What do you do if a patient strikes?

Tweety, BSN, RN · May 1, 2005

Obviously if a nurse is in danger and being attacked she/he should use whatever force necessary to end the attack and keep safe. Any institution that doesn't back you up on that isn't worth working for.

But if a patient strikes you, and you are able to get out of harms way and get help, that is the route you should take rather than strike back in anger and instinct. Many attacks on nurses are done by confused, pyschotic or concussed and head injuried patients and I'm sure institutions aren't going to bat for nurses that hit back at these types of patients.

Here it is a felony to assault a health care profressional, but I have never seen a patient prosecuted.

FutureRNMichael · May 1, 2005

Most likely place to recieve the type of training mentioned in this thread is by a employer before starting in your position. If you ever work in Psych, you will go through a course by the employer consisting of containing a patient, keeping other patients, yourself and other staff safe. I have worked in Psych for several years now, with the most chronically ill indviduals in my state and have never been attacked to the point where I felt in serious danger. If you form a bond and treat patients with respect your almost always likely to be the last person they attack. Most patients will always attack the staff who treats them undignified or direspectful and/or has no rapport with them first and foremost. Just make sure you do not ever find yourself in such a position.

Your best bet is to analyze and recognize a person who might be one to cause you harm and keep a safe distance at all times as best possible, never get the patient between you and the exit/door and most of all get the heck away!! Escaping is always best because you are not risking harm to yourself or your job by HAVING to defend yourself.

Yes, it is a disgrace to be fired for defending yourself, in most cases. However, some nurses I have know used excessive force to threat they faced and we're fired, rightly so.

mshultz · May 1, 2005

I once had a patient grab my wrist with both hands and twist. I tried to pull away, but he had a really good grip. I screamed for help and finally slapped his wrist with my free hand when I heard a pop and felt the most horrible pain I had ever felt on the wrist he was twisting. It hurt so bad I almost passed out...six weeks later the cast came off and I was told I was fired for hitting a patient. Thank goodness for lawyers...:)

This is why there is a problem with healthcare workers being physically assaulted. You can bet the patient told his friends how the hospital felt he was justified in breaking the nurse's wrist, since he suffered no consequences, and they tried to fire the nurse.

The hospital should have filed charges against the patient, and gone to the local media with a big story about how they have zero tolerance for violence against healthcare workers. Assuming that the patient would have gone to jail under this scenario, the resultant publicity would have gone a long way toward discouraging assaults on healthcare workers.

Kikumaru · May 1, 2005

In the county where I used to work (within the psych setting) it was mandatory to take MAB (management of abusive behavior). It goes by a different name in different places.

danu3 · May 1, 2005

Do you know if those "self defense" classes you were talking about are required for nursing? I don't remember seeing it on my class list. If it isn't I'm sure it would be adventageous to take, eh?

It is best if you can take it in the institution you are working for because the class would not violate any of the institution policy.

If you want to take one outside your institution, there are different ones but you better look at the techniques and see which one you can really use.

One possible one is CDT which are taught to police officers and is open to the public also. Basically it has no strikes but it can get you or another person out of trouble. Once you are out of trouble, you RUN. There are whole bunch of locks and pins also, but these are really for police officers as these techniques emphasize safety for the officier and the person being persfomed on. However, since it is open to the public, won't hurt taking it as it might come in handy outside the hospital environment.

The drawback of CDT is that it is expensive (quite a few hundred dollars usually unless you belong to a martial art school who happens to teach it). Also you need to renew it every year.

The advantage is that if you are sued for using these techniques, they will back you up and witness for you. That is why you need to renew your license every year. The other advantage is that you don't need to know martial art. Actually if you know martial art (depending on the art), it can be a disadvantage because you have to relearn everything. It is about a 2 day training once a year.

CDT information is at http://www.cdt-training.com/

Ask them what level is appropriate for a nurse. I took "Level I" which is not on the web site unfortunately. In my class, about 30% are police officers and there are definitely some stuff I have no use for (like getting a uncooperative person out of a car with no damage to the person) and forutnately we who are not officiers did something else instead.

-Dan

steelcityrn, RN · May 1, 2005

I would not try to defend myself as much as I would be trying to protect myself. One patient I had who struck out was having a bad reaction to a medication. What was I supposed to do...take the old man down? lol..No, j/k . its all about protecting the patient and yourself.

Hi! I'm a pre-nursing student and I am in Intro to Health Care this semester. My teacher said that if a patient attacks you, you're not allowed to defend your self. I was kind of shocked at that and when I questioned it, she was very insistant that nurses are not allowed to physically do anything to the patient to get them away. I don't know much at all, but I know if a patient is biting me or grabbing me in such a way that I will get hurt, my first reaction would be to not hit them but to get them off of me in anyway that I can. Am I wrong in my thinking? What do you do when a patient gets violent? I'm a little confused.
Thanks in advance for your advice!
Emery

Emery · May 2, 2005

I would not try to defend myself as much as I would be trying to protect myself. One patient I had who struck out was having a bad reaction to a medication. What was I supposed to do...take the old man down? lol..No, j/k . its all about protecting the patient and yourself.

Well, I can understand if the person really has no control over his actions, but the guy who broke the nurses wrist should have been taken down. I can't believe that they tried to fire HER!! Thats crazy!!

danu3 · May 2, 2005

I once had a patient grab my wrist with both hands and twist. I tried to pull away, but he had a really good grip. I screamed for help and finally slapped his wrist with my free hand when I heard a pop and felt the most horrible pain I had ever felt on the wrist he was twisting. It hurt so bad I almost passed out...six weeks later the cast came off and I was told I was fired for hitting a patient. Thank goodness for lawyers...:)

You did not slap his wrist. You just "patted" his wrist to distract him so hopefully you can get out of the hold. Come to think of it, if you are within reach and if he is not totally psyched out, you can actually tickle him and at the same time pull your other wrist away. But if you are in pain, tickleing him so you can get away is the last thing on your mind.

-Dan

danu3 · May 2, 2005

Well, I can understand if the person really has no control over his actions, but the guy who broke the nurses wrist should have been taken down. I can't believe that they tried to fire HER!! Thats crazy!!

Actually in this situation, the nurse ideal should try to get away (which she did not as her wrist is broken) and call whatever code the hospital has to have a team of people to do the take down (if they decide that is appropriate). It is like cops, you can't use or even give the impression of "excessive" force or you can get into big legal trouble.

-Dan

RN4NICU, LPN, LVN · May 2, 2005

Funny, I had a teacher who basically said the same thing. Patient hit the nurse, and the nurse hit her back. The nurse was fired, or that was what my teacher said.
Maybe it depends on the circumstances.

It does. If the nurse was not in imminent danger, she should not have struck the patient, rather than retalliate. If she WAS in danger, than she had the right to do whatever she had to to get away. Employers may or may not take that into consideration, but it would do them well to keep in mind that they are responsible for keeping their employees safe.

If a nurse is hit by an alert and oriented patient, but can get away, she should do so and then file assault/battery charges against the patient.