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When a Nurse Hits a Patient: A True Story

<ѻý class="mpt-content-deck">— Assault or self-defense?
MedpageToday

A nurse says she hit a violent patient. Was she defending herself or is this an example of assault?

ZDoggMD examines the instance and a healthcare system where workers are left to fend for themselves.

Read the transcript below:

What's happening Z-pack? It's your boy, ZDoggMD, or Z Dog, as they call me in Canada, the UK, and the rest of the civilized world. Today, I'm doing a show for the whole page, not just supporters. If you are a supporter, use your inside voice, not the voice we use on the supporter page where the f-bombs go flying and career-ending statements are made.

Today, I want to talk about something that one of the fans sent me. It's a Reddit post by a female nurse in Pennsylvania who posted it on the r/legaladvice Reddit. Hi, Cynthia! Waddup, Supporter Cynthia? It is entitled "I hit one of my patients tonight." I think this is an important story that we should all listen to because it gets to the heart of the #SilentNoMore, the whole idea that frontline health care workers are being assaulted... thank you for the stars, Sarah. That's a nice tip. They are being assaulted with very little support, usually often a management statement of, "This is what you signed up for. This is what you're paid for to take this kind of abuse." Then when something goes wrong, we're kind of left to fend for ourselves. But what can we do? What are some ins and outs of this? Let's read this story.

I'm going to read her words. "Tonight, I assaulted a patient of mine. I'm an RN in Pennsylvania." Now, first of all, she shouldn't have said that because that's not really what this is in my opinion, but take a look. "I had to do care for a known..." But think why she might say that. She's a nurse. Nurses care about people. They're taking care of patients. If something like this happens, she's going to feel terrible. All right, let's read this.

"I had to do care for a known violent patient who had attacked several nurses in the past. I had to draw his blood and change him because he was covered in urine. I brought a male nurse in with me. While drawing his blood, the male nurse was holding him down and he was still punching and kicking and threatening us. I told the male nurse -- my superior, by the way -- that we needed to stop or get more help, but he refused and said we had to get him changed." Okay. Here we are.

"Now, we finally got the blood and we're trying to take his clothes off, and get a clean brief and gown on him. Then, he grabbed my arms so hard he left bruises and started kicking me, and threatening to piss on my face." Some people pay for that, but not in health care when you're being attacked.

"I panicked. I don't know what else to say but, I hit him in the nuts because it was the closest part to me. He let me go and we finished changing him." Wow! I mean, already it's like holy shit! Right? "In my defense, I say it was self-defense and the male nurse with me said it was okay afterwards. He suggested I 'take a walk and have a cigarette.'" That's highly, highly appropriate in health care. You're not even a respiratory therapist. We all know only the respiratory therapist goes out and has cigarettes.

"Then, when I was outside, he called the supervisor who then called our Director of Nursing." Oh, my god. "As soon as I got back inside, I was told I had to leave and was escorted from the building. I was told that what I did was unacceptable and there would be a hearing with HR." Oh, vader has been in those hearings. I'll tell you that much.

"Can they seek legal actions against me? I don't even care at this point if they fire me. I just don't want to lose my license. If I lose my nursing license, I'm $50,000 in debt with student loans and have no way to provide for my family. I don't know what I should do next."

Now, she put an update on here, but first I want to stop and talk to you guys about this. How many people might have been in a similar situation where they are being attacked by a patient and their instinct is to defend themselves? How do we teach women to defend themselves when men attack them? You punch square in the nuts, right? This person did what they are conditioned and instinctually driven to do, which is defend themselves.

Now, here's how I see this situation. This female nurse was placed in a position of risk by a male superior. She complained, asked for more help and was denied. When the patient grabbed her and started kicking and punching, she did what most people ought to instinctively do and that's defend themselves. Is that correct in this setting? We can argue about that because we have a vulnerable patient who's not in their right mind. It turns out later it was clear in her comments that this is not a patient who's doing this volitionally, but is demented or what-have-you.

