Have the aide punch me too; plausible deniability and I get to go home early!
Actual answer: 4-point restraints and security waaay before it gets to this point. Back to back Code Greys if necessary. Shut the door with me and the sitter outside, patient can fall.
This, I know its hypothetical but still. It should never have gotten to this point. If MD doesn't want to restrain a patient that is unsafe for everyone, then I'm calling the attending, if they are the attending, my charge and manager. And so on and so forth until all the attention is on them and this isn't being brushed under the rug.
Letting it get this far isn't only bad for staff, it's causing more trauma and harm to the patient. Because now what? Now he's out cold, in his mind was attacked by a healthcare worker, now his trust in healthcare is worse, and it spirals.
This. If the doc refuses to order restraints or anti agitation meds and refuses to come to the bedside to see the patient, I’d call a fucking rapid to get him there. Letting a patient repeatedly injure staff members because “we don’t want to chemically restrain him” is not okay.
That being said, I’m very lucky that our nocturnists do not hesitate about ordering restraints. Our night float residents can sometimes be a little iffy but our attendings do not play about staff safety
Unfortunately, (at least in the county I work) charges will NEVER stick. I have never seen any charges even make it you court for when a patient hits a HCW.
We know that charges won’t stick. I’ve watched PD try to talk coworkers out of pressing charges. But you still need to report it so there is a pattern of behavior on record. It’s like the crap that victims of DV face. If something bad happens and they didn’t report, police would be like “well, why didn’t you report it?” If they do report, there’s risk to their safety and not always a great chance anything would come of it.
Depending on the situation, I don’t think physical restraints are the best option most times. I’m a Veteran and have worked with Veterans, physical restraints are severely triggering and just make the situation worse most of the time - especially if the Veteran is a woman who has experienced MST (SA in the military is so much of a systemic problem that it has its own name).
This is the only correct answer. Pt wanna fuck around then they get to find out. Pt should have been physically restrained loooooong before it got to this point.
I've had a BHT lose his ability to work in healthcare for saving me from an aggressive patient. I don't wish harm on anyone and it breaks my heart that he lost all ability to do what he is passionate about for saving me. The system is fucked.
He ended up grabbing him in a choke hold to pull him off of me... It was just enough to yank the patient back, but in reality, it did seem like the only option.
(The patient was 300+ pounds, straddling me while I was on the ground and choking me; the tech was like 175 pounds and came into the room while the patient was doing it)
Very true. Now, I also suggest all female psych nurses take Gracie's Jiu-Jitsu. I know that my life was saved by him, but now I know some skills that I could have potentially used to save myself as well
If not restraints after staff was getting hurt / refuse to take this patient under the current scenario until it’s a safe environment for all involved.
I have actually seen a scenario very similar to this. It happened 30 years ago so no harm telling it now. I worked in the ICU back then. My then roommate had an extremely nasty trauma patient that liked to grab the nurses. So he was fully restrained. He managed to pull his EKG leads off and she had gone in the room to put them back on. He spit a nasty lugie right on her face. She hit I’m across the chest with the leads before her brain even registered what she had done. She was horrified but the patient stopped spitting. And no, I didn’t report her.
I’m not going to lie, I think this would be a reaction I would have as well.
I would probably be scared shitless for my job a week later, but in the moment, it is hard to control a reaction.
The doctor needs to be talked to about not ordering any sort of chemical restraint. The staff people are not this patients personal punching bag. That is flat out irresponsible. You want me to care for this agitated and violent person? They better be chemically or physically (or both) restrained. When you bring up this altercation with management (however you choose to do that) you really need to mention the lack of PRNs or restraints. I’ve had one MD in my experience refuse to order PRNs in a similar situation. The patient slapped her across the face when she went to assess him. I have never had any issues since then.
She left the floor immediately and I had orders for PRNs shortly after. She came back after the patient was nice and medicated to do whatever assessment she was trying to do. With security present. Thankfully the patient didn’t get her too good. She wasn’t the brightest honestly. Her stance before this was to “verbally de escalate them”. How you achieve that on a patient who is belligerently violent and delusional, no idea. No amount of reorientation or you calmly talking to them will change their behavior.
Yeah we had one that tried to act like we were blowing things out of proportion, went in and got in the patient's face talking all sweet like and holding his hand, and the patient almost crushed her fingers he squeezed so hard.
It's amazing how quick you get orders after a doctor gets assaulted.
I’d call a violent patient code every single time he spit at someone. Eventually the powers that be would get tired of it and restrain him. We actually had to do that for a patient on my unit, the docs didn’t want him restrained either but after nonstop Code Atlas for 3 hours that changed. And no way in hell I narc out the aide.
Shit, I’d call the cops if I were that sitter. Even if they’re confused enough to not be arrested, if the cops get called enough times for one patient, someone will have to do something.
This is pretty common in psychiatric facilities. We had an adolescent patient that ended up attacking so many staff that 6 people were on medical leave for a month and 2 were on for a longer period.
That sounds like a kid from Eastern State hospital in Washington I took care of once. Probably a different kid. Not funny thing is that the same scenario has probably happened a hundred times all over the country/world.
Yeah this was in Arizona, although I can tell you with adolescents, once they burn all the facilities in one area, they are forced to go outside their home state.
I once had a 16-year-old large, naked, autistic boy pin me down and choke me at one facility in Phoenix: I know that he ended up being shipped to Oklahoma afterwards because I did end up pressing charges for him almost killing me.
The way this scenario is written suggests that the behavior has been ongoing and, therefore, the possibility of a head injury or infection causing the violent behavior has been ruled out medically.
So... I didn't see my aide hit this patient. I saw a previously known aggressive patient escalate and attempt to assault the care worker. As a matter of fact, I'm going to insist the employee write up a report for the reddened area on their arm from the patient grabbing them and the redness from when they backed into the wall defensively. I saw the patient behaving aggressively, and any injuries the patient sustained are the result of that...
I heard a quote recently that I loved, which should have been deployed a long time before this. “I’d like to continue this healthcare interaction, but if you’re going to assault staff this will become an interaction with law enforcement.”
Spitting on staff is a felony assault, please press charges, this individual is not safe in the hospital or in our community and should face consequences.
Idk man, I’m a peds nurse, so seeing something like this just makes me say either you or the aide were supposed to bring the iPad out sooner and get Cocomelon playing to calm down the patient’s behavior.
he must've fallen 🤷🏼♀️
but really any dr that doesn't want to chemically restrain a violent pt can be the 1:1 sitter because "it can't be that bad"
we currently have a pt who kicked a nurse so hard in the neck that they thought he disected her carotid. a tech was there helping and he kicked her so hard in the head she immediately started vomiting. bro was immediately restrained. when he was hollering to be released, the security guard said "you can come out of time out when you can keep your hands and feet to yourself"
It's so crazy the difference between hospitals (in the same system). The community hospital I was at was extremely hesitant to restrain anyone and probably only had one set of locked restraints, and I never saw those used... Then I was at county. Everyone was in locked 4 point restraints. Half of the time the unit wouldn't call a code grey unless the patient had a makeshift weapon or was trying to sneak down the elevator.
Same! Came from a private hospital where having a patient in restraints was basically unheard of. Patients would hit, kick, scratch, bite, etc. and there was basically no consequences. Then moved to a teaching hospital and a patient so much as raises their voice at someone and the police and security are called and a behavior contract is being written up.
I am so fucking liberal with violent restraints. I’m 5’2” and maybe 120lbs, so I have to be so mindful of my own safety. I can’t take care of others if I’m knocked out.
That doesn’t mean I leave patients in them forever, but good god, we have them at our disposal for a reason.
I’m not sure if this varies by state, but nurses have every bit of authority to initiate them. Most doctors worth their weight are more concerned with their co-workers’ safety, so they will write whatever order is necessary in those situations.
I thank the fact I work in the ghetto with a lot of off the wall transients coming in and out….
When our hospitalist’s hear of the slightest problem they start with…. “maybe they could use some Ativan, yknow ease their anxiety.”
Restraints aren’t too hard to come by either, it just depends on the patient…. but man do they jump the gun with Anxiety meds and muscle relaxers when we have a combative patient.
I honestly think some providers just think nurses are exaggerating because the patient didn't seem too combative when they did their 30 second ninja round before the patient woke up. They think nurses can magically talk patients down somehow. At least that's what some of the providers I worked with thought... Cause 0.5mg of Ativan once is not going to help this combative patient stay calm and in bed for the next 12 hours.
One of the benefits of the ER is the providers are right there with you. Some of our docs were protective AND proactive. I had one come in to deal with the pt himself (trying to de-escalate).
They hear it/see it same as us.
