Why don't we talk much about these scenarios?

NightNerd, MSN, RN · Apr 17, 2019

I commented on the other post regarding this article too, so I won't reiterate that. How I feel about the risk of getting hurt working as a nurse...not good, not at all!

My workplace has seen a spike in violent behavior recently, combined with lessened security measures throughout the hospital. The past few months I have been increasingly scared to go to work, and I keep waiting for the day I or someone I work with gets hurt. I'm coming to the end of a week off and am dreading going back to this constant state of high alert; it's crazy how it affects your whole life.

I wonder how we are allowed to protect ourselves at work, and who officially decides what measures are acceptable? At this point I think I would do whatever it took to defend myself. At a recent debrief from a violent situation, a chaplain asked me how I balance my professional responsibilities with my own safety, and it was honestly a shock to realize that I have a choice, even within the workplace. Outside of the hospital, people carry pepper spray, take self-defense classes, etc., but I bet a nurse using this against a violent patient, even one who was fully alert and oriented, would be scrutinized and possibly lose his or her job. How seriously are we "allowed" to take our own duty of self-preservation as nurses? And who is "giving" us this permission? It's just wrong; any other work setting would have no input into how their employees defended themselves from attack, but in healthcare you have to think about whether you'll be in trouble afterward. It's utter nonsense.

TriciaJ, RN · Apr 17, 2019

I would stay alive first and worry about the mortgage second. I would fight dirty if need be, because it's a bad time to be worrying about your license or your job.

I might still be killed, but that doesn't mean I have to make it easy.

Daisy4RN · Apr 17, 2019

I have witnessed this many times. Psych pts on med-surg, step down etc units because they cannot be transferred until they are medically stable. Many are ambulatory and violent. After violent acts nobody does anything because "they can't help it". If I was personally attacked I know my instinct would be to fight back with whatever I have (although I dont know how much it would help!). While the usual strategies help (de-escalation, not leaving yourself an exit etc) it will never be foolproof because nurses are always busy and you never know when someone will go off the rails. I find it absolutely ridiculous that more is not done by admin and prosecutors, I am afraid the problem just gets worse everyday.

Persephone Paige, ADN · Apr 17, 2019

Thanks everyone who commented, I didn't see that this was posted before so I apologize for a duplication.

Recently, I had a patient that I couldn't get out of his room fast enough.

I'm of the same mind as many of you. The hospital has exactly as long as it takes to notify security of impending disaster. That's how long I will give them before taking steps to avoid any physical harm to myself. Then, it's fair game.

JKL33 · Apr 17, 2019

1 hour ago, NightNerd said:
I wonder how we are allowed to protect ourselves at work, and who officially decides what measures are acceptable?

Ultimately, the law. Not your employer.

You are most certainly allowed to defend yourself, with the goal of freeing yourself to make escape possible.

1 hour ago, NightNerd said:
How seriously are we "allowed" to take our own duty of self-preservation as nurses? And who is "giving" us this permission?

Very generally: You are allowed to take defensive measures such that you are able to flee the attack or stop it if unable to escape. What you aren't allowed to do is escalate a situation or continue physical measures when you have the opportunity to escape.

You aren't required to place yourself in harm's way in the course of your daily work, period. It isn't your job to keep a patient in a room, in a facility, or from jumping off the stairs or anything else. You're not security and you aren't a LEO.

CPI (Crisis Prevention) training/similar or self-defense course would help you feel empowered and give you more tools and some answers to the questions you have. It begins with being aware of risks and signs of the progression of others' behavior, and taking measures to prevent violent scenarios whenever possible.

NightNerd, MSN, RN · Apr 17, 2019

7 minutes ago, JKL33 said:
Ultimately, the law. Not your employer.
You are most certainly allowed to defend yourself, with the goal of freeing yourself to make escape possible.
Very generally: You are allowed to take defensive measures such that you are able to flee the attack or stop it if unable to escape. What you aren't allowed to do is escalate a situation or continue physical measures when you have the opportunity to escape.
You aren't required to place yourself in harm's way in the course of your daily work, period. It isn't your job to keep a patient in a room, in a facility, or from jumping off the stairs or anything else. You're not security and you aren't a LEO.
CPI (Crisis Prevention) training/similar or self-defense course would help you feel empowered and give you more tools and some answers to the questions you have. It begins with being aware of risks and signs of the progression of others' behavior, and taking measures to prevent violent scenarios whenever possible.

