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

[Abby McCoy RN]

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.

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Reference(s)

¹ Crisis Prevention Institute (CPI)

[BeatsPerMinute, BSN, RN]

On 9/6/2022 at 3:20 PM, 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've heard this too but its usually used on animals