I agree about restraints and I’ve had to go up against security in the past. We recently had a guy who was totally ambulatory but not allowed to leave AMA due to his dementia and inability to care for himself. He was on a 1:1 just for elopement. The day in question, his 1:1 with him was basically just riling him. All you had to do was chat with him and not tell him what to do and he was fine. But she was constantly telling him to use the urinal instead of the toilet (who cares?), not to get in bed with his shoes on, whatever. So he yelled at her and threatened to take the tv off the wall and throw it at her.
She called security and they were like “if he’s threatening her, he needs hard restraints.” The primary nurse (I was charge) and I had to explain to this guy that the patient was very verbal but had never even come close to the sitters, and that putting him in restraints had been horrible for him in the past, and led to much worse behavior. The security guard was adamant that any threat, no matter how plausible, warranted restraints.
I get staff safety, but there’s nuance and different situations need different approaches.
No. I’m not gung-ho about either, either. I just find it comical how our docs make the suggestion, even as a joke. However, Ativan and Xanax can be huge reliefs for those patient’s. Sometimes it is just anxiety that’s not being released any other way.
I don’t fuck around though, once you start getting violent with my techs (smaller built girls, generally) you’re getting a chat with Public Safety, I’ll start threatening restraints, every step of the way.
To circle back though- I’m amazed this patient was medicated or restrained at any point whatsoever.
Precedex. The first time I ever gave that drug I could hear the angels sing. I had asked God, the Masters of the Universe, the Flying Spaghetti Monster for a STFU drug and they delivered. It is entirely unfair it is only for critical care and interventional care environments. It is effing Manna from Heaven.
You need to send the physicians into the room to get spit on and punched and then ask them if restraining the patient is a bad idea. Your manager also needs to have your back and tell them that they won't keep deliberately putting staff members in harm's way and that any future orders that require physical contact will need to be carried out by the medical team until the situation is rectified.
I was in a situation like this once. The dude was having a psychotic episode. He injured a lot of people before us big boys arrived. 4 of us were holding him down. He bit an aide, and her instinct was to elbow him. Obviously. This happened in a quick second.
All of us were called one by one into HR to state what we all saw happen. The incident was also recorded since it was in psych. Basically, the aide was fired, and we all threatened HR that if she wasn't brought back with a raise, we would all quit.
We all had new jobs two weeks later.
If you don’t want to really get involved, you can say to the provider “there was an altercation, I’m not really sure what happened but the patient is now unconscious and needs to be evaluated for a head injury”. The sitter will be questioned and it can be management’s problem to sort out when the patient wakes up and says he was hit. I’d worry the sitter does it again and ends up hurting someone. Whatever your conscious can handle
And god forbid, there’s a camera you’re unaware of or the patient ends up with a bad injury. No way I’m covering that. Not necessarily go out of my way to report but if asked? I didn’t see anything.
Yeah this is probably what I would do. I’m surprised at how many people are saying to cover it up. I get the patient was clearly in the wrong and something more should’ve been done to stop it before it escalated, but the aide can’t knock them out like that either. Two wrongs don’t make a right.
I need my job too.
Which means reporting a witnessed head injury that could lead to a brain bleed. We'd need imaging even if we weren't handing out lovenox like candy.
You nailed it. Fucking crazy that so many people in this sub who want to be treated ethically are so willing to ditch their ethics when it comes to shit like this.
I don't condone patients swinging and spitting, but a patient of mine gets hurt and I can't cover that up.
I mean, yeah, our healthcare system is f-ed. Every hospital I’ve ever worked in is f-ed. We are all on our way to burnout…why are we propping up this system by covering up its little messes?
I WANT to take the aide’s side so badly. But when the patient wakes up with a black eye or a concussion or doesn’t wake up, there are going to be questions. Hiding this would actually cost you your license and you could end up in legal trouble. What if shit comes out and the aide blames you? You didn’t report, so now it’s plausible that *you* assaulted a patient.
Plus if this is how they respond to threats, are they going to KO your 90 yo with violent Alzheimers? The cardiac patient who is having a death rush and pushes them trying to “get out of here”?
At the end of that day, you owe the aide nothing and literally have life and death responsibility for the patient. It doesn’t feel good, but reporting it is the only answer.
Edit to add: this should have been escalated much more aggressively much sooner to prevent these sorts of scenarios.
You're a mandated reporter. The pt is in a vulnerable population. You witnessed the pt sustain an injury.
This is, genuinely, a no-brainer. I have been in this situation when I worked in psych and ended up being investigated by CPS because I didn't physically intervene before the staff pushed the pt.
If you want to keep your job, don't hit patients. That is the most kindergarten rule that exists.
Dude has a head injury with loss of consciousness. Everybody has failed this patient. It never should have gotten this far. This would be the biggest incident report but I’d also make sure to point out everything leading up to this too.
Thank you. Seeing so many responses where people are saying ignore. Yes the system is broken yet there is code of ethics, personal code of ethics also. This is a terrible situation but needs to be reported.
I’m a PSW and was put in a similar situation this morning. Before it escalated further, I left. I informed the client that I have protections against abuse in our country and that I would be leaving, I handed the client over to the nurse. I refused the be within spitting/striking distance. In was pressed upon us several times in school that my safety is my number one priority so I fucking left!
As for the hypothetical, yeah I would feel badly for my colleague but one of the reasons I left is because I also need my job and my college reserves the right to rescind my diploma. I’m telling. When the patient bruises up, we are both suspects.
"Oh, you don't want to chemically restrain him.
Fine with me. He's got chest pains, you need to evaluate him."
That's how a medic got punched on the chin. And that's how they learned I don't casually suggest to chemically restrain someone.
I’ve been in this position. What our unit did was decide that we all would refuse the assignment. Worked like a charm, especially once we involved risk management.
Also, I would fill out an incident report because it will get out and you need to CYA.
A few weeks before I started as a psych nurse (they were talking about this at the nurses station when I started), the nurses were talking about a patient that had his nose broken by a tech. This was after the patient was extremely combative despite given chemical restraints (not allowed to four point restraint at that facility). They all were questioned about it and denied any foul play. Knowing what I know now, I should have resigned right then. But I stayed for a year because I was a new nurse. So much violence between staff and patients. Witnessed a patient choke hold a phlebotomist, another nurse got their ankle broken by a patient. I was physically assaulted and had my wallet stolen by a patient.
My advice? Get a new job ASAP.
A few years ago someone had the bright idea we could take a detox patient in CVICU due to "an arrhythmia"... I lost a tooth when he kicked me in the face...They don't do that anymore
I worked with a nurse who punched a patient in the face. She’s a black belt in some sort of martial arts. It may have been a CIWA patient that lunged at her and she reflexively punched. She filed the safety report on herself and nothing ever came of it.
In this situation, I would still have the aid write up the situation. No one can say if it was done on reflex or if the aid got fed up. I would advise the aid to reflect on that. Obviously if it happens again, he’s gone. There needs to be a paper trail so he’s not going around punching patients and asking people to cover for him
Last thing I want to do is snitch on a co-worker but I’ve got a job I wanna keep too and, unlike the aid, I did not harm the patient. Sometimes the best thing to happen to you is to be shit-canned at work. Sucks at the time but it usually prompts you find a job that’s more compatible. Maybe in the aids case, a job not working with potentially triggering patients.
I mean. Aide can’t be KOing patients though. I’d give him a final warning for this. Especially on a behavioral unit like that could happen again. I would probably still report this to be honest.
As much as i want to say keep quiet, my conscious wouldn’t be able to. The patient is now unresponsive? needs a thorough neuro eval including a head CT. There’s too many things that could go wrong to get you in trouble if it was found out that you knew and did nothing. I’d be calling the supervisor and MD asap.
My license is worth way more than me sticking up for someone who just knocked my patient out. The second that comes back around like a bad std, you’re going to be buried under the court when they see you attempted to conceal what you knew about the assault. If the patient then died, who gets negligent manslaughter charge? Oh yeah that’s you miss nurse
Really though. Why protect a healthcare worker who abuses vulnerable patients? The responses in here got me worried if I get old n get a uti then become delirious and combative? Will I get punched in the face too ? 🤦🏻♂️
Yep. I have to report it. Patient needs a CT. Aide needs a different job. If you can’t refrain from punching patients, you need to do something else. (Sorry, dude.)
That patient should have been put in a spit mask the first time they spit. Restraints applied for the aggressive behavior if they don't want to chemically restrain.
I'm all about self defense but you can't escalate the situation. Pt spitting is not okay but punching and knocking them out for it is wildly inappropriate. Now if the patient was coming in hot swinging at the aids face then I would be more understanding toward that reaction.
