What do you do when a patient threatens harm?

elkpark · Jan 25, 2018

What do you do in a situation like that? I just quickly changed the conversation & de-escalated her, then she was fine.

That's what you do.

ruby_jane, BSN, RN · Jan 25, 2018

And document. In quotes. "Patient said she would punch me in the face." And document what you did to de-escalate (which was really good, BTW).

In the example you gave, pt was leaving but maybe she'll be back.

Also make sure you're aware of where you are in relation to the door every time, and do your best to be closer to the door than your patient is. This is more of an ambulatory nursing thing but a quick exit may be your friend.

Is that going to help you not get hit? Nope. Probably someone's going to swing at you. It's happened once in the 10 years I've been a nurse. And if it comes to it - yell for the code. That's going to get people where you are if you're really in danger.

OrganizedChaos, LVN · Jan 25, 2018

And document. In quotes. "Patient said she would punch me in the face." And document what you did to de-escalate (which was really good, BTW).
In the example you gave, pt was leaving but maybe she'll be back.
Also make sure you're aware of where you are in relation to the door every time, and do your best to be closer to the door than your patient is. This is more of an ambulatory nursing thing but a quick exit may be your friend.
Is that going to help you not get hit? Nope. Probably someone's going to swing at you. It's happened once in the 10 years I've been a nurse. And if it comes to it - yell for the code. That's going to get people where you are if you're really in danger.

Thank you. I just wanted to make sure I did the right thing. I'm new to floor nursing & it's a huge adjustment to me.

It's really a shame we have to put up with all of this harassment whether it be verbal or physical. I was treated with more respect by INMATES when I worked in corrections!!! I got more please/thank you/you're welcome/yes ma'am/no ma'am. It just turns my stomach to see how everyone is treated.

Crush · Jan 25, 2018

And document. In quotes. "Patient said she would punch me in the face." And document what you did to de-escalate (which was really good, BTW).
In the example you gave, pt was leaving but maybe she'll be back.
Also make sure you're aware of where you are in relation to the door every time, and do your best to be closer to the door than your patient is. This is more of an ambulatory nursing thing but a quick exit may be your friend.
Is that going to help you not get hit? Nope. Probably someone's going to swing at you. It's happened once in the 10 years I've been a nurse. And if it comes to it - yell for the code. That's going to get people where you are if you're really in danger.

Exactly what ruby jane said. Document, document, document. Utilize good verbal de-escalation. Know where the closest escape route may be. If the patient has threatened you once, be sure a co-worker knows you are heading in there again. Doing all the above is not a guarantee of not getting hit/assaulted though but it is good prevention.

LonghornChic, BSN · Jan 25, 2018

If de-escalation doesn't work then I assess their mental status. If they are pretty oriented and know what they are doing then I say "since you know what you are doing then I should inform you that hitting a nurse is considered a felony". I ususally get an apology afterwards and make sure to document that interaction. We let ourselves get abused too much.

OrganizedChaos, LVN · Jan 25, 2018

Exactly what ruby jane said. Document, document, document. Utilize good verbal de-escalation. Know where the closest escape route may be. If the patient has threatened you once, be sure a co-worker knows you are heading in there again. Doing all the above is not a guarantee of not getting hit/assaulted though but it is good prevention.

That is very true & is such a shame. Thank you!

OrganizedChaos, LVN · Jan 25, 2018

If de-escalation doesn't work then I assess their mental status. If they are pretty oriented and know what they are doing then I say "since you know what you are doing then I should inform you that hitting a nurse is considered a felony". I ususally get an apology afterwards and make sure to document that interaction. We let ourselves get abused too much.

We really do. I had a conversation with a coworker about it yesterday. I can't tell you how many times a code is called for security. We should be able to carry mace.

There was a patient on the floor who got irate & had a pocket knife. You're telling me I have a whip out my ascom, call a code & wait for security to get there?

It's one thing if a patient is verbally abusive when if someone ever starts to become physically abusive with me, I will do whatever it takes to protect myself. I have 2 little ones at home & I want to go home at the end of the day.

Guest219794 · Jan 25, 2018

And document. In quotes. "Patient said she would punch me in the face." And document what you did to de-escalate (which was really good, BTW).
In the example you gave, pt was leaving but maybe she'll be back.
Also make sure you're aware of where you are in relation to the door every time, and do your best to be closer to the door than your patient is. This is more of an ambulatory nursing thing but a quick exit may be your friend.
Is that going to help you not get hit? Nope. Probably someone's going to swing at you. It's happened once in the 10 years I've been a nurse. And if it comes to it - yell for the code. That's going to get people where you are if you're really in danger.

Good points. But, when you use quotes, what goes between the quotation marks is exactly what was said:

Rather than "Patient said she would punch me in the face." , use patient stated "I am going to punch you in the face."

Also- distinguish between bad behavior in which there is no actual threat, and real danger, and act accordingly. As a fit 180 lb man, my level at which I am concerned for my safety my be different from somebody else's. But, my safety comes first. By a long shot.

Threatened by a visitor or family member? Call security. If security is ineffective or non existent, call the police.

elkpark · Jan 25, 2018

We really do. I had a conversation with a coworker about it yesterday. I can't tell you how many times a code is called for security. We should be able to carry mace.
There was a patient on the floor who got irate & had a pocket knife. You're telling me I have a whip out my ascom, call a code & wait for security to get there?
It's one thing if a patient is verbally abusive when if someone ever starts to become physically abusive with me, I will do whatever it takes to protect myself. I have 2 little ones at home & I want to go home at the end of the day.

Be aware that if you "protect yourself" using any techniques or weapons outside of what hospital policy approves, you are opening yourself up to possible criminal charges, as well as discipline from your employer.

Sour Lemon · Jan 25, 2018

We should be able to carry mace.

Well, that's a rather entertaining thought! I respond to threats based on how credible they appear to be. Sometimes, I simply ignore the threat. Other times, I leave immediately and return with a full show of force, if need be.

Horseshoe, BSN, RN · Jan 25, 2018

We really do. I had a conversation with a coworker about it yesterday. I can't tell you how many times a code is called for security. We should be able to carry mace.
There was a patient on the floor who got irate & had a pocket knife. You're telling me I have a whip out my ascom, call a code & wait for security to get there?
It's one thing if a patient is verbally abusive when if someone ever starts to become physically abusive with me, I will do whatever it takes to protect myself. I have 2 little ones at home & I want to go home at the end of the day.

What kind of "code" would you be calling? Does your facility have a "code green" or some such that reflects a threat made against your person?