Would You Press Charges?

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I worked on the adolescent psych unit tonight and a 14 year old with a long history of violence and psychiatric problems punched me in the jaw. She was already in the midst of attacking another nurse and when I stepped in to help is when I was punched. Went to the ER, nothing's broken, but my jaw is so sore! Also when she made contact, the force threw my head back and I pulled a neck muscle.

Would you press charges against this patient? She is already due for a court date for a similar charge.

Hi Meerkat

In my facillity (adult forensic), if a staff member is assulted and charges are pressed, the staff member will be moved to another unit while that patient is still on the unit.

For example, one of our techs was punched a couple of months ago and needed surgery. He is back to work but, cannot work on my unit since the patient who hit him is still here. The DA sometimes will press for more jail time but often the fact that the patient is "mentally ill" means it will not go very far.

So, for me, the question is would you be assigned to a different (worse) unit while the legal system and the facillity work this out??? Should charges be pressed?? YES... Will it make things better or worse for you??? Will it make ANY difference to the patient's outcome???? Tough call

Psych is a tough field. I honestly don't know what I would do in your shoes. On my unit I wouldn't press charges because I don't want to be moved to another area of the hospital.

Good Luck to you

Lori

Actually, the patient was moved to the acute setting, lock down.

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Jail time for 14 yr old? Okay, you said end of story and I respect your opinion. ;)

We have juvenile detention for a reason. I don't think 14 year olds should get free rein to assault people.

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Specializes in Telemetry, OR, ICU.
We have juvenile detention for a reason. I don't think 14 year olds should get free rein to assault people.

I agree, I'm glad to read from one of Meerkat's recent post that this 14 yr old was moved to the acute setting, lock down. In fact, I posted earlier I thought the patient belonged in a lock down Unit. So, I hope you were not implying I want this patient to have free reign to assault staff & other patients? I do agree with you that Juvenile Detention serves a very viable purpose, yet it is not the same as jail time.

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Specializes in Telemetry, OR, ICU.
...BTW, how long have you worked as Psych RN, anyway?

- - -

A little under a year

Do you like psych nursing? I realize it it is highly specialized and certainly takes an extreme amount of patience dealing with such volatile patients.

Are you going to press charges? Did you ever discuss at length with your supervisor why they decided not to press charges? You supervisor might give you some insight that would be helpful to you since they have probably been doing psych nursing a great deal longer than you.

I must say this has been a very interesting Thread.

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Meerkat, you owe it to yourself, the patient, and others who will encounter this patient in the future to prosecute. You asked for opinions, this is mine. Was your supervisor injured during this incident? If not that may influence the supervisor's decision as to legal action. But you had injury, and in my experience you will wish you had prosecuted.

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Specializes in pure and simple psych.

Meerkat, the issue of assaults on nursing staff has always been an area of concern. Have been in psych since 1963, and have watched the evolution of psychiatric responses to assaultive behavior in various settings: adult, child. adolescent, gero, in-patient, outpt., Day Tx, Partial Hosp, etc. 40+ years ago, staff used physical restraints, locked seclusion, even IM meds as retribution. Of course, it was always described as treatment for violence, but eventually, we figured out that we were perpetuating the interpersonal violence, demonstrating that "might makes right."

We then moved into a paternalistic, patronizing mode of "poor thing, she just can't help herself." Following an assault, we would "process" the incident with the assultive person, (ignoring the victim, BTW) and try to get verbal agreement that the behavior was an innappropriate way of communicating, and the next time, "we" would try to use our words.

As observation revealed neither one of these approaches seemed as effective as we would wish, we began to : set clear limits BEFORE an event, set a clear and fair response, and finally, follow through with the consequences. When a VA hospital instituted a violence free expectation, informing patients on admission that any acts of violence would be prosecuted, any property damage would be billed to the patient, assaults and purposeful destruction diminished from 98 the year prior, to 21 the first year after institution. One patient made a telling comment when informed of the policy. He said, "Oh, treating us like responsible people, huh?"