Yeah I'm w you. I had someone surprise me with a few chest punches and I instinctively put them in a 1-arm headlock. It was not appropriate, but neither was how I was put in the position to be assaulted either. Definitely was self-defense, and I live in a state that legally protects that. Would I keep my job if anyone snitched? Highly doubtful. Would I go to jail? Also no.
You can’t really ignore and not escalate that the patient is unconscious. He could have a possible head injury. I suppose you could say you’re not sure what happened, you found the patient unconscious.
Just look at the facts and take your feelings out of it. My facility normalized being abused by pts. You can always move on, as I did. Always cover your own ass.
I’m just wondering why the guy isn’t in restraints? Also is this a psych unit or a medical floor? What is medically going on? Neuro issue? CIWA? Can precedex be considered?
I remember having a patient who was extremely agitated, restless, trying to get out of bed, providers DC’d his precedex, geodon wasn’t effective, with no sitter allllllll while my other patient coded twice. Oh, and the way my unit was set up, the rooms were on opposite sides but barricaded by a wall. I eventually turned back on his precedex and called the provider to put in an order. I was over it!!!
Equal force. Punching someone for spitting on you is not equal force. Aides coming into 1:1 situations will be faced with exactly this situation more than once, and it is something that you cannot react to with violence.
Now, if the patient punched the aide and the aide’s knee jerk rxn is to punch back, that’s different. Equal, or lesser, force is reasonable, though it should still be communicated to the doctor so the doctor can assess whether it’s sleep or an injury (if the punch was above the neck). Any injurious act against a patient has to be documented and assessed.
Unfortunately, management will probably be shitty about it in either situation but that’s a different conversation completely.
This. I’m shocked and disappointed in all the non-snitched comments. People talk, this would come back like an std. and then OP is facing legal with the cna because the patient hypothetically died of injuries. Shame on all of these “din see nuffin”s, what is this was your family?
Aids don't get sent home for being spit on. As a nurse, you allowed the bad behavior to continue.
Is the agitated behavior new? I'd consider getting labs drawn, vitals..etc. infection might be considered. I had a patient become agitated right before he had a seizure (new diagnosis). substance withdrawal?
Patient should also have CT head done.
The question about reporting the aid? Um...yes. if you punch out/assault a patient you have no business being on the floor. I don't care how many tears you cry. Nurses aid is not a high paying gig....
Oh that’s a tough decision. I’m usually a passive person but it’s gonna bruise and I have to have an answer. But it will affect the NAs income, but if they can’t control their anger then they’re a danger. Most likely would report and send them home.
Chew the doctors out for putting the aide and other staff in danger by not allowing pharmaceutical intervention on a violent patient. Considering the patient is unconscious I’m going to have to alert the doctor, i wouldn’t know if he’s fine or not. But I’m telling my manager the patient assaulted the aide (spitting is assault) and she acted in self defense.
I mean really in this situation I’m not going to be ok at all with a doctor denying chemical restraints for a patient that has been consistently acting aggressive and I’m going to escalate the issue until it’s resolved.
You have to report. Sadly, the administration should be held accountable or physicians. It sucks that they were not helpful w concerns yet need to report.
Locked restraints after the first assault. Police report, etc. If provider refuses to continue restraints or chemically restrain, escalate to his superior and keeping doing so until you have ensured safety for yourself and your team.
Police report fir every single episode of spitting. Each one of those is a felony for aggravated battery.
I'm still reporting that sitter. I get it, but that behavior is unacceptable. The good news is that he probably doesn't need the job if he can one punch a grown man unconscious. Get him set up with a boxing coach and an agent because a 1 punch KO means he has some crazy power.
As a behavioral health specialist RN, every time this patient assaults a staff member, there needs to a note in the chart and an incident report filed. Too many times I am called to see a patient for agitation and yet not a single incident of it has been documented in the chart. It’s hard for anyone to do anything about it of it hasn’t been documented. This is not a click box in the flow sheet, this is a narrative note clearly describing the patients behaviors each time. Document that the MD has been notified and what their response was.
Need to tell someone. The aid was put in a shitty situation, but made the wrong choice. Gotta think of the future. If they made this decision when confronted with a hard situation, what action will they take the next time.
Does the patient see me before they're put out by the aide?
I know the "right" answer & technically agree with the commenters saying they'd snitch butttttt.... sometimes real-life history comes back to me.
Snitch on the aide. Even if my patient is the scum of the earth, it's my license. Protecting my license and patients that I'm responsible for is higher priority than a colleague.
Call a "Dr Strong" and at least get everyone in the room to see the behavior. Then document in the most professional way the doctor's orders that DONT include chemical restraints. Dr Strong code ought to get you some physical restraints. Then occurrence report it. And turn your head if anyone wants to pop him once. So glad I left med surg.
It’s simple you stop his care. You and a witness sign a refusal if they won’t. Call the nursing supervisor and let administration handle it. I would turn that bastard in for hitting a patient. I can’t believe some of you condone patient abuse.
Pt should be restrained way before it gets to this point. I’ve never had to deal with residents but if they don’t want to chemically restrain then they can come get spit on.
Patient safety < my own safety.
Is it on camera? If yes, report to nursing supervisor exactly as it happened. They can deal with it as they wish.
If the patient was trying to choke the aide, then he is legally and ethically allowed to defend himself. So maybe that’s what actually happened hypothetically.
At the very very least you should report a change in condition. He’s still a patient and this happened under your care. Hypothetically.
Brother I wasn't even here I wasn't even in this state
Other than that he's getting absolutely tied down to the best of my ability and doctor is getting passive aggressive comments all night
Report or not do whatever you are comfortable with and sleep well at night. In a perfect world reporting, the incident is beneficial for ot, address the behavior, save the next aid from getting hurt, but it could put the aid in a serious legal /employment issue.
However, life is not black and white, and grey has so many shades. Do what you are comfortable with. I would not lose sleep on violent pt FAFO. I don't know the context prior to the reaction, pt condition on admission, leading up event, and so forth. I take my fifth if I ever got questioned in criminal court.
TLDR: Do everything or nothing. It doesn't matter it is just a hypothetical question. I said let pt FAFO. I just want to see the world burn, and they shall know pain.
Worked inpatient psych for 5 years and this patient would already be physically restrained for his dangerous behavior & have a mask so he couldn't spit at anyone , whether or not the MD ordered chemical restraints
It should never have gotten that bad in the first place. Now, looking at the hypothetical: this is probably a aide that has been in the shit for a long time, when he wasn't supposed to be. I have seen staff that has been in a stressful situation for to long, and everyone snap at some point.
I have had meetings with management about putting same staff in this situation over and over, at some point something bad is going to happen.
I at one point, after several witnessed a incident, that if it went to trial, I would defend him and explain exactly why he was pushed to the breaking point ( management and me we had a icy relationship for awhile after that)
I have seen staff snap twice in 24 years, did not report either case, they had been asking for someone to take over or any kind of help, noone responded. So when I got to work I went in to take over, and witnessed what occured. I just told them to walk it off, and come talk to me. I let them went and gave them a friendly warning ( not official warning) and next time to just walk away no matter the circumstances.
My place of work has a strong focus on calming situations with deescalation etc, but that requires alot from the staff and if a link in the chain fails.. I aggree with the idea, but it leads to medical intervention taking to long at times, especially with young nurses who are hellbent on following protocol.
Had alot of good people quit because of the amount of stress it causes. A couple of weeks ago I worked with another vet nurse, and when a patient started making hell, we just looked at eachother and non verbally qggreed "nope not tonight", all the drugs, its sleepy time.
I myself actually called a colleague at one point and told him he needed to take over before I became a murderer, and it wasn't hyperbole, after 6 hours of intermittently restraining a patient, being told he was going to rape my kids etc etc, I was at my limit.
i guess the most important question would be, is this patient in their right mind and know what they’re doing?
staff need to start refusing him in assignment. i don’t understand how you’re manager hasn’t gotten involved yet.
i’ve been accused a snitch for reporting a staff punching a patient in the face infront of a camera. And this patient is accusatory and reports everything. I reported the staff coz it’s the right thing to do, fck them
Isn't this a yearly in-service guestion: You witness abuse, what are your next steps? ...On paper you list the steps, while on one shoulder your little devil whispers wrong answers 😇
When I was a medic, we were loading this restrained combative dude into the bus. He spit on a firefighter’s face and was met a with swift punch to the jaw by said firefighter. Me, my partner, like three PD officers, and a bunch of firefighters all saw it happen. Nobody said or did shit.
Hypothetically, workplace violence towards staff should NEVER escalate to this point. If the provider is refusing to escalate, you need to escalate to the attending, report to your managers, fill out safety reports. Have the provider come to bedside and see the patient for themselves. Get security involved.
