Why don't we talk much about these scenarios?

[Persephone Paige]

I have personally known one nurse who was attacked and killed in an intake facility. They found her body shoved up underneath the patient's bed.

I get that there are certain inherent risks when dealing with people, in general. I just think that when a nurse dies at the hands of a patient, it doesn't generate the same sympathy or shock. Why? People are people and some people are nuts, but all people are human.

Just wondering how it feels to other nurses when they read these type articles? Do you get angry, are you incredulous? Or do you just take that gamble everyday when you go to work? Would you fight back if you were being seriously attacked, are we even allowed to fight back? I know for myself, some of our Med-Surg patients are crazy but too sick to be transferred yet to the psych ward. And by sick, that could just mean infection, etc... These folks are still VERY mobile and capable of great harm. There are times when I've been afraid. And saying we have 'security' in these type situations is a joke. A nurse would be severely injured by the time security made it up to the floor. So, to think I am safe simply because I don't work in a psych ward or an intake facility isn't accurate.

Interested on different takes and safety strategies.

http://www.ksla.com/2019/04/15/baton-rouge-nurse-dies-days-after-attack-by-patient/?fbclid=IwAR2dpYzPC5_1wyTPyIPbJ_HGLEXdGCqh3yB1RRXEKqR9dW5BwfkVKmHwcb8

[Davey Do]

Back in 1978, in an attempt to explain a use of power, a coworker once asked me, "What's the difference between an explosion in a cylinder of an automobile and an explosion in a house?"

I use this concept of controlled power in dealing with patients who have the potential to do harm. I will push them in order to have a controlled situation.

Now, nothing I say or do is inappropriate (wink wink nudge nudge), but I would rather have a patient go off in my presence than have the patient go off unexpectedly when the situation is less conducive to a controlled outcome.

[NurseBlaq]

13 hours ago, Daisy4RN said:

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.

Because management hides in their offices so they don't know what it's like to be in the position of being attacked. They only come out when joint commission or some other accrediting body is in the building.

[NurseBlaq]

14 hours ago, TriciaJ said:

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.

This! You can get another job (maybe) but you can't get another life if killed.

[OldDude]

8 minutes ago, Davey Do said:

Back in 1978, in an attempt to explain a use of power, a coworker once asked me, "What's the difference between an explosion in a cylinder of an automobile and the explosion in a house?"

I useth is concept of controlled power in dealing with patients who have the potential to do harm. I will push them in order to have a controlled situation.

Now, nothing I say or do is inappropriate (wink wink nudge nudge), but I would rather have a patient go off in my presence than have the patient go off unexpectedly when the situation is less conducive to a controlled outcome.

You are psyche Ninja!!

[Persephone Paige, ADN]

For the poor nurse in the article... I sincerely hope they don't try and say that her death was unrelated to the attack. Even if a nurse is older or has health issues, he/she was successfully working from either want or necessity. She might not have possessed the strength or skills to defend herself even IF she had a mind to.

Honestly, I don't have a great know how myself. The only thing I might be able to do is to put a little space between myself and an attacker. Grab an IV pole or something...

I wish bed pans were still stainless steel.

[JKL33]

29 minutes ago, Persephone Paige said:

For the poor nurse in the article... I sincerely hope they don't try and say that her death was unrelated to the attack.

So far, they have already said that it was directly related.

[HarleyvQuinn, MSN, RN, NP]

16 hours 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.

Be aware, CPI techniques will are helpful for verbal de-escalation and becoming more aware of situations with potential to escalate and how to handle them, but the basic class will not teach you how to handle a hands-on situation. They teach basic "escape" maneuvers and many are questionable at best. There is an advanced class that I hear has a lot better skills/information in it, but my current workplace (an inpatient psychiatric facility/ward) does not offer it to us. CPI teaches that you cannot do anything to the patient that would cause pain. Even when defending/escaping. The theory is that'll just escalate the situation.

[NightNerd, MSN, RN]

2 minutes ago, HarleyvQuinn said:

Be aware, CPI techniques will are helpful for verbal de-escalation and becoming more aware of situations with potential to escalate and how to handle them, but the basic class will not teach you how to handle a hands-on situation. They teach basic "escape" maneuvers and many are questionable at best. There is an advanced class that I hear has a lot better skills/information in it, but my current workplace (an inpatient psychiatric facility/ward) does not offer it to us. CPI teaches that you cannot do anything to the patient that would cause pain. Even when defending/escaping. The theory is that'll just escalate the situation.

Yeah, that's kind of been my experience with CPI as well. Helpful in some scenarios, but if an angry able-bodied person of any respectable size is coming for me, I don't think this will cut it. Our instructors even admitted as much during the class.

[HarleyvQuinn, MSN, RN, NP]

8 hours ago, FolksBtrippin said:

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.

I'm jealous. The push now is to be restraint free and to not lay hands on the patient at all. At our facility the push is to be at capacity at all times, regardless of staffing levels. We're not allowed to decline patients based on staffing. Acuity doesn't matter. Sometimes we don't have enough techs for each unit. There's one security guard covering the psych facility, and he/she's also rounding elsewhere. When staff have had to go hands on and restrain, there's been an uptick of scrutinizing and retaliation/punishment by management and minimizing of staff injuries. There's been a lot of damage to the milieu lately. Decrease in retention. It's not fun.

[Daisy4RN]

6 hours ago, OldDude said:

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.

I am sorry to say that I agree with you completely. I remember my first experience in the hospital setting in the early 70's. I was a Candy Stripper and we had one old lady (probably my age now haha) that sat at a desk in front of the long hallway they led to the patient rooms (no security at all). Visitors listened to what she said when she told them the rules etc. nobody screaming and flipping out because it was "their right" to do this/that. I used to go from room to room delivering jello, magazines etc and I don't remember the people acting as they do now (and I would remember bc it would have left an impression). People behave badly (to put it mildly) because they are allowed to get away with it and because they just don't care, this has been getting worse and worse over the years and I am afraid it will just continue.

[Daisy4RN]

5 hours ago, Davey Do said:

Back in 1978, in an attempt to explain a use of power, a coworker once asked me, "What's the difference between an explosion in a cylinder of an automobile and an explosion in a house?"

I use this concept of controlled power in dealing with patients who have the potential to do harm. I will push them in order to have a controlled situation.

Now, nothing I say or do is inappropriate (wink wink nudge nudge), but I would rather have a patient go off in my presence than have the patient go off unexpectedly when the situation is less conducive to a controlled outcome.

Interesting! Does this usually work, what stops them from having another "explosion" ? You do this on certain patients you know so you have a pretty good idea how they will react I guess huh?

[FolksBtrippin, BSN, RN]

3 hours ago, HarleyvQuinn said:

I'm jealous. The push now is to be restraint free and to not lay hands on the patient at all. At our facility the push is to be at capacity at all times, regardless of staffing levels. We're not allowed to decline patients based on staffing. Acuity doesn't matter. Sometimes we don't have enough techs for each unit. There's one security guard covering the psych facility, and he/she's also rounding elsewhere. When staff have had to go hands on and restrain, there's been an uptick of scrutinizing and retaliation/punishment by management and minimizing of staff injuries. There's been a lot of damage to the milieu lately. Decrease in retention. It's not fun.

That's really terrible. I'm sorry that you're not getting adequate support. I strongly recommend that you make a report to OSHA. They will come in and investigate and make management think twice.