Biting the Hand that Heals: Patient Violence on Nurses Gets Worse

Photo: Brano Hudak

Occupational violence is not a new concern here in the nursing world but it is getting worse. The dept. of labors 2011 report states that being a nurse in the ER or in the mental health unit or community is ranked top highest job for violence. A nurse in the ER, nationally, is at a higher risk of being injured than a coal miner and a police officer. The Emergency nurses association did a report on occupational violence in 2010 that polled over 13,000 ER nurses and the statistics of that study are astounding.

A middle aged man is brought to the ER by the local PD after they were dispatched to the street that he lives on for “a man walking up and down street aggressively, yelling and screaming at things that aren’t there.” The man is cuffed and wide eyed, sweating with spittle on his chin. His cloths are filthy and he has multiple sores on his exposed arms. He is looking at things and muttering. He does not know his name or wear he is. He is fighting the officers and they physically have to drag him to a room. He has to be strapped to the bed for safety of the staff after he spits in the nurses face and tries to lunge at her while she is assessing him. This is a man on bath salts. (This is a case I am familiar with.)

A newly 20 something young man is brought to the ED by the police in cuffs after he took a few swings at his mother while intoxicated and angry. He made some suicidal statements so the holding tank becomes the ER. The patient is uncooperative and spitting at the officers and the nurse. He is sneering and making vulgar sexual comments to the nurse. His raised voice echo’s down the hall as he swears and threatens the nurse. Another all too often occurrence in the ER. (A case I am familiar with).

A male family member of a young woman gets very angry that they are waiting over an hour for the doctor. (Actual time 25 min) He begins slamming the door repeatedly and yelling threats down the hall. Security is called and the nurse asks him to please calm down, the doctor is with another patient and he will be down in just a few minutes. He then tells the nurse to go **** herself and slams the door again. Security asks him to wait in the waiting area to which he refuses. Police are called for staff safety. (A case I am familiar with).

A 20 something male patient is in the ER requesting narcotics for back pain. The patient does not receive any narcotics after the doc does his assessment, x-rays and lab work. The patient throws the discharge paperwork in the nurse’s face after calling her a name that makes my skin crawl and then he proceeds to push the nurse into the wall before leaving. (A case that I am familiar with).

As I write about these instances I can feel my heart is racing. Every day in our ER we nurses and techs are met with at least one patient every few hours that is angry at something or is on something that causes them to be dangerous. Our ER is just like every other ER across the country. Patients are getting angrier and their behavior is escalating quicker to violence against us and our staff. This behavior is NOT what we signed up for and it is NOT a part of the job. Why do you think that many nurses and many nursing administrators feel that “it’s just a part of the job?” I am lucky to work at a place that puts nurse safety above all else and that does not penalize us for reporting the violence~ and our local PD are very protective of us as well. That is not so for many nurses across the country. How has the violence changed in your work area? How do you stay safe?
A few press releases recently on nurses being targets of violence.

http://www.ena.org/media/PressReleases/Pages/workplaceviolence.aspx
http://www.wpix.com/news/wpix-bronx-hospital-emergency-room-shooting,0,5266436.story
http://vitals.msnbc.msn.com/_news/2011/11/08/8705246-swearing-spitting-choking-er-nurses-endure-this-and-more

• Christine Murphy, RN

  I don’t know why violence is “an expected part of the job”.  I worked in a psychiatric unit for 11 years, and although I was routinely threatened, I was never physically injured.  However, those that were, also were told that this is just to be expected on a psychiatric unit, and could not persue any compensation.

  • Bobbi Mccarthy

    Christine~  that is just NOT right.  Our hospital administration has come on board with the notion that harming a nurse/tech/doc etc is assault and they are ok with us pressing charges if we want to…our ER staff has pressed charged a couple of times but usually it just gets swepped along… I like to say “if I was a bank teller and the customer began yelling, swearing or threatening me the police would haul them away! so why is it ok in the medical world?”

• Glenda Gschnell

  Hmmm!  I remember when I first began nursing (30+ years ago) a doctor shoved a nurse up against a wall.  Nothing happened.  She was too scared to do anything because she might be fired. The doctor suffered no punishment and it was never reported to the police.  I never had a problem–I think he knew better than to pull that with me.  Those assaults don’t happen today; at least I hope they don’t.

  • Bobbi Mccarthy

    Glenda,  how awful for that nurse…what an Ass!!!  of course nothing happened to that doctor.. Sadly this still happens~  A friend of mine is an RN in the NICU and she went up against an older doc who actually grabbed her arm and twisted it…she went over his head and placed a grievance and then the whole floor turned against her… it was bad!  The old boys club still functions in some institutions… I do feel its better though.  We still have work to do as nurses to take care of ourselves and each other! 

• katb

  When I was a student nurse, our instructor told us about a nurse in a Winnepeg, Manitoba ER, who was assaulted by a drunk patient.  Her jaw was broken and cervical spine dislocated.  She pressed charges and the hospital promptly fired her.  We were instructed to discuss our feelings about this.  I was outraged at the treatment of this nurse.  If the drunk had hit a police officer (who is armed and trained to deal with violence) charges would be laid and no one would expect otherwise!  Imagine my surprise when the great majority of my class did not feel as I did.  They felt that as caregivers we had to take whatever the patient did to us!  I have often wondered how their opinions changed once they were in the real world.  Just because someone is a patient does not give them the right to abuse the medical staff.  Everyone deserves to be treated with dignity and respect, and that includes the nurses who are caring for you! 

  • Bobbi Mccarthy

    Katb~ I hope that the nurse in Manitoba recovered fully~~  I certainly can imagine your surprise…sadly!!  I too wonder what that group of nurses now think..esp. if they work in the high risk areas!   Hopefully you work in a safe place or at least work in a place that protects you allows you to press charges against a patient if they assault you.

    • katb

      As far as we were told the RN never did get her job back.  I am not sure if she ever recovered fully.  And yes, I have never encountered a situation where I was expected to accept violence as part of my job.  I have not spent much time in the ER where I hear it is more dangerous, though.  Thanks for your concern Bobbi!