Um... Can you hit before you get hit?

Specialties Emergency

Published

As a 1yr ms RN going into ED, one of the top things that concerns me is the safety. I'm sure you have seen lots of crazy things that happen at ed, and I'm not doubtful that one of them include violence against staff.

I have heard from others that people bring guns to the ed, sometimes you can get punched, kicked, put in choke holds, wrestled like in the octagon, etc.

In my state, we have a law that makes assaults on ed staff a felony, but I don't think that will stop the real crazies. I already have a bad back for which I go to the chiropractor, and I don't want to get disabled.

I understand that the best thing to happen is just avoid the violence when it's happening, but what if I have a coworker who is 5ft and will surely go to Valhalla if I run away? Or what if I'm cornered and have to fight? I be honest with you, if there's two options, one being a saint and risk being disabled for rest of my life or being badly hurt, and the other being "selfish " and knock the snap out of someone so I can support my family, I will happily put someone to sleep as best as I could with the blessings of Rocky Marciano. This is not really something you would worry too much about in MS setting, so I feel apprehensive about it.

As you all know this is my first ed position and I know I will defend myself and my coworkers in violent situations. So the question is probably this: what is the realistic approach in hitting someone before yourself can get hurt bad in ed? I'm not going to just simply start punching pts but I'm taking about real danger situations where you know it's either do something or get hurt.

Many ED nurses I talk to about this said they had to use "rough" methods to avoid having themselves or coworkers from getting badly injured... Or am I worrying about something that happens very very rarely?

And although not exactly on topic, allow me to take this opportunity to point that this is the type of situation where you might have to defend yourself in court and having your own could make the difference in saving your job or career.

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Specializes in Emergency, Telemetry, Transplant.
Trust me, I will be happy to charge criminal charges because man with knife in ED is no different than a man with a knife at the street, and if you are happy to be punched and stabbed and smile with heart full of adrenaline, maybe that's why our treatment is not improving.

Why is it that we assume that nursing, and in the ED in general, is the only profession that deals with violent clients, family members etc. What about the fast food clerk in a "bad" neighborhood? Near where I live there was a shooting at a major national chain department store. Look at school violence--after the Connecticut school shooting, there was staff members I worked with who were afraid to send their kids to school. I'm sure the teachers have similar feelings. Violence in any aspect of our society society is tragic, but we need to stop thinking that ED nurses are the only ones who deal with it.

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Why is it that we assume that nursing, and in the ED in general, is the only profession that deals with violent clients, family members etc. What about the fast food clerk in a "bad" neighborhood? Near where I live there was a shooting at a major national chain department store. Look at school violence--after the Connecticut school shooting, there was staff members I worked with who were afraid to send their kids to school. I'm sure the teachers have similar feelings. Violence in any aspect of our society society is tragic, but we need to stop thinking that ED nurses are the only ones who deal with it.

No one said or even implied that ED nurses are the only ones to deal with violence in the workplace.

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Specializes in ER, ICU.
Sorry guys- I am going to let the cat out of the bag.

OP- Of course it's ok to hit somebody first. The more experienced nurses are having fun at your expense.

Every ER has a list of instances in which a preemptive strike is allowed, or even encouraged. This list varies from facility to facility, and you need to become familiar with it.

But the list is not given to new nurses until orientation is over. It's kind of an open secret you would have learned about sooner or later. You will also be taught some one-punch knock out techniques after you finish your telemetry training.

This is a joke, but not funny.

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well regardless of whether I agree with some advices or not, I still thank everyone for the advice. I am by no means saying "yes, ED nurses SHOULD be allowed hit patients if we see fit", I think I have made it quite clear in my post-posts (pun? haha) that I am not talking about preemptive strikes, but in an extreme situation, what would you do where you know the chu-chu train to your doom/severe injury is quite high in percentage.

To add on the criminal press thing, I work currently at quite of a "hood" hospital, you know the usual things where pts will put residents, doctors, nurses, and techs on headlocks for not giving them dilaudid, you know, the "hood" stuff (although that could happen anywhere, but believed to happen more frequency in relativity in tougher areas?). I don't hear about police charges all the time down there, but I know they happen, and I know we have a police protecting us at the ED. Recently one of my coworkers got struck and police came to subdue the pt (at which point, she pretended like she was asleep) and asked the nurse if she will press charges and if so, they will follow up with investigation; she didn't, but just because I can't hit back, I will press the crap out of them just saying. It isn't encouraged, but not discouraged either so far from what I see.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I have worked in some pretty rough areas in my time....areas that were amongst...and some still are ....the amongst the highest gun violence in the country....but I had NEVER felt so threatened when I was in a rich suburban hospitals ED and was chocked by a commercial airline pilot because his daughter had to wait 15 min for a temp of 99.9 rectal.