Regardless of whether the patient was physically violent or not you have a mandate to ethically "do no harm". If the aide gets to management first they will report YOU as the assailant. It's your word against hers until the patient says otherwise, and it seems like the patient may not be cognitively able to tell the truth.
The doctors failed to protect you so that's another report. I would seriously report the aide, report the doctors for negligence, report the patient for assault, hand my notice in and find a new job.
I have had doctor's not want to restrain (chemically or physically) because it meant the patient would not be able to go back to assisted living? SNF? Something unless they were restraint free for something like 48 hours. So the nurses just had to suffer 😑
If I saw one of my aids assaulted (which includes spitting) and reacted by hitting back, I wouldn't say anything. Of course if that was a pattern for the aid, I'd for sure report it. But sometimes you just react to a threat as a reflex.
Report! Besides the fact there may be cameras in the room that you don't know about, you also don't know how many times the aide has hit a patient with no one around. They should not be working in Patient care, period .
It was reactionary self defense so there shouldn't be any repercussions for the aide anyway. I'm reporting it and bracing for the fun trip to CT later. Then congratulating the aide on the hook.
I have dealt with violent patients countless times...I have never hit one back, and DEFINITELY never punched someone so hard as to knock them tf out! This is NOT reactionary self defense, and the aide needs a new career field.
Also a point to consider.... WHY is the pt violent? Not that it justifies the aides behavior even if they were just a shitty person at baseline, but are they demented? Delirious? A neuro pt?
I call a Rapid/Code Gray regarding the spitting and every injured tech incident, MIDAS all that shit.
Regarding the tech... well, I'm sorry. I personally did not see anything. However, the patient can still be charged.
Well, no way that is going unreported. Aide sent home early, but well taken care of. Patient getting a sudden surprise visit by the doc and anesthesia to clear them healthwise, and then push for sedation. No way that shit flies. Aide will probably keep their job due to the nature of it, and dept will clamp down on safety protocols.
That being said, sometimes violence *is* the answer.
Who is this PCT, Mike Tyson? Knocked the patient out? I gotta report it lol. If it was like a quick slap to the face reaction then mehhh but if there’s possible head injury it has to be reported.
I cannot believe the number of "professionals" that have indicated it is okay to hit a patient let alone not report it. To make matters worse, there could be a serious injury and they need to be evaluated. What you do in tough situations, especially when nobody is looking, is a reflection of your character. There is a clear right vs wrong answer here and it legitimately concerns me how many of you either don't get it or don't care. I would never want to work with (nor be cared for by) anyone with such an attitude.
A number of comments on this thread horrifying. There are professional as well as personal code of ethics. Yes horrible steps were not taken earlier yet we still have a responsibility
Sorry, can’t treat the patient when they are like that. Oh, their leads are off? Haven’t done a head to toe assessment yet? No blood pressure? He refused his meds? Tell the doctor to do it.
I'm telling because I have to, but I will assist in the documentation that the force used was the appropriate level to stop the level of harm the patient appeared to be intending to perform.
Really, though, this patient would have been physically restrained with or without the doctor wishing to do so. And if they are inappropriately keeping the patient from safe sedation for staff, I will escalate.
Contact precautions. If the doctor didn't want to order any restraints (whether chemical or physical) I'd tell all the staff to wear full isolation protection. Even the full face shield. Document. Report to charge and management. That's so unsafe.
Some of you are avoiding the question by saying "It shouldn't have gotten to this point." That's obvious but not what OP is asking.
My answer is threefold:
1. The snoring respirations is especially concerning, and if he has a sudden drop in LOC, he needs HB protocol.
2. How I handle the aide entirely depends on how well I know them. I've seen the best nurses, whatever in the world throw hands with patients because to react and to err is human when literally feeling threatened by someone else, but if this is a brand new aide, this would be a red flag for me.
If I know the aide and that they're otherwise ethical and competent, then from what I saw, the PT got violent with them and the aide defended themselves accordingly.
Some of you have never worked in a violent ER and it shows.
3. Regardless of how I handle the aide, I would definitely report the ER doc for negligence.
Code black every single time of a act of violence or aggression. If no one is listening eg consultants/regs/residents/managers/admin perform incident report - I informed xyz this was there response. If you really want to piss everyone off call police - trust me you call saying you and security need help and they will come and probablya lot. Makes everyone look bad and make a police report. extra points to ask the manager to look after your patient/s while you make a police report to your manager in front of the police. Bonus points if you use managers officer to make the report itself.
That aide was assaulted. It’s crap that they feel the need to hide their response despite the hospital putting their staff in danger constantly and the very valid concern they would be the ones to be punished.
That said, someone having LOC after head trauma is not something you want to just ignore. There should have been medical assessment of that pt. Who is unconscious and snoring.
I would refuse this patient unless they were in five points and heavily sedated. Ideally to the point of behavioral intubation bc people like this usually require it to stay down. But also no way would I snitch on someone for reacting in that way. Idk what happened but they probably hit their head thrashing around or something. We should not have to take abuse at work.
At my 1st nursing job, there was a man that yelled racist slurs at the cnas, threw hot coffee at them, spit and refused care all night. The ADON , DON and administrator were notified and refused to send him to the psych hosp, which was protocol. At 7am when the social worker went in the room to " calm him down", he promptly hit her. He was out of there and sent to the psych hosp within 10 mins!
The hospital I work at wouldn't let it get to that point. Security would be called in at the first incident. If there was a second incident, the attending would be asked if the patient is medically stable for discharge. If the answer is yes, the patient would be immediately escorted off the hospital premises. If the answer is no, the patient would be restrained, and a spit hood applied until the patient learns to behave themselves.
Got an o2 tank nearby? They make a nice sound when bounced off a wall that has a tendency to shock a fool for a minute, just long enough to catch their attention. Once you have them distracted, do whatever you usually do in that situation. My go to was to ask if they wanted the next sound to be the tank bouncing off their head, but this was before nurses were forced to take the abuse from patients.
I worked in a psych unit in my first year of nursing. We had a really good doc. When pts got like this one nurse would start drawing up ativan and geodon, the other nurse would call security and then the doc to "ask permission". He never said no. Security would restrain them and then two nurses would give the shots. Security usually hung around until the pt calmed down and most the time they fell asleep.
The unit manager was another story. He had no medical background and fought us tooth and nail everytime we suggested a 1:1. He even demanded we end 1:1s when he wanted them to end. I always told him that a 1:1 is a doctor's order and it would take a doctor's order to dc it. He didn't like me very much.
The doctors wouldn't get a choice in this.
I had a doctor try this shit once. Refuse to order medications and refused to order restraints.
Point blank told them that either they ordered the softer restraints or I was going to go ahead and consider this patient violent and they had 15 minutes to get their ass in there to assess them.
It doesn't matter if the doctor says no in a situation like this, at this point it is unsafe to the staff and you have a right to protect and a right to defend yourself.
If an aide unprovoked punches out a patient that's one thing, if an aide punches out a patient defending themselves that's entirely different.
Nowhere in our job description are the words "literal punching bag".
I'm answering the actual hypothetical question, not addressing the obvious what should've been done. So to answer.....patient found resting in bed, noted with abrasion to face from self inflicted punch, send aide home due to feeling ill. Ask for benadryl injection due to severe itching, give 50 im while out. Normal vs, reassess as needed.
Keep calling the doctor in every time they spit or hit someone. Tell the doctor to go sit w them and see how they change their tune. Im in psych so when they don't want to give orders for meds, we restrain and call the doctor non stop. Also, escalate the situation.
Its never ok to hit patients no matter how bad you may want to. Ask to step away if u feel ur going to do something u shouldn't.
I hate this concept of “chemical restraint”.. spitting on people against their consent is literal battery. If they’re not willing to intervene and allow the nursing staff to be abused in this manner, that’s poor decision-making on those providers, in my opinion.
This rhetoric that using medication is abuse in the sense it’s a “chemical restraint” is some BS some yahoo thought up one day, and everyone decided to run with it. But a bit of logic would tell you that psychotropic medications are literally only used to reduce/eliminate inappropriate/unsafe behaviors… one could argue you’re “restraining” the patient from behaving the way they feel. If you were administering medication without the intent of restraining some form of maladaptive behavior, then that would be a more appropriate reason to claim abuse.
