When Did Nursing Become a Contact Sport? | Life of a Nurse

Nurses have long been recipients of a patient's bad day, and none of us are strangers to angry yelling or name-calling. But when did it get so violent? This article explores the experience of one nurse and asks what more we can be doing for our nurses.

Updated:  

When Did Nursing Become a Contact Sport? | Life of a Nurse

I have cared for many patients throughout my career. Tiny newborns, withered great-grandmothers, heroin addicts, diabetics, and trauma victims, among many others. I have met my share of sweet, sensible, gracious, and kind patients over the years. Unfortunately, I have also met their opposites.

Introduction to Violent Behavior

In my first hospital job (on a step-down trauma floor), I was called a *** daily. And I was a shy, soft-spoken 21-year-old people-pleaser. Imagine what they called the other nurses.  Not only did I live with verbal abuse at work, but sometimes physical as well.

The patients coming down from a heroin high were probably the most violent. But the detoxing alcoholics were the meanest. I didn't even work in psych. The psych nurses joked once that their new chairs were "too heavy to throw.” So I felt lucky.

Only once in my years there was I required to physically restrain a patient. We had security on speed dial, and we'd normally hide with a shot of Haldol ready until the officers had gotten it under control. Another time I did have to help hold a patient (300lb heroin addict who required nine medical staff to keep him on the bed), but he was mostly already down by the time I jumped on a leg.

Next Level 

Fast forward a dozen years. Suddenly, I found myself in a CPI1 class where I'm taught how to escape a chokehold and "take someone to the ground.” I (sort of) learned how to handle someone grabbing my ponytail or my wrist. We learned de-escalation techniques and learned what to do when they failed.

Putting it Into Practice

A year later, I was leading a (routine) CPI response for my violent patient. I started assigning limbs quickly:

"You - left arm.

You - right arm.

You - left leg ...."

I'm sure you get the picture. Everyone had their assignment. Everyone had their bite guards and gloves on. Security waited in the wings (in case something got excessively nasty).

I yelled, "let's go.” We flung open the door and rushed through. Arms people grabbed first, taking the patient down. Then the legs person tackled the knees, cushioning them underneath with an arm and their body on top. Then we secured the feet and head.

"Tackle Them Carefully"

A nurse couldn't just take a patient down - we had to very carefully place the patient in a hold so that neither patient nor staff got injured. Once on the ground, the arms people got down on their sides, pinning the patient with their backs.

The problem with this position was that the violent patient could easily bite staff on the shoulder or back, so the nurse or tech in charge of the head always had to be on the lookout. Needless to say, we preferred to respond to these situations with nurses and techs we knew and trusted.

Movin' On Out

I eventually decided my body was no longer designed for this kind of physicality and moved to a more local community hospital where I surely would not face this kind of violence on a daily basis. I was wrong.

At least no one's tried to bite me so far. I have to look at the positives. I'm surprisingly nimble at dodging punches and kicks. But I'm wondering how many nurses can take much more of this. Nurses and techs are quitting in droves, and I'm concerned about what this means for the profession and our healthcare system in general. I don't want to leave. I want to be part of the solution. I've yet to see any good ideas stick, but perhaps we're getting close to an answer.

Reference(s)

1 Crisis Prevention Institute (CPI)

5
Up Vote Up Vote ×
Abby McCoy RN

About Abby McCoy RN

I am an RN of 16 years who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. I am a married mother of 4 and love the circus that is my home! I have family all over the world and we love to travel as much as possible. I am passionate about health education and love using my experience and knowledge in my writing.

1 Article   2 Posts

Share this post

Share on other sites
Specializes in Med-Surg.

To answer your question "when", probably long before either of us were born.  I remember CPI training over 25 years ago.

My sister who was a nurse got body slammed into a wall by a patient and cracked her pelvis.