In interviews, patients can remember events from years back, and define the reason that they assaulted. Rarely does it come from a purely psychotic thought, ie: He is stealing my thoughts, but rather in response to staff attempts to "set limits" as the phrase goes. That means that the patient got a message that they did not want, and exploded in anger. That is not psychosis, it is poor impulse control. If this behavior were to happen anywhere else, it would constitute a crime. Psych units should not be seen as a legal duty free zone.

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I agree, I'm glad to read from one of Meerkat's recent post that this 14 yr old was moved to the acute setting, lock down. In fact, I posted earlier I thought the patient belonged in a lock down Unit. So, I hope you were not implying I want this patient to have free reign to assault staff & other patients? I do agree with you that Juvenile Detention serves a very viable purpose, yet it is not the same as jail time.

I didn't mean we should send her to Folsom or anything.:lol2: I just don't think poor impulse control is an excuse in anyway for her behavior. She should get the same treatment as anyone would doing this in any other place.

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Specializes in Telemetry, OR, ICU.
I didn't mean we should send her to Folsom or anything.:lol2: I just don't think poor impulse control is an excuse in anyway for her behavior. She should get the same treatment as anyone would doing this in any other place.

Well, sounds like this patients lack of impulse control needs to be addressed via a psych tx facility... lockdown unit. I'm not sure what you mean by the same tx as anyone would doing this in any other place? If you mean in any other psych tx facility, then I certainly agree.

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No, I mean unless someone has been diagnosed with a condition that impacts their ability to be held criminally responsible for their actions, they should be held responsible for their actions.

You can be a psych patient who is just a jerk. Simply being admitted to a psych unit doesn't mean that your violent behavior is excusable or relates to some sort of disorder. If you're angry and lack impulse control, etc. and hit a cop I doubt you'd have more than 20 seconds before the handcuffs would be on. That's because none of those conditions excuse assault. In fact, I'd argue that anyone who assaults another person is lacking in impulse control and has some anger. Where they do it isn't the issue.

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Specializes in Emergency & Trauma/Adult ICU.
Meerkat, the issue of assaults on nursing staff has always been an area of concern. Have been in psych since 1963, and have watched the evolution of psychiatric responses to assaultive behavior in various settings: adult, child. adolescent, gero, in-patient, outpt., Day Tx, Partial Hosp, etc. 40+ years ago, staff used physical restraints, locked seclusion, even IM meds as retribution. Of course, it was always described as treatment for violence, but eventually, we figured out that we were perpetuating the interpersonal violence, demonstrating that "might makes right."

We then moved into a paternalistic, patronizing mode of "poor thing, she just can't help herself." Following an assault, we would "process" the incident with the assultive person, (ignoring the victim, BTW) and try to get verbal agreement that the behavior was an innappropriate way of communicating, and the next time, "we" would try to use our words.

As observation revealed neither one of these approaches seemed as effective as we would wish, we began to : set clear limits BEFORE an event, set a clear and fair response, and finally, follow through with the consequences. When a VA hospital instituted a violence free expectation, informing patients on admission that any acts of violence would be prosecuted, any property damage would be billed to the patient, assaults and purposeful destruction diminished from 98 the year prior, to 21 the first year after institution. One patient made a telling comment when informed of the policy. He said, "Oh, treating us like responsible people, huh?"

In interviews, patients can remember events from years back, and define the reason that they assaulted. Rarely does it come from a purely psychotic thought, ie: He is stealing my thoughts, but rather in response to staff attempts to "set limits" as the phrase goes. That means that the patient got a message that they did not want, and exploded in anger. That is not psychosis, it is poor impulse control. If this behavior were to happen anywhere else, it would constitute a crime. Psych units should not be seen as a legal duty free zone.

An excellent post from sanctuary.

I would press charges. Imposing appropriate limits on this pt.'s behavior may be the most important part of her therapeutic treatment.

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