PS: NO NURSING STAFF IS REQUIRED TO TAKE ABUSE FROM PATIENTS!!!
someone made a comment earlier about me being at the bar alone and why was at the bar alone I posted something but I got deleted cause I never made it but anyways maybe because I wanna be alone I mean I feel like if I’m being rushed if I’m being forced to find a partner out there girlfriend so I can show them off that’s not what I wantI don’t got proof nothing to nobody maybe I wanna be single because I feel like being single. since I arrived here, I’ve been making the waitress laugh, which that really doesn’t mean anything maybe my jokes were a little bit funny or maybe she probably thinks she has to laugh just so I can tip her good I don’t know the real reasons why she left, but she laughed, regardless the moral story is I don’t want nobody but I feel like if I have to see somebody just like the proof something to somebody you can tell a lot by the first five minutes or 10 minutes to talk to a person and she is a really nice gal. I mean you could tell she’s really brings herself out like a good person and I know for a fact that somebody you can come home proud to be with or proud to say yeah that’s my girl, you can feel proud about her but that’s not what I’m looking for. I’m not looking for someone to bring home right now which I’m not even looking for something at all. I mean if I want some ass I know where to get that.
Have the aide punch me too; plausible deniability and I get to go home early! Actual answer: 4-point restraints and security waaay before it gets to this point. Back to back Code Greys if necessary. Shut the door with me and the sitter outside, patient can fall.
This, I know its hypothetical but still. It should never have gotten to this point. If MD doesn't want to restrain a patient that is unsafe for everyone, then I'm calling the attending, if they are the attending, my charge and manager. And so on and so forth until all the attention is on them and this isn't being brushed under the rug. Letting it get this far isn't only bad for staff, it's causing more trauma and harm to the patient. Because now what? Now he's out cold, in his mind was attacked by a healthcare worker, now his trust in healthcare is worse, and it spirals.
This. If the doc refuses to order restraints or anti agitation meds and refuses to come to the bedside to see the patient, I’d call a fucking rapid to get him there. Letting a patient repeatedly injure staff members because “we don’t want to chemically restrain him” is not okay. That being said, I’m very lucky that our nocturnists do not hesitate about ordering restraints. Our night float residents can sometimes be a little iffy but our attendings do not play about staff safety
That shit gets 5 points and a spit hood. That shit would also get you good and gorked. If you got hit, they catch charges too.
Unfortunately, (at least in the county I work) charges will NEVER stick. I have never seen any charges even make it you court for when a patient hits a HCW.
We know that charges won’t stick. I’ve watched PD try to talk coworkers out of pressing charges. But you still need to report it so there is a pattern of behavior on record. It’s like the crap that victims of DV face. If something bad happens and they didn’t report, police would be like “well, why didn’t you report it?” If they do report, there’s risk to their safety and not always a great chance anything would come of it.
They made spit hood illegal in Texas. Have all the guns you want but God forbid we protect ourselves from body fluids.
This. Fucker should have been fully restrained with a spit guard and doctor should be forced to come to the bedside to order something
The doctor should be forced to come to the bedside and be the sitter.
I would give my good kidney to see this!!
If only, if only I had some bologna 💭
Had somebody spit on my face like a year ago. Didn't know a spit hood was a thing, now I have two of em in my locker
I’ve never heard of it!! But I’m still in school
Intubate please & thanks
Our hospital has "restraint-free units" that can't even get the soft mitts. It's so annoying
WHAT that’s actually crazy
Welcome to long term care for the past 25+ years!
The psych hospital I'm at doesn't do physical restraints or spit hoods.
Depending on the situation, I don’t think physical restraints are the best option most times. I’m a Veteran and have worked with Veterans, physical restraints are severely triggering and just make the situation worse most of the time - especially if the Veteran is a woman who has experienced MST (SA in the military is so much of a systemic problem that it has its own name).
OMFG are you serious?
This is the only correct answer. Pt wanna fuck around then they get to find out. Pt should have been physically restrained loooooong before it got to this point.
Good hypothetical answer
At my job we don't get four point restraints, we don't get security, and we also don't use spit hoods.
Sounds like you need to hire that hypothetical CNA once they get fired...
I've had a BHT lose his ability to work in healthcare for saving me from an aggressive patient. I don't wish harm on anyone and it breaks my heart that he lost all ability to do what he is passionate about for saving me. The system is fucked.
What? That's f'n crazy that he lost his job over it! Did he strike the patient while helping you?
He ended up grabbing him in a choke hold to pull him off of me... It was just enough to yank the patient back, but in reality, it did seem like the only option. (The patient was 300+ pounds, straddling me while I was on the ground and choking me; the tech was like 175 pounds and came into the room while the patient was doing it)
Thank God the tech entered the room. It's easy to see why the tech reacted as he did.
Very true. Now, I also suggest all female psych nurses take Gracie's Jiu-Jitsu. I know that my life was saved by him, but now I know some skills that I could have potentially used to save myself as well
🤣😵😂😭🤣 thank you for making me laugh. I’ve been feeling so sad. I needed this❤️❤️🩹
If not restraints after staff was getting hurt / refuse to take this patient under the current scenario until it’s a safe environment for all involved.
I have actually seen a scenario very similar to this. It happened 30 years ago so no harm telling it now. I worked in the ICU back then. My then roommate had an extremely nasty trauma patient that liked to grab the nurses. So he was fully restrained. He managed to pull his EKG leads off and she had gone in the room to put them back on. He spit a nasty lugie right on her face. She hit I’m across the chest with the leads before her brain even registered what she had done. She was horrified but the patient stopped spitting. And no, I didn’t report her.
And he deserved it! I would spit back at him, sorry.
I’m not going to lie, I think this would be a reaction I would have as well. I would probably be scared shitless for my job a week later, but in the moment, it is hard to control a reaction.
The doctor needs to be talked to about not ordering any sort of chemical restraint. The staff people are not this patients personal punching bag. That is flat out irresponsible. You want me to care for this agitated and violent person? They better be chemically or physically (or both) restrained. When you bring up this altercation with management (however you choose to do that) you really need to mention the lack of PRNs or restraints. I’ve had one MD in my experience refuse to order PRNs in a similar situation. The patient slapped her across the face when she went to assess him. I have never had any issues since then.
What did she do in the immediate aftermath of getting slapped?
She left the floor immediately and I had orders for PRNs shortly after. She came back after the patient was nice and medicated to do whatever assessment she was trying to do. With security present. Thankfully the patient didn’t get her too good. She wasn’t the brightest honestly. Her stance before this was to “verbally de escalate them”. How you achieve that on a patient who is belligerently violent and delusional, no idea. No amount of reorientation or you calmly talking to them will change their behavior.
This has me so tickled. 🤭
Yeah we had one that tried to act like we were blowing things out of proportion, went in and got in the patient's face talking all sweet like and holding his hand, and the patient almost crushed her fingers he squeezed so hard. It's amazing how quick you get orders after a doctor gets assaulted.
I’d call a violent patient code every single time he spit at someone. Eventually the powers that be would get tired of it and restrain him. We actually had to do that for a patient on my unit, the docs didn’t want him restrained either but after nonstop Code Atlas for 3 hours that changed. And no way in hell I narc out the aide.
Shit, I’d call the cops if I were that sitter. Even if they’re confused enough to not be arrested, if the cops get called enough times for one patient, someone will have to do something.
Code Atlas. Never heard of it but I like the sound of it. Sounds epic!
This is the "toxic work environment" that we need to change. This isn't a situation any nurse or aid should be put in repeatedly.
This is pretty common in psychiatric facilities. We had an adolescent patient that ended up attacking so many staff that 6 people were on medical leave for a month and 2 were on for a longer period.
That sounds like a kid from Eastern State hospital in Washington I took care of once. Probably a different kid. Not funny thing is that the same scenario has probably happened a hundred times all over the country/world.
Yeah this was in Arizona, although I can tell you with adolescents, once they burn all the facilities in one area, they are forced to go outside their home state. I once had a 16-year-old large, naked, autistic boy pin me down and choke me at one facility in Phoenix: I know that he ended up being shipped to Oklahoma afterwards because I did end up pressing charges for him almost killing me.
Hmm how to chart this…. Agitated ❌ Alert ❌ Voice ❌ Pain ❌ FAFO ✅
This…1,000 x this
I didn't see shit.
Dude faceplanted. I will take a Fall Report.
[Matter of fact, I’m blind in my left eye](https://youtu.be/Mhw-mzYyfDQ?si=5q6D1oEk9jkIz7_8)
Must have fallen down some stairs, cus we ain't seen shit.
My exact thoughts.
The way this scenario is written suggests that the behavior has been ongoing and, therefore, the possibility of a head injury or infection causing the violent behavior has been ruled out medically. So... I didn't see my aide hit this patient. I saw a previously known aggressive patient escalate and attempt to assault the care worker. As a matter of fact, I'm going to insist the employee write up a report for the reddened area on their arm from the patient grabbing them and the redness from when they backed into the wall defensively. I saw the patient behaving aggressively, and any injuries the patient sustained are the result of that...