Most of the violence I receive these days in the unit I work for is from elderly and demented patients and I usually see it coming.  Thankfully, it's not that often.  When I worked the trauma unit sometimes the people coming off alcohol or drugs or the head injured with get physical.  Occasionally someone coming off anesthesia might get confused and violent.

I don't know what the answer is because as long as there are psych patients, dementia patients and alcoholics and drug addicts, it seems to be a hazard of our profession.

 

5
Up Vote Up Vote ×
Specializes in Critical Care.

Medical staff do their jobs in scrubs. Nurses are demanded to keep a patient under control with no physical barrier or protection and little help - even basics.

Forget about safety in numbers - we all know we don't have that going for us either. 

Maybe some physical protection, you know, like how the other community service people have? (fire fighters, police officers, etc). This might sound like a stupid share and TBH it IS an incomplete thought.. but why are medical staff so ignored and left without "gear" that would protect them when we handle so many dangerous situations?

I often think about why are we left without proper equipment in the first place that would allow us to help us handle and care for patients safely - I am curious what others have done. Did you approach management? What was the response? How did you take the response? What is it that your hope for in the future for nursing, or career whatever that looks like? For those who continue to be in nursing and are feeling less than optimistic, why do you continue to do it? For those who have been kicked / punched / spat on / fallen on / verbally abused by the A&Ox4 peeps 

I am young enough to still be considered naive in all of this but old enough to be getting a little fed up... especially when there is no consideration for the fact that I am human too. My tact is starting to go and I am giving less crap about write ups or termination at this point. 

An impatient family member does not care that we do not have enough staff nor physical therapy today. They do not care that we do not have walkers on site without physical therapy.

They do not understand why their father is high risk for falling when he is on HFNC and NRBM - as he has always been tough and stubborn. They know what is best for him. They want them to walk about the ICU as he pleases. The chair and beds are uncomfortable! OH! Also, it is a family of lawyers. I am told I best pay attention to them by them. So, I had better figure out how to make their requests happen, right here and right now. It also doesn't matter that the patient is 250+ pounds and I am 5'2" and 120 pounds.

"That is your job... You are a nurse" They say 

Literally how can anyone demand an expectation like that onto another person? I AM A HUMAN TOO. 

3
Up Vote Up Vote ×

I don't like the idea of teachers with guns. I also don't like the idea of nurses with any kind of weapon. I think that nurses have to start rejecting the idea  (which management has tried to place in our heads) that we have to do the job of everyone from the janitor to security and every one in between. The answer is that patients who attack staff should be escorted off of the premises by security. If you are strong enough to attack staff, you're strong enough to find somewhere else to go. It's unacceptable. What other profession allows this?

4
Up Vote Up Vote ×
Specializes in CNA telemetry progressive care ICU.

Ridiculous as it seems security is often taught that they are not qualified to restrain or hold down a patient who is conducting violentally, instead these places expect us to chase or run behind them when they are non complaint. Even though many places don't use restraints I felt safer even with soft ones used on patients during covid because of the idea they are intabated and shouldnt pullout tubing ect. Now dealing with drug addiction substance abuse as mental health is an entirely different scope of care and my thoughts are many of my costaff are not trained or know what should be done in these type situations. It's never any protocalls no codes one place called it code gray and that only meant to request for backup but didn't instruct on how to deescalate these type things. Most of us depend on veteran nurses who know what to do and take the reign by pushing an elbow into their shoulder for them to surrender hold onto us.  Our state is not concerned on protecting us by any means its only one sided and this is why we have lost so many career nurses due to after graduating they feel that they didn't signup to combat these concerns and especially are not going to risk there lives to get the job done for facility who will throw us under the bus. Side with patients as there always right no matter how many times there not its a constant threat and struggle that needs some damage control 

1
Up Vote Up Vote ×
Specializes in Critical Care.

Here's a story just from yesterday: 

I helped a fellow nurse get free from her patient's grip on her wrist. He was already in restraints.

