a big gas container and a lighter in their hand? Or did they just let them waltz on in?

Btw, how did a mentally disturbed patient WALK IN a clinic? Why were they outside to begin with? If they were from another clinic? How did they get passed staff and security?

1 Votes