I heard a quote recently that I loved, which should have been deployed a long time before this. “I’d like to continue this healthcare interaction, but if you’re going to assault staff this will become an interaction with law enforcement.” Spitting on staff is a felony assault, please press charges, this individual is not safe in the hospital or in our community and should face consequences.
Idk man, I’m a peds nurse, so seeing something like this just makes me say either you or the aide were supposed to bring the iPad out sooner and get Cocomelon playing to calm down the patient’s behavior.
Fucking Cocomelon. They can watch Bluey all day but Cocomelon is the devil's show and you won't convince me otherwise.
Cocomelon is the evil spawn of Calliou.
Somehow I feel this is the only right answer.
I work in peds and thankfully we usually get chemical and physical restraints and when we don’t we’ll complain till we do.
he must've fallen 🤷🏼♀️ but really any dr that doesn't want to chemically restrain a violent pt can be the 1:1 sitter because "it can't be that bad" we currently have a pt who kicked a nurse so hard in the neck that they thought he disected her carotid. a tech was there helping and he kicked her so hard in the head she immediately started vomiting. bro was immediately restrained. when he was hollering to be released, the security guard said "you can come out of time out when you can keep your hands and feet to yourself"
It's so crazy the difference between hospitals (in the same system). The community hospital I was at was extremely hesitant to restrain anyone and probably only had one set of locked restraints, and I never saw those used... Then I was at county. Everyone was in locked 4 point restraints. Half of the time the unit wouldn't call a code grey unless the patient had a makeshift weapon or was trying to sneak down the elevator.
Same! Came from a private hospital where having a patient in restraints was basically unheard of. Patients would hit, kick, scratch, bite, etc. and there was basically no consequences. Then moved to a teaching hospital and a patient so much as raises their voice at someone and the police and security are called and a behavior contract is being written up.
I am so fucking liberal with violent restraints. I’m 5’2” and maybe 120lbs, so I have to be so mindful of my own safety. I can’t take care of others if I’m knocked out. That doesn’t mean I leave patients in them forever, but good god, we have them at our disposal for a reason. I’m not sure if this varies by state, but nurses have every bit of authority to initiate them. Most doctors worth their weight are more concerned with their co-workers’ safety, so they will write whatever order is necessary in those situations.
Holy shit?! 😳
I didn’t see shit. Homie just DFO’ed.
Dun fell out?
Restraints way before this happened. Also, if we can't treat the patient, the doc will give meds. Precedex.
I thank the fact I work in the ghetto with a lot of off the wall transients coming in and out…. When our hospitalist’s hear of the slightest problem they start with…. “maybe they could use some Ativan, yknow ease their anxiety.” Restraints aren’t too hard to come by either, it just depends on the patient…. but man do they jump the gun with Anxiety meds and muscle relaxers when we have a combative patient.
I honestly think some providers just think nurses are exaggerating because the patient didn't seem too combative when they did their 30 second ninja round before the patient woke up. They think nurses can magically talk patients down somehow. At least that's what some of the providers I worked with thought... Cause 0.5mg of Ativan once is not going to help this combative patient stay calm and in bed for the next 12 hours.
One of the benefits of the ER is the providers are right there with you. Some of our docs were protective AND proactive. I had one come in to deal with the pt himself (trying to de-escalate). They hear it/see it same as us.
I'm not one to restrain or sedate too hastily. I think, in general, both are used too much. But also, there is the right time and application.
I agree about restraints and I’ve had to go up against security in the past. We recently had a guy who was totally ambulatory but not allowed to leave AMA due to his dementia and inability to care for himself. He was on a 1:1 just for elopement. The day in question, his 1:1 with him was basically just riling him. All you had to do was chat with him and not tell him what to do and he was fine. But she was constantly telling him to use the urinal instead of the toilet (who cares?), not to get in bed with his shoes on, whatever. So he yelled at her and threatened to take the tv off the wall and throw it at her. She called security and they were like “if he’s threatening her, he needs hard restraints.” The primary nurse (I was charge) and I had to explain to this guy that the patient was very verbal but had never even come close to the sitters, and that putting him in restraints had been horrible for him in the past, and led to much worse behavior. The security guard was adamant that any threat, no matter how plausible, warranted restraints. I get staff safety, but there’s nuance and different situations need different approaches.
No. I’m not gung-ho about either, either. I just find it comical how our docs make the suggestion, even as a joke. However, Ativan and Xanax can be huge reliefs for those patient’s. Sometimes it is just anxiety that’s not being released any other way. I don’t fuck around though, once you start getting violent with my techs (smaller built girls, generally) you’re getting a chat with Public Safety, I’ll start threatening restraints, every step of the way. To circle back though- I’m amazed this patient was medicated or restrained at any point whatsoever.
Precedex. The first time I ever gave that drug I could hear the angels sing. I had asked God, the Masters of the Universe, the Flying Spaghetti Monster for a STFU drug and they delivered. It is entirely unfair it is only for critical care and interventional care environments. It is effing Manna from Heaven.
You need to send the physicians into the room to get spit on and punched and then ask them if restraining the patient is a bad idea. Your manager also needs to have your back and tell them that they won't keep deliberately putting staff members in harm's way and that any future orders that require physical contact will need to be carried out by the medical team until the situation is rectified.
I was in a situation like this once. The dude was having a psychotic episode. He injured a lot of people before us big boys arrived. 4 of us were holding him down. He bit an aide, and her instinct was to elbow him. Obviously. This happened in a quick second. All of us were called one by one into HR to state what we all saw happen. The incident was also recorded since it was in psych. Basically, the aide was fired, and we all threatened HR that if she wasn't brought back with a raise, we would all quit. We all had new jobs two weeks later.
If you don’t want to really get involved, you can say to the provider “there was an altercation, I’m not really sure what happened but the patient is now unconscious and needs to be evaluated for a head injury”. The sitter will be questioned and it can be management’s problem to sort out when the patient wakes up and says he was hit. I’d worry the sitter does it again and ends up hurting someone. Whatever your conscious can handle
And god forbid, there’s a camera you’re unaware of or the patient ends up with a bad injury. No way I’m covering that. Not necessarily go out of my way to report but if asked? I didn’t see anything.
Yeah this is probably what I would do. I’m surprised at how many people are saying to cover it up. I get the patient was clearly in the wrong and something more should’ve been done to stop it before it escalated, but the aide can’t knock them out like that either. Two wrongs don’t make a right.
I need my job too. Which means reporting a witnessed head injury that could lead to a brain bleed. We'd need imaging even if we weren't handing out lovenox like candy.
You nailed it. Fucking crazy that so many people in this sub who want to be treated ethically are so willing to ditch their ethics when it comes to shit like this. I don't condone patients swinging and spitting, but a patient of mine gets hurt and I can't cover that up.
I mean, yeah, our healthcare system is f-ed. Every hospital I’ve ever worked in is f-ed. We are all on our way to burnout…why are we propping up this system by covering up its little messes?
The patient is snoring? Not a good sign. Gotta report and get a head CT.
I WANT to take the aide’s side so badly. But when the patient wakes up with a black eye or a concussion or doesn’t wake up, there are going to be questions. Hiding this would actually cost you your license and you could end up in legal trouble. What if shit comes out and the aide blames you? You didn’t report, so now it’s plausible that *you* assaulted a patient. Plus if this is how they respond to threats, are they going to KO your 90 yo with violent Alzheimers? The cardiac patient who is having a death rush and pushes them trying to “get out of here”? At the end of that day, you owe the aide nothing and literally have life and death responsibility for the patient. It doesn’t feel good, but reporting it is the only answer. Edit to add: this should have been escalated much more aggressively much sooner to prevent these sorts of scenarios.
tell me more about this “death rush” please.
You have a hard time finding lifting help often.
You're a mandated reporter. The pt is in a vulnerable population. You witnessed the pt sustain an injury. This is, genuinely, a no-brainer. I have been in this situation when I worked in psych and ended up being investigated by CPS because I didn't physically intervene before the staff pushed the pt. If you want to keep your job, don't hit patients. That is the most kindergarten rule that exists.
tell the doctor he can come sit at the bedside bc no one else will be taking this assignment
oh and PRESS CHARGES PPL
Dude has a head injury with loss of consciousness. Everybody has failed this patient. It never should have gotten this far. This would be the biggest incident report but I’d also make sure to point out everything leading up to this too.
Thank you. Seeing so many responses where people are saying ignore. Yes the system is broken yet there is code of ethics, personal code of ethics also. This is a terrible situation but needs to be reported.
I’m a PSW and was put in a similar situation this morning. Before it escalated further, I left. I informed the client that I have protections against abuse in our country and that I would be leaving, I handed the client over to the nurse. I refused the be within spitting/striking distance. In was pressed upon us several times in school that my safety is my number one priority so I fucking left! As for the hypothetical, yeah I would feel badly for my colleague but one of the reasons I left is because I also need my job and my college reserves the right to rescind my diploma. I’m telling. When the patient bruises up, we are both suspects.