As this event happened, the male superior then of course reports as it's probably appropriate to report these events, right? The next thing you know she's in trouble. She's escorted off the property and is now terrified that all her hard work, loans, and everything are at risk because if she loses her nursing license she can't practice. This is pretty terrifying.

Now, Cecilia Armstrong pretty much nailed it. "Get a lawyer from nursing insurance." I don't know how nursing insurance works, but get a lawyer is probably the first thing you should do. She went to our Reddit legal advice. You need real legal advice. On top of that, you need to talk to risk management at the hospital. On top of that, you need to document everything that happened as soon as it happens, ideally in the chart. If you can't do it in the chart, keep your own notes and documentation with names and everything.

Look, Aaron Dunn says it. Would someone be held to the same standard in a different profession? No. If you were a postal worker and someone hit you and you punch them in the nuts, you'd be held up as a hero of self-defense. Right? Now, again, the people who are hitting you aren't necessarily demented patients in a hospital. There are known problems.

Here's my take. It's not about having self-defense. It should never have gotten to that point. There should have been enough staffing, resources, and support from the management and superior nurse in that case to prevent this from having happened or to have enough staff to restrain the patient so that no nut punching has to occur. Am I right? There should never have been a situation where that was conducive to this happening. That's the problem.

Now, let's be honest. Our hospitals are now full of the most acute, sick, combative patients. The acuity level in hospitals have gone through the roof because now we're managing so much stuff as an outpatient. In general, nursing acuity has gone sky-high in inpatient facilities. As a result, we're putting everybody in a crucible, asking them to do more and more with less and less. Right?

We did this show the other day about using a telehealth solution to try to offload some of that, but that alone isn't an answer. You need appropriate staffing. You need appropriate training of the staff. You need to appropriate security. You need appropriate guidelines, training, resources, tools, and autonomy so people can keep themselves safe in healthcare scenarios. You need a zero-tolerance policy and criminal litigation when a patient in their right mind -- or a patient's family -- attacks health care staff. We've talked about this again and again and again. You should not have to punch a patient in the nuts. But if you do, what happens? Let's read on.

Here's her update. "HR called me with the D.O.N. and the lady who hired me, who is a legal nurse now. They said they're definitely not pressing charges as far as police go and that will not be an issue." Thank god! You're not going to jail. Jesus.

"They also said that their lawyer told them that this may not even be a board-reportable offense. The HR lady said she honestly didn't think it was reportable, but she was still waiting to hear back from corporate's risk management team and that they will let me know more tomorrow. I told them I was assaulted and reacted out of reflex and self-preservation. They said that the patient's wife was sympathetic and sorry that he hurt me." That tells me something about the general behavior of the patient. It doesn't excuse hitting a patient, but there's a self-defense argument here. Right?

Let's see. "I told them I had multiple photographs of the bruising on my arm and that I showed my arm immediately after to the other staff. That seemed to make them hesitate a bit. They said they will contact me again tomorrow to let me know where they were and until then I'm suspended without pay. They said this is something that they've never had to deal with before and wanted to make sure they took the correct steps." Oh, I bet others have had to deal with it and I wonder even if they've had to deal with it before.

"At this point, I hope they just fire me and leave the boards out of things. I can find another job farther away from confused and violent people. Maybe a nice doctor's office job or maybe a change to teller nursing. I definitely do not ever want to have to see or work with that male nurse again."

Now, we have a situation where this nurse is traumatized where she's now afraid to do bedside stuff where she's clearly frustrated, scared, and doesn't know what to do. How was this all set up? Probably by the superior in the room who did not listen to the concerns of this nurse. She's asking for more help, he's saying no. When something goes wrong, instead of taking responsibility, this is what happens.

Now, yes, this has to go through risk management. I'm very happy that the patient's wife was notified and they didn't try to cover this up because that would have been a disaster, unethical, and immoral. It's good that family was brought in. Hopefully, an apology was given because that's appropriate. Again, this is a really illustrative case.