Thank you for clarifying. I'm repeatedly surprised by how important it is to hear that we are allowed to get out of harm's way. Makes it all the more necessary to remind each other. No need to worry about me continuing a fight; once I am able to get away, I an running to the first therapist with an open appointment, lol.

Our hospital does have us take CPI, but unfortunately there are some situations where it simply hasn't been enough. It has come in handy before, but I have been considering taking additional self-defense classes on my own too.

allnurses Guide · Apr 17, 2019

5 hours ago, Persephone Paige said:
Would you fight back if you were being seriously attacked, are we even allowed to fight back?

I have and I would fight back on any occasion that I was attacked. I have put many patients on the floor in a legally accepted manner. Still constant situational awareness is the key to staying safe in any situation. If I fear for my life all holds Are off. I will punch, kick, bite scream and fight until my opponent quits or gives up. I was taught by an Army Ranger and MMA instructor how to defend myself and have no problem with it. Nobody is ever going to hurt me without getting hurt back.

Hppy

TheMoonisMyLantern, ADN, LPN, RN · Apr 17, 2019

I all nursing specialties are becoming more dangerous. I think our psych patients get a bad rap, a lot of violent people are just plain mean and not necessarily mentally ill.

On top of that, it isn't the depressed suicidal patient or the patient having a psychotic break or even the opiate detoxer that makes me nervous. It's the antisocial or narcissist transferred from the jail with a documented history of violence who views nursing staff as playthings for his amusement that makes me nervous. In psych we get these types of patients and there's honestly not a flying figgin thing we can do for them because they will never think that they have the problem.

FolksBtrippin, BSN, RN · Apr 17, 2019

When I worked inpatient psych, I was really safe. There was a lot wrong with that hospital, but I was much safer there than I am working in the community as I do now.

We had security, but we also had techs whose job was to keep everyone safe. If a patient got out of control you called a code gray and a minimum of 4 techs/security plus the techs on your unit came running to restrain the violent person in seconds. 4 point locked restraints. Then you gave him an IM. We were safe.

The medical floors do not have this same level of safety. You cannot use 4 pt restraints on a medical floor. Your techs aren't all trained in restraining people. Yet, you often have patients who need this level of care. It's not right.

I encourage everyone who feels unsafe at work to call OSHA. It's amazing the effect they have on policy.

ETA: If I am threatened by my patient with violence, I will do everything in my power to get away. If he has my throat, my hair, or I feel I am in mortal danger I will do anything to survive. I will go for the eyeballs, testicles, whatever. And if my employer has a problem with it well *** them. Nobody gets my life.

allnurses Guide · Apr 17, 2019

3 hours ago, TheMoonisMyLantern said:
I all nursing specialties are becoming more dangerous. I think our psych patients get a bad rap, a lot of violent people are just plain mean and not necessarily mentally ill.
On top of that, it isn't the depressed suicidal patient or the patient having a psychotic break or even the opiate detoxer that makes me nervous. It's the antisocial or narcissist transferred from the jail with a documented history of violence who views nursing staff as playthings for his amusement that makes me nervous. In psych we get these types of patients and there's honestly not a flying figgin thing we can do for them because they will never think that they have the problem.

This!

Amen

Hppy

OldDude · Apr 17, 2019

Personally, I think MOST of this behavior is an extension of how our society is evolving into not holding each other accountable for anti-social behavior. You see it every day. I think if it was automatic that when a patient commits an assault on anyone while on the premises they should be immediately charged with the crime and transported to jail upon discharge so they can be magistrated to answer for the crime. As mentioned above, those who have legitimate psyche issues are in the minority of these types of assault perpetrators but I'd let the Magistrate sort that out. An assault was committed on a person, or persons...end of story.