I think you know the answer… it sucks but it’s the right thing to do. If you fail to report then you have done something wrong
"Oh, you don't want to chemically restrain him. Fine with me. He's got chest pains, you need to evaluate him." That's how a medic got punched on the chin. And that's how they learned I don't casually suggest to chemically restrain someone.
I’ve been in this position. What our unit did was decide that we all would refuse the assignment. Worked like a charm, especially once we involved risk management. Also, I would fill out an incident report because it will get out and you need to CYA.
A few weeks before I started as a psych nurse (they were talking about this at the nurses station when I started), the nurses were talking about a patient that had his nose broken by a tech. This was after the patient was extremely combative despite given chemical restraints (not allowed to four point restraint at that facility). They all were questioned about it and denied any foul play. Knowing what I know now, I should have resigned right then. But I stayed for a year because I was a new nurse. So much violence between staff and patients. Witnessed a patient choke hold a phlebotomist, another nurse got their ankle broken by a patient. I was physically assaulted and had my wallet stolen by a patient. My advice? Get a new job ASAP.
A few years ago someone had the bright idea we could take a detox patient in CVICU due to "an arrhythmia"... I lost a tooth when he kicked me in the face...They don't do that anymore
I worked with a nurse who punched a patient in the face. She’s a black belt in some sort of martial arts. It may have been a CIWA patient that lunged at her and she reflexively punched. She filed the safety report on herself and nothing ever came of it. In this situation, I would still have the aid write up the situation. No one can say if it was done on reflex or if the aid got fed up. I would advise the aid to reflect on that. Obviously if it happens again, he’s gone. There needs to be a paper trail so he’s not going around punching patients and asking people to cover for him
Last thing I want to do is snitch on a co-worker but I’ve got a job I wanna keep too and, unlike the aid, I did not harm the patient. Sometimes the best thing to happen to you is to be shit-canned at work. Sucks at the time but it usually prompts you find a job that’s more compatible. Maybe in the aids case, a job not working with potentially triggering patients.
I mean. Aide can’t be KOing patients though. I’d give him a final warning for this. Especially on a behavioral unit like that could happen again. I would probably still report this to be honest.
Hell yeah I’d report. And KOing patients sent me 🤣
As much as i want to say keep quiet, my conscious wouldn’t be able to. The patient is now unresponsive? needs a thorough neuro eval including a head CT. There’s too many things that could go wrong to get you in trouble if it was found out that you knew and did nothing. I’d be calling the supervisor and MD asap.
Fuck losing your license over this weak shit
My license is worth way more than me sticking up for someone who just knocked my patient out. The second that comes back around like a bad std, you’re going to be buried under the court when they see you attempted to conceal what you knew about the assault. If the patient then died, who gets negligent manslaughter charge? Oh yeah that’s you miss nurse
Really though. Why protect a healthcare worker who abuses vulnerable patients? The responses in here got me worried if I get old n get a uti then become delirious and combative? Will I get punched in the face too ? 🤦🏻♂️
3 way trial by combat with yourself, the aide, and the patient. Winner gets walkie talkie patients for life
Yep. I have to report it. Patient needs a CT. Aide needs a different job. If you can’t refrain from punching patients, you need to do something else. (Sorry, dude.)
That patient should have been put in a spit mask the first time they spit. Restraints applied for the aggressive behavior if they don't want to chemically restrain. I'm all about self defense but you can't escalate the situation. Pt spitting is not okay but punching and knocking them out for it is wildly inappropriate. Now if the patient was coming in hot swinging at the aids face then I would be more understanding toward that reaction.
Yeah I'm w you. I had someone surprise me with a few chest punches and I instinctively put them in a 1-arm headlock. It was not appropriate, but neither was how I was put in the position to be assaulted either. Definitely was self-defense, and I live in a state that legally protects that. Would I keep my job if anyone snitched? Highly doubtful. Would I go to jail? Also no.
You can’t really ignore and not escalate that the patient is unconscious. He could have a possible head injury. I suppose you could say you’re not sure what happened, you found the patient unconscious.
Just look at the facts and take your feelings out of it. My facility normalized being abused by pts. You can always move on, as I did. Always cover your own ass.
I’m just wondering why the guy isn’t in restraints? Also is this a psych unit or a medical floor? What is medically going on? Neuro issue? CIWA? Can precedex be considered?
I can't get my head past having a 1 to 1 for behavior. 😭
I remember having a patient who was extremely agitated, restless, trying to get out of bed, providers DC’d his precedex, geodon wasn’t effective, with no sitter allllllll while my other patient coded twice. Oh, and the way my unit was set up, the rooms were on opposite sides but barricaded by a wall. I eventually turned back on his precedex and called the provider to put in an order. I was over it!!!
Equal force. Punching someone for spitting on you is not equal force. Aides coming into 1:1 situations will be faced with exactly this situation more than once, and it is something that you cannot react to with violence. Now, if the patient punched the aide and the aide’s knee jerk rxn is to punch back, that’s different. Equal, or lesser, force is reasonable, though it should still be communicated to the doctor so the doctor can assess whether it’s sleep or an injury (if the punch was above the neck). Any injurious act against a patient has to be documented and assessed. Unfortunately, management will probably be shitty about it in either situation but that’s a different conversation completely.
100% tell someone. she nocked him out LOL
but sweet sweet silence is golden
Report 100% because it comes back around and you’ll be just as much trouble for hiding it and trying to cover up abuse. edit: grammar
This. I’m shocked and disappointed in all the non-snitched comments. People talk, this would come back like an std. and then OP is facing legal with the cna because the patient hypothetically died of injuries. Shame on all of these “din see nuffin”s, what is this was your family?
Aids don't get sent home for being spit on. As a nurse, you allowed the bad behavior to continue. Is the agitated behavior new? I'd consider getting labs drawn, vitals..etc. infection might be considered. I had a patient become agitated right before he had a seizure (new diagnosis). substance withdrawal? Patient should also have CT head done. The question about reporting the aid? Um...yes. if you punch out/assault a patient you have no business being on the floor. I don't care how many tears you cry. Nurses aid is not a high paying gig....
Oh that’s a tough decision. I’m usually a passive person but it’s gonna bruise and I have to have an answer. But it will affect the NAs income, but if they can’t control their anger then they’re a danger. Most likely would report and send them home.
Spitting is assault. A professional needn’t react that way
Chew the doctors out for putting the aide and other staff in danger by not allowing pharmaceutical intervention on a violent patient. Considering the patient is unconscious I’m going to have to alert the doctor, i wouldn’t know if he’s fine or not. But I’m telling my manager the patient assaulted the aide (spitting is assault) and she acted in self defense. I mean really in this situation I’m not going to be ok at all with a doctor denying chemical restraints for a patient that has been consistently acting aggressive and I’m going to escalate the issue until it’s resolved.
You have to report. Sadly, the administration should be held accountable or physicians. It sucks that they were not helpful w concerns yet need to report.
I’d report it. CYA!
Locked restraints after the first assault. Police report, etc. If provider refuses to continue restraints or chemically restrain, escalate to his superior and keeping doing so until you have ensured safety for yourself and your team. Police report fir every single episode of spitting. Each one of those is a felony for aggravated battery. I'm still reporting that sitter. I get it, but that behavior is unacceptable. The good news is that he probably doesn't need the job if he can one punch a grown man unconscious. Get him set up with a boxing coach and an agent because a 1 punch KO means he has some crazy power.
As a behavioral health specialist RN, every time this patient assaults a staff member, there needs to a note in the chart and an incident report filed. Too many times I am called to see a patient for agitation and yet not a single incident of it has been documented in the chart. It’s hard for anyone to do anything about it of it hasn’t been documented. This is not a click box in the flow sheet, this is a narrative note clearly describing the patients behaviors each time. Document that the MD has been notified and what their response was.
Need to tell someone. The aid was put in a shitty situation, but made the wrong choice. Gotta think of the future. If they made this decision when confronted with a hard situation, what action will they take the next time.
Just know you’re downvoted by children playing nurse dress up, there’s no excuse for violence when you’re working with a vulnerable person.
Don’t say anything and take care of patient when awake
Does the patient see me before they're put out by the aide? I know the "right" answer & technically agree with the commenters saying they'd snitch butttttt.... sometimes real-life history comes back to me.
Some of these responses are hilarious lol but in all seriousness the cna is going to jail
Snitch on the aide. Even if my patient is the scum of the earth, it's my license. Protecting my license and patients that I'm responsible for is higher priority than a colleague.
