Nurses on the Front Lines: When Patients Attack

This article was republished with permission from SCRUBS Magazine.

All nurses have stories to tell about “problem” patients. Usually, these stories are funny rather than scary. There’s one patient who finds ridiculous things to complain about. Another wanders the halls singing show tunes.

But some patients pose a danger to themselves, other patients and the nurses charged with caring for them. Here, we look at some of these tales from brave nurses who have met the challenges posed by violent patients and answered the question “What is it like to be attacked by a patient?”

 

 

Which Patients Are Most Likely to Attack?

 

In our informal survey, the patients most frequently reported as violent were also among the most vulnerable. Almost all were suffering from dementia, psychosis, PTSD or traumatic brain injury.

Elderly dementia patients are especially likely to lash out. Nurse Kathleen David-Cote’s story is a common example of how quickly things can go wrong: “I had a dementia patient grab my name badge lanyard and try to strangle me with it. When I ducked my head out of the necklace, she took her fingernails and scratched my arm, making it bleed. Very frightening. Her eyes were so scary.”

Bonnie Holman Erwin says she has been attacked many times. “I worked in an Alzheimer’s unit in a geriatric facility…don’t ever believe that feeble old people aren’t strong! You definitely need to be alert, quick and, most important, understanding of their condition.”

Psychiatric instability can also make patients, even young children, act out aggressively. Sometimes, nurses endure many non-life-threatening acts of anger in a single shift. Nurse Kim Ostrander Crum gives this account of what it’s like for her: “I work in a children’s psychiatric facility. I’m attacked routinely—trash can thrown at my head, punched, kicked, bitten, spit on and (my particular favorite) breasts pinched. That was all in one day.”

PTSD is another condition that can make an otherwise peaceful patient suddenly dangerous. Gina VaVerka tells this story about a patient who was a veteran: “I am an army nurse and I was working on a telemetry unit in an army hospital in Texas. My patient started screaming in the middle of the night and thrashing around the bed. I went to see what was going on. As I leaned over the bed, he grabbed onto my stethoscope and scrub top and started choking me with it. My coworkers had to pry us apart. Turned out he was having a full-blown PTSD attack from the war in Iraq. It looked like he was wide awake and looking at me. Apparently he saw me as someone completely different.”

 

 

- How Should You Respond to an Attack?

 

If you are attacked by a patient, there are always legal repercussions to consider. Melissa Thomas Goodson makes this astute observation: “I work on an Alzheimer’s unit. Being attacked by a patient is not uncommon. It just takes teamwork and trusting your staff to keep an ear out for trouble. What bothers me most is that while being attacked, if you aren’t careful and the resident bruises himself while beating on you, you’d better be able to explain how he got that bruise or the facility will accuse you of abuse.”

That doesn’t mean you aren’t allowed to defend yourself. Jahna Dyer tells the most important lessons she learned after a life-threatening attack: “Always leave yourself an out, and never forget that you are human, too. The patient is important, but so is the nurse.”

Being trained and prepared to defend yourself appropriately is always a good idea. Nurse Betty Reckling recounts how she escaped a tight situation: “I recently had a patient trap me in a room and threaten to break my arm, on which he had a very firm grip. Fortunately, I had nonviolent defensive training in a former job and was able to use this to get out of his grip and get out of the room!”

 

 

- How Do Nurses Feel After an Attack?

 

Some nurses are rattled enough to seek out a different assignment after being attacked by a patient. Others find ways to shrug it off (but they never forget the experience). Laughter is sometimes the best coping mechanism in situations where no one was hurt. Nurse Angie Maxwell Pemberton tells her story about getting attacked as more humorous than frightening: “I had a little lady with dementia beat me over the head with her catheter that came apart…urine flying everywhere. Coworkers were laughing so hard and dodging urine to stop her.”

Whatever the outcome, sudden acts of violence do leave their mark. Nora Breuer points out that everyone who witnesses an attack is impacted: “As a psychiatric nurse, I have had it happen to me several times. It’s very frightening for everyone, including the other patients.”

One thing that most nurses have in common is compassion for their attacker. They understand that patients who assault nursing staff are usually acting out of fear and disorientation rather than any desire to cause harm. In fact, many of the patients mentioned above later apologized profusely when they were calmer and realized what they had done.

 

Do you have any “war stories” to tell from your life as a nurse? What’s your advice for dealing with dangerous situations? Let us know in the comments section.

 


This article was republished with permission from SCRUBS Magazine.

14 COMMENTS

  1. I work in a long term care facility as well as a dementia care unit. Dementia patients can be difficult to care for at times. You just have to remember they are not responsible for their actions. I had one dementia patient threaten me that her son had a gun and she was calling him because I was holding everyone hostage (in the lockdown unit). I know she knew what she said to me because I told her I would have to call security if she threatened me again. She ran off like the energizer bunny on roller blades! She stayed away from me the rest of the night. Another resident was singing “Benny and the Jets” by Elton John. It was quite entertaining and I thought it was humorous. So, there are some funny stories that make you laugh. You just have to remind yourself that they cannot control their behaviors.

  2. My mom has Parkinson’s and she has tried to throw a lamp and do much more harm. My mom lives at home and how do you prevent this from getting worse

  3. I was working in the dementia unit of my work last night when a female patient tried to attack the RN on duty i stood in front of the nurse and took the brunt of the attack, i was rammed by the wheelie walker punched kicked spat in the face and had the patient try and savagely bite me , we were stuck in the nurses station for about 30min being attacked before another care worker came in and we managed to get the patient in to a wheel chair so she could not fall over and hurt her self or us and as a result i was kicked in the face and neck, we finaly managed to get her back to her room while waiting for the ambulance to arive she finaly calmed down this lasted for an hour and a half. Even thou the patient is old the level of strength and agression they showed was shocking to me, you dont get trained for that kind of incident.

