Violence towards staff and mgmt response

[horus2001]

I need to vent but i also want to pose a question.

today, i had a six year old psych patient who threw a tantrum on the unit. This kid functions at the level of a 18 month old, so the tantrum i can handle. he then started slamming doors, i intervened because i did not want him to chop his fingers off. the tantrum then grew more violent and he bit me. i did not medicate him because he really is not able to understand his actions as well as someone who is all there. i just wrote up an injury report and moved on.

Later in the day, i had another kid (17 year old) who got angry because the doctor would not increase her meds. She threw chairs and overturned a table and finally punched a nurse in the eye.

At this point, i had the nurse who was assaulted call the police to file an assault report. they came on to the unit, did their due diligence and finally decided to arrest her. she was led off in handcuff. The problem is that the patient advocate was angry with the police for doing this as well as being upset at the nurses for calling the them. she was demanded we implement a process for going through administration before we call the police.

now my questions are (keeping in mind i work at a state hospital in texas)

1. what right does she have to trump my right to file a report of assault?

2. has anyone had this problem before?

3. just because i do a job as a nurse does not mean i will allow myself or staff to be assaulted, am i out of line for thinking this?

[stephva1008]

We've had assaults on our unit and the adult unit and we could file charges at the station. But no police come to the unit to make an arrest. They stay their regular course, and then we put them on our "do not readmit" list after discharge. That is often reward enough. Of course, we have a debriefing and look at ways we can prevent it from happening again.

Not sure if that helps.

[maxthecat]

While I think it is within your rights as a nurse to file an assault report, I can also see the patient advocate's concern that there be a process in place that includes administration input before police are called. I was surprised that the police came to the unit and arrested the patient. In my experience patients stay and finish out their course of treatment, then may be subject to be handed over to police at that time. Usually nothing comes of cases like this legally, because a psych patient is presumed not to have ordinary control over their behaviors (even if we suspect otherwise). Chairs get thrown and nurses punched fairly frequently on the adolescent unit I'm familiar with and I don't remember charges ever being filed. "You choose to work in psych, you accept the risk ." Personally I'd like to say back "then those of us who work in psych, er, etc, where violence is more probable, should get a hazard pay differential," but that's another story. Not saying this is right, but this is the way it is in my facility. I'd be interested to hear what others do. Also, I have been told it is illegal to have a "do not readmit" list. I'm in Illinois--this may vary by state.

I don't think you did anything wrong, but you'd be on firmer ground with your facility if you had some sort of protocol in place for these types of situations.

[stephva1008]

I agree it's part of the job. I almost had my jaw broken when I was 9 months pregnant by a psychotic pt from the brig (I was in the navy) who saw "something" suspicious in my eyes. Everyone i know has been assaulted in some form. I'm not one to bring charges either but it is our right to do so.

Our "do not readmit" list is informal. We get intake on a teen and remember if they were violent or not. If they were violent toward staff in the past (over and above the normal expected violence), then we say they are not appropriate for our milieu and they go to the state hospital. It's perfectly legal to have admission criteria for an inpatient unit. Prior violence toward staff can rule out an admission.

For instance, we don't take pedophiles if the only bed on our unit is with an 8 year old boy. We turn that one down. If he can have a private room, we take them. We don't take MR kids or those with feeding tubes and wheelchairs because those patients aren't appropriate for our program. Now the definition of MR is loosely defined by many communities. We get some intakes that say the patient has normal to above average IQ and they get to our facility and are profoundly retarded. CSB's will lie to get their patient a bed somewhere, esp after hours.

[Jules A, MSN]

I would have called an administrator first. If we want to file charges we need to go to the police station when our shift is over. Personally I would not let a police officer on my unit to arrest a patient. I haven't ever felt it was worthwhile to press charges on one of my patients but I might change my mind at some point depending on the circumstances. Pressing charges against a patient with a known mental defect is pretty futile, imo. I don't think there are 100% answers to this problem that we all face.

FWIW I definitely would have medicated your 6yo. PRNs are not punitive and if their behavior is dangerous, as this one was, whether they understand what they are doing or not, they need medication, imo.

[elkpark]

FWIW I definitely would have medicated your 6yo. PRNs are not punitive and if their behavior is dangerous, as this one was, whether they understand what they are doing or not, they need medication, imo.

I agree -- the comment that one didn't medicate a client "because he really is not able to understand his actions as well as someone who is all there" implies that one sees (uses?) prn medication as punishment rather than appropriate medical treatment. That jumped out at me from the OP.

In every facility in which I've ever worked (psych), it was policy that administration was to be notified/involved any time a staff member was significantly injured by a client. They don't have a legal right to prevent you from filing charges if you choose, but there's usually a policy regarding procedure for that. I agree, though, that there's usually not much point -- I haven't seen much in the way of results from the legal system over the years (when dealing with identified psychiatric clients).

[stephva1008]

I agree that the attending MD and administrator should have been called before a teenager was hauled off. And the parents. Whenever a child injures someone, we have to notify the MD, nurse manager, nursing supervisor, security, and parents.

Your situation is a slippery slope. I wouldn't be surprised if the parent files a suit as litigious as our society is these days. Keep us posted!

[chazman1040]

I agree it's part of the job. I almost had my jaw broken when I was 9 months pregnant by a psychotic pt from the brig (I was in the navy) who saw "something" suspicious in my eyes. Everyone i know has been assaulted in some form. I'm not one to bring charges either but it is our right to do so.

It worries me that an RN can think being a "punching bag" is "part of the job". This teen punched an RN because she didn't get her way. The assault was out of anger, not because she was psychotic. Is it to much to ask that people be held accountable for their actions?

Chaz

[morte, LPN, LVN]

yes, one complaint/arrest may not amount to much.....but we need the paper trail......EVERY time .....