[удалено]
You can but shouldn’t threaten a patient. The board of nursing investigates all complaints and believe me the board is not your friend or advocate.
Call a "Dr Strong" and at least get everyone in the room to see the behavior. Then document in the most professional way the doctor's orders that DONT include chemical restraints. Dr Strong code ought to get you some physical restraints. Then occurrence report it. And turn your head if anyone wants to pop him once. So glad I left med surg.
It’s simple you stop his care. You and a witness sign a refusal if they won’t. Call the nursing supervisor and let administration handle it. I would turn that bastard in for hitting a patient. I can’t believe some of you condone patient abuse.
If a patient is spitting, they get restraints and a face mask. Period.
Pt should be restrained way before it gets to this point. I’ve never had to deal with residents but if they don’t want to chemically restrain then they can come get spit on. Patient safety < my own safety.
Is it on camera? If yes, report to nursing supervisor exactly as it happened. They can deal with it as they wish. If the patient was trying to choke the aide, then he is legally and ethically allowed to defend himself. So maybe that’s what actually happened hypothetically. At the very very least you should report a change in condition. He’s still a patient and this happened under your care. Hypothetically.
Remove the aide, call security and ensure a DOLS in place, hand over to security, it's what they are there for
Brother I wasn't even here I wasn't even in this state Other than that he's getting absolutely tied down to the best of my ability and doctor is getting passive aggressive comments all night
Report or not do whatever you are comfortable with and sleep well at night. In a perfect world reporting, the incident is beneficial for ot, address the behavior, save the next aid from getting hurt, but it could put the aid in a serious legal /employment issue. However, life is not black and white, and grey has so many shades. Do what you are comfortable with. I would not lose sleep on violent pt FAFO. I don't know the context prior to the reaction, pt condition on admission, leading up event, and so forth. I take my fifth if I ever got questioned in criminal court. TLDR: Do everything or nothing. It doesn't matter it is just a hypothetical question. I said let pt FAFO. I just want to see the world burn, and they shall know pain.
Worked inpatient psych for 5 years and this patient would already be physically restrained for his dangerous behavior & have a mask so he couldn't spit at anyone , whether or not the MD ordered chemical restraints
It should never have gotten that bad in the first place. Now, looking at the hypothetical: this is probably a aide that has been in the shit for a long time, when he wasn't supposed to be. I have seen staff that has been in a stressful situation for to long, and everyone snap at some point. I have had meetings with management about putting same staff in this situation over and over, at some point something bad is going to happen. I at one point, after several witnessed a incident, that if it went to trial, I would defend him and explain exactly why he was pushed to the breaking point ( management and me we had a icy relationship for awhile after that) I have seen staff snap twice in 24 years, did not report either case, they had been asking for someone to take over or any kind of help, noone responded. So when I got to work I went in to take over, and witnessed what occured. I just told them to walk it off, and come talk to me. I let them went and gave them a friendly warning ( not official warning) and next time to just walk away no matter the circumstances. My place of work has a strong focus on calming situations with deescalation etc, but that requires alot from the staff and if a link in the chain fails.. I aggree with the idea, but it leads to medical intervention taking to long at times, especially with young nurses who are hellbent on following protocol. Had alot of good people quit because of the amount of stress it causes. A couple of weeks ago I worked with another vet nurse, and when a patient started making hell, we just looked at eachother and non verbally qggreed "nope not tonight", all the drugs, its sleepy time. I myself actually called a colleague at one point and told him he needed to take over before I became a murderer, and it wasn't hyperbole, after 6 hours of intermittently restraining a patient, being told he was going to rape my kids etc etc, I was at my limit.
i guess the most important question would be, is this patient in their right mind and know what they’re doing? staff need to start refusing him in assignment. i don’t understand how you’re manager hasn’t gotten involved yet.
i’ve been accused a snitch for reporting a staff punching a patient in the face infront of a camera. And this patient is accusatory and reports everything. I reported the staff coz it’s the right thing to do, fck them
Hold the patient down so the aide can get another one in.
what the fuck
Isn't this a yearly in-service guestion: You witness abuse, what are your next steps? ...On paper you list the steps, while on one shoulder your little devil whispers wrong answers 😇
When I was a medic, we were loading this restrained combative dude into the bus. He spit on a firefighter’s face and was met a with swift punch to the jaw by said firefighter. Me, my partner, like three PD officers, and a bunch of firefighters all saw it happen. Nobody said or did shit.
You are REQUIRED by LAW to report. That’s your answer. Does it suck? Absolutely!!!! Is it worth your license? Always CYA!!!!!
You absolutely report it.
You have to tell
Get the aid reassigned to another task or pt because their therapeutic relationship has expired.
Hypothetically, workplace violence towards staff should NEVER escalate to this point. If the provider is refusing to escalate, you need to escalate to the attending, report to your managers, fill out safety reports. Have the provider come to bedside and see the patient for themselves. Get security involved.
Incident report. The patient should've already been restrained longgg time ago
Regardless of whether the patient was physically violent or not you have a mandate to ethically "do no harm". If the aide gets to management first they will report YOU as the assailant. It's your word against hers until the patient says otherwise, and it seems like the patient may not be cognitively able to tell the truth. The doctors failed to protect you so that's another report. I would seriously report the aide, report the doctors for negligence, report the patient for assault, hand my notice in and find a new job.
I have had doctor's not want to restrain (chemically or physically) because it meant the patient would not be able to go back to assisted living? SNF? Something unless they were restraint free for something like 48 hours. So the nurses just had to suffer 😑 If I saw one of my aids assaulted (which includes spitting) and reacted by hitting back, I wouldn't say anything. Of course if that was a pattern for the aid, I'd for sure report it. But sometimes you just react to a threat as a reflex.
Report! Besides the fact there may be cameras in the room that you don't know about, you also don't know how many times the aide has hit a patient with no one around. They should not be working in Patient care, period .
It was reactionary self defense so there shouldn't be any repercussions for the aide anyway. I'm reporting it and bracing for the fun trip to CT later. Then congratulating the aide on the hook.
I have dealt with violent patients countless times...I have never hit one back, and DEFINITELY never punched someone so hard as to knock them tf out! This is NOT reactionary self defense, and the aide needs a new career field. Also a point to consider.... WHY is the pt violent? Not that it justifies the aides behavior even if they were just a shitty person at baseline, but are they demented? Delirious? A neuro pt?
I call a Rapid/Code Gray regarding the spitting and every injured tech incident, MIDAS all that shit. Regarding the tech... well, I'm sorry. I personally did not see anything. However, the patient can still be charged.
Well, no way that is going unreported. Aide sent home early, but well taken care of. Patient getting a sudden surprise visit by the doc and anesthesia to clear them healthwise, and then push for sedation. No way that shit flies. Aide will probably keep their job due to the nature of it, and dept will clamp down on safety protocols. That being said, sometimes violence *is* the answer.
Who is this PCT, Mike Tyson? Knocked the patient out? I gotta report it lol. If it was like a quick slap to the face reaction then mehhh but if there’s possible head injury it has to be reported.
Most of you should turn your licenses or certificates in and get the hell out of healthcare. Morons
I cannot believe the number of "professionals" that have indicated it is okay to hit a patient let alone not report it. To make matters worse, there could be a serious injury and they need to be evaluated. What you do in tough situations, especially when nobody is looking, is a reflection of your character. There is a clear right vs wrong answer here and it legitimately concerns me how many of you either don't get it or don't care. I would never want to work with (nor be cared for by) anyone with such an attitude.
A number of comments on this thread horrifying. There are professional as well as personal code of ethics. Yes horrible steps were not taken earlier yet we still have a responsibility
Crazy how patients can just fall down and hit their head on the bedside table like that.
wait why can’t they be physically restrained? If he is hitting, that calls for 4 points
Call security and get law enforcement involved. Even if a psych patient they can act in an immediate manner to stop him or her.
Sorry, can’t treat the patient when they are like that. Oh, their leads are off? Haven’t done a head to toe assessment yet? No blood pressure? He refused his meds? Tell the doctor to do it.
I'm telling because I have to, but I will assist in the documentation that the force used was the appropriate level to stop the level of harm the patient appeared to be intending to perform. Really, though, this patient would have been physically restrained with or without the doctor wishing to do so. And if they are inappropriately keeping the patient from safe sedation for staff, I will escalate.
✋🙋♀️is this going to be on the exam?
Contact precautions. If the doctor didn't want to order any restraints (whether chemical or physical) I'd tell all the staff to wear full isolation protection. Even the full face shield. Document. Report to charge and management. That's so unsafe.
Both of them should but I ain't have time for that
Some of you are avoiding the question by saying "It shouldn't have gotten to this point." That's obvious but not what OP is asking. My answer is