  4. AMEN to all those replies.
    I have had . A nursing license for 60yrs & am here to say that our employers need to protect the people who take care of the patients ..us the nursing staff!!
    ALICE,RN,CRNA(ret.)

  5. I find all responses amusing.
    17 years as psych RN and I’m still amazed at some of the responses programed into our RNs. Firstly, I have great compassion for the gero and actual psych patient. Problem being that much of my time dealing with violent patients are with the acting out borderline with drug addiction issues. Many of which act out for entertainment and frustration release from having limit setting applied on a locked unit.
    I’ve have been on inner city hospital psych units, private hospital acutr psych units, home care psych C.M. assignments. The common thread is when your attacked you better not count on DON, Medical Director or Corporate Compliance to be there for you if you have to defend yourself to exit the attack or others in your assistance.
    While each nursing chain and admin are somewhat unique, corporate office and medical director s rarely are. Without a hesitstion I can say from a side position (thank God) Nursing Boards never look to salvage respect , dignity, job status of the RN even as the victim from brutal attacks from patients. Usually the senario is the patient will beat the staff then complain about staff abuse. The beating gets put asside and the complaint is investigated by the chain mentioned above. If there is a mark on the patient and you are the one being investegated, depending on the number of cases similar over last 6 months you better look for another job. It’s to easy for the director, DON to solve the issue by letting you go and report as required to mental health board and joint commission as well as state board that they took action and covered themselves by removing you.
    Remember this the board is not there to promote any part of your position or role. They are only there to protect the public. Most of the time they justify there appointments and subsequently the employees at the boards role by dictating and managing consent agreements and administering fines to licensed health care in thier respective state.
    Regardless if you were attacked or pushed a dangerous aggressor patient or were seriously injured. If you caused counter injury to patient while trying to flee the situation, it will fall in your lap. There are no common sense failsafe laws that protect RNs from the constant roles in the corporate office to keep accreditation and the money rolling in. Even if charges occurr against patient o have seen a colleague unable to work untill the board investigated.
    Best way to handle agressive attacking patients is to become a Plummer.

    • Hopefully you meant PLUMBER as in a person that deals with plumbing and not a Plummer as in the Christopher Plummer and his family. BTW, plumbing is an awesome profession and they make a lot more money that nurses. Sure you have to deal with human waste, but you, as a psych nurse deal with wasted humans.

  6. While responding to a “Dr. White ” incident I luckily caught a glimpse of the patient with her walker held high over her head. Clearly ready to bash the first person over the head with said walker.

  7. Myself and another nurse worked several hours with a very unstable PACU patient. The surgeon was at the bedside and we coded her for about 15 minutes-unsuccessfully. A large family rushed the PACU doors and came into our PACU at the end of the code. The grandson got verbally abusive to us and the surgeon and threatened our lives. To go from working so hard to save a life and then to having our lives threatened was traumatic. I had a lot of anxiety when I left the hospital to go to the parking garage-fearing the grandson was going to come back and fulfil his threats. Violence towards healthcare can be more than a physical attack.

  8. I had a drunk 40 year old male in our OR holding area, with an open fracture that needed surgical intervention quickly; no time to let him sober up. His wife was in charge of signing consents. On our way back into the OR, he tried kicking me as I pulled the stretcher along with the anesthesiologist, who was pushing it from the head. The doc stopped right there in the hallway & got in the patient’s face with a vial of succinylcholine. He told the guy if he didn’t settle down, he’d give him the sux right then & there, while he was awake, & he wouldn’t like it very much. With eyes wide open the patient quieted right down.

  9. Hello. Thanks for the article as it has very good tips and advice. I would caution words like “front lines” and “war stories” as they contribute to a negative connotation of the relationship between nurses and their work with patients (particularly those with mental illness). We can still have interesting hook titles and headlines without those words.

    • Though I do appreciate the suggestion for utilization of more gentle or friendly verbiage, this topic warrants reality. When a nurse or other healthcare provider is assaulted and or battered by definition of the law, while at work performing their professional duties, there is not reason to down play or soften the incident.
      The long term damage incurred by the professional is most likely life altering to some degree. In short, regardless of the patient diagnosis or diagnoses, the actual physical pain, multifaceted psychological rigors of going through workers compensation during healing phase, the financial burden of missing work during recovery from patient assault, to name a few points is horrific!
      The ongoing pain and necessary medical treatment needed after workers comp. stops paying for treatment is burdensome and a constant reminder of the assault.
      This being said, this topic needs to be brought forward more frequently in nursing forums. Nurses and other healthcare professionals need to acknowledge just how quickly ones life can be altered and how to best protect themselves while continuing to serve those in need.

    • I feel like it is a war zone at times. And I think there needs to be an awareness about this violence against nurses. I was assaulted for the first time—2 shifts in a row! One of them I pressed charges against. Being someone’s punching bag isn’t part of the job. It feels like a war zone.

  10. Psychiatric disorders and dementia may be at the root of most incidences of healthcare workplace violence, but they’re certainly not the only causes, and this article tends to ignore the rest. Ask any ER nurse, and they’ll tell you about the patients and their families who see nurses as subservient and contemptible, and see no reason not to act out in violence. Legally, this is called assault, but far too many organizations discourage employees from pursuing criminal charges against those who beat up on their employees. And woe to the nurse who defends himself!

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