So it can happen anywhere. You are newish to the ED You need to tread lightly. Be careful with your authority....you can end up being sued. Be sure you have .

Good luck!

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Why is it that we assume that nursing, and in the ED in general, is the only profession that deals with violent clients, family members etc. What about the fast food clerk in a "bad" neighborhood? Near where I live there was a shooting at a major national chain department store. Look at school violence--after the Connecticut school shooting, there was staff members I worked with who were afraid to send their kids to school. I'm sure the teachers have similar feelings. Violence in any aspect of our society society is tragic, but we need to stop thinking that ED nurses are the only ones who deal with it.

Police can hit back; firefighters can hit back. Teachers can shoot back, assuming they have a gun. (Some that I know do carry guns.) The fast food clerk may be armed and can shoot if he is threatened with a weapon; ditto the national chain department stores. Nurses can't shoot, knife or hit the patients. That's the big difference.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
well regardless of whether I agree with some advices or not, I still thank everyone for the advice. I am by no means saying "yes, ED nurses SHOULD be allowed hit patients if we see fit", I think I have made it quite clear in my post-posts (pun? haha) that I am not talking about preemptive strikes, but in an extreme situation, what would you do where you know the chu-chu train to your doom/severe injury is quite high in percentage.

To add on the criminal press thing, I work currently at quite of a "hood" hospital, you know the usual things where pts will put residents, doctors, nurses, and techs on headlocks for not giving them dilaudid, you know, the "hood" stuff (although that could happen anywhere, but believed to happen more frequency in relativity in tougher areas?). I don't hear about police charges all the time down there, but I know they happen, and I know we have a police protecting us at the ED. Recently one of my coworkers got struck and police came to subdue the pt (at which point, she pretended like she was asleep) and asked the nurse if she will press charges and if so, they will follow up with investigation; she didn't, but just because I can't hit back, I will press the crap out of them just saying. It isn't encouraged, but not discouraged either so far from what I see.

Although you NOW say you're not talking about a pre-emptive strike, your header says it all: "Um . . . Can you hit before you get hit?" So you WERE talking about hitting a patient before they hit you. I still don't think you get it, and I'm still not seeing where ER is the place for you. Please rethink your plan.

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Although you NOW say you're not talking about a pre-emptive strike, your header says it all: "Um . . . Can you hit before you get hit?" So you WERE talking about hitting a patient before they hit you. I still don't think you get it, and I'm still not seeing where ER is the place for you. Please rethink your plan.

Already explained myself in previous posts. Concerning your advice, uh... No.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Already explained myself in previous posts. Concerning your advice, uh... No.

Yes, I saw the explanations. After you entitled the thread "Can you hit first?"

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Already explained myself in previous posts. Concerning your advice, uh... No.
You still can't hit. I just don't get what you aren't seeing. Maybe this is a tongue in cheek joke.

I had a MD once that was in a choke hold by a patient...did I use noxious stimuli to get him to late go? Yes. Did I haul off and punch the guy? NO. I was once grabbed from behind and crazy enough I remembered from the movie Miss Congeniality to SING... solar plexus, instep, groin, nose...but did I turn around and punch they guy? no...I ran as fast as I could and let the police get him that were coming down the hall.

I used a fire extinguisher to break up a fight in the waiting room. I once used cetacaine spray from the counter when a gang member had me pinned against the wall (which was my mistake...I got myself cornered in the room....always have an escape route)I sprayed his eyes and ran. But you cannot punch them

You can take defensive and evasive maneuvers but haul off and punch the patient...No you can't.

Aggressive patients do not respond well to aggressive nurses. They feel provoked. I'm not saying be a wimp. But you can be firm and stand your ground without being aggressive. You don't reach out and slap and aggressive dog...you just don't you WILL get bit. In the position of authority and "power", in manner of speaking, you cannot be the aggressor..you will lose your license and be sued.

Like I said be sure you have malpractice. The ED is a high litigation arena and you just might have a rough ride.

Um... Can you hit before you get hit?

Ummmm...NO!

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from hherrn

Sorry guys- I am going to let the cat out of the bag.

OP- Of course it's ok to hit somebody first. The more experienced nurses are having fun at your expense.

Every ER has a list of instances in which a preemptive strike is allowed, or even encouraged. This list varies from facility to facility, and you need to become familiar with it.

But the list is not given to new nurses until orientation is over. It's kind of an open secret you would have learned about sooner or later. You will also be taught some one-punch knock out techniques after you finish your telemetry training.

This is a joke, but not funny.

Maybe not.

But, the OP was given a number of very reasonable answers from experienced nurses who not only adressed her concerns, but gave rationales. She didn't really seem to like those answers. Thought I would try a different approach.

OP- Good luck.

If you have the ability to save this thread to look at it in a few years, I suggest you do so.

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