We're in the ICU. She was just trying to give a scheduled medication. this patient jumped at the opportunity to try to hurt her. he had a mean grip on her and was hurting her. I started helping her get her free from his grip by pulling back his pinky finger. and that was enough to start him loosening the grip on her. when he freed his grip on her, he then started to bite at the restraints and got free from one and quickly chewed out 2 of his IV lines, then kicked another co-worker who was walking by and seeing what was going on. she tried to help... unfortunately she just ended up getting kicked hard. 

typically on the ICU we don't call for assistance from officers (we're also short on help there these days) but in this case one of the nurses felt like was best as this patient was very violent and strong. thankfully two officers came and they each held a patient's limb.

Meanwhile I make my way to the head of the bed, climb over it, find pressure points and hold the patient's torso down while simultaneously gaining control of his head with my forearms so that he would stop trying to bite at people. This whole scenario was a mess and no one knew what they were doing. 

Im 120lbs & 5'2" but know enough / have had enough experience (both professionally and personally) to know what to do to gain control of a violent human. At least enough ... so far. 

This is another incident. I'm tired of this. I don't like this. I don't like seeing my colleagues putting themselves harms risk because of inadequate resources. 

At the very least nurses should be offered an opportunity to learn some techniques to get themselves out of dangerous situations like this.

This is not what nurses signed up to do and they DO NOT HAVE TRAINING in this. 

Beyond an online training course designed to inform nurses about how to deal with the most extreme situations (example: a hospital shooting) nurses are given ZERO training in how to deal with harmful patients and other everyday threats to the nurse 

2
Up Vote Up Vote ×

This has been going on forever. I had my thumb bent back and dislocated by a patient when I was a 98lb student because he didn't want his blood draw. I remember a course I was forced to take that suggested tapping on the upper lip of a patient biting you would get them to release. Sure, they'll release...just long enough to bite your tapping finger off. SMDH.

1
Up Vote Up Vote ×
Specializes in trauma, med-surg, ortho, peds.

They taught us to "feed the bite" which meant pushing the bitten body part further into the person's mouth, causing their jaw to automatically release. Generally, it worked, but sometimes it took awhile. 

Up Vote Up Vote ×
4 minutes ago, Abby McCoy RN said:

They taught us to "feed the bite" which meant pushing the bitten body part further into the person's mouth, causing their jaw to automatically release. Generally, it worked, but sometimes it took awhile. 

I think I'd rather just kick them in the nuts and get it over with.

1
Up Vote Up Vote ×
Specializes in Critical Care.

Abby and Wuzzie - noted. 

This week my hospital had us do a mandated safety training thing. It was real cute. 

1
Up Vote Up Vote ×
Specializes in Psych (25 years), Medical (15 years).

As long as caregivers deal with those who are impaired and/or angry, there will be contact.

Forty-seven years ago, as an attendant in a DD facility, there was contact. Forty-one years ago, as a Houseparent, there was contact. As a student nurse in 1983, there was contact, as there was contact and for the remaining 36 years that I worked as a nurse.

Learning de-escalation techniques early on in my career was a good first intervention, but learning self-defense came in handy several times throughout the years. 

 

1
Up Vote Up Vote ×
Specializes in Critical Care.

De-escalating techniques absolutely should be a first intervention. Unfortunately (at least in my current ICU) we have many patients who cannot be reasoned with. We have a lot of drug users and ETOH-ers these days. 

I am really considering learning self defense... Is it fair to put it on the nurses to take it on themselves, pay the money, spend the time, just so that they can do their jobs, safely, without fear of lawsuit for accidentally injuring an out of control patient? 

I am just thinking out loud and these are just ideas... I think that it would be great if instead of some crap online training session about the things we already know about, how about we learn some self defense, and/or be reassured that it's OK to do so vs waste everyones time with useless info.

I understand that idea can come with challenges... however at the same time nurses everywhere are getting tired of the BS and the whole thing is becoming more and more costly to both the nurses and the hospitals. 

Up Vote Up Vote ×
+ Add a Comment