Now, here's another thing. I'm not sure I would have gone to Reddit with this because they can figure out what's going on. You have to be really careful. My advice if this happens to you is #1, make sure you get good legal counsel using whatever insurance, talk to risk management, communicate and document everything. The second thing is try not to hit a patient. Probably not a good thing. I know she didn't intend to do this. I know she's acting in self-defense. Unless you really feel like your life's in danger, in which case... I can't say this, but I would say, "You need to do what you need to do to keep yourself safe." You've got kids. You've got responsibilities. You've got a life to protect.

Many, many, many people in health care give up their own personal needs to take care of others and they should not. You have to take care of yourself. I've said this before when I talked about the obesity crisis in nursing. Now, there's a suicide crisis in nursing, which we're going to talk about on another show. There are recent articles that have come out about this. If we don't take care of ourselves, we cannot take care of others.

Let's read some comments. "The administration is responsible for mitigating things, yes, but they're also responsible for supporting their staff" - Aaron Dunn. Exactly. Now, let me pull up your comments on the iPad so I can see them better because this little phone is a little difficult. Meanwhile, I'll read that. "It's so unfair. I'm sorry she's having to go through this" -Laurie Luralt, who's a supporter. By the way, if you're not a supporter, you suck. All the best conversations we have are on the supporter page. It's $4.99 a month, dude. It's not that hard and it clears out all the riffraff. There's no anti-vaxxers. There's no garbage and we can talk hella smack. Usually I'm going live there because the main page can get to be a zoo with the anti-vaxxers and the crazy people that show up, and the buttholes.

"A recent case in Australia, a guy high on God knows what, proper assaults of paramedic. 18 months community service. Fuck that to the moon!" - Melinda Canal. I'm with you on all of that. "I will never allow myself to be trapped and beaten by a demented patient again. It ruined my life. I'm still working and I will stand up and defend myself and others in this situation" -Suzan Tillotson. It's hard to argue with you Suzan, but you should have never been put in a position like that in the first place. It's very hard to with patients that aren't in the right mind. With psychiatric patients, we need better resources, better training, and better support. But the patient's themselves are going to do crazy shit because that's part of the disease process. It doesn't mean you condone it, but it means that we have to have some compassion. These people are also like not in their right mind. It can be a unique form of suffering for them to be in a position where they feel like they have to attack. Right? Why is that going on? Again, I'm not trying to lessen anybody's suffering in this. I'm saying the patient is suffering.

Thank you for the stars, Monica Thompson. For those who don't know, you can send these little stars. It's a way to support the show. I deeply appreciate it. Sandra Bradfield, who sent stars, says, "It's a big concern on our psych unit. Thankfully, we have staff who do their best to avoid confrontation." There's de-escalation, awareness, and ways to deal with that. They're not perfect, but we at least have to provide our staff with that.

My wife recently had to go through that training at the VA because she's credentialed at the VA, even as a radiologist, and said the de-escalation training was actually very useful that they had. Thanks for the stars, Britney Stone.

Let's see. Eric Kincaid-Sharp says, "That's why I always carry a light saber. No one is going to mess with me." I'm with you on that and so is Lord Vader.

"We don't get paid enough for what we deal with" - Jodi Wilson. That I agree with. No one gets paid enough to deal with that shit.

"I have PTSD and I've been through a lot of therapy to get me back to work after some close calls as a sitter in the past" - Nancy Cardoza. It can be scary and the long-lasting trauma from that can be real.

Listen, I think what I want you guys to do -- if you can't become a supporter and support the show that way -- is I want you to share this video with anyone you can. What it does is it's going to raise awareness because here's the thing. I get a lot of messages, "Hey, Z! What can I do? This happened to me at work. I feel like I have no voice." Get your homies, your colleagues, to stand with you and speak with one voice. When one individual in a hierarchical organization, where it's a top-down power structure, speaks up they get beaten down. When everybody speaks up, the people above have no choice but to listen. One way to speak up has to do the simple act of sharing a video like this and saying I agree with what he's saying. We should all stand together and say we need better tools, resources, and autonomy to deal with this. We need to deal with violence against healthcare providers in an effective, aggressive, and supportive way. We haven't done that so far because we're all struggling. Right?

That being said, thanks to all my supporters. Thanks to people who sent stars and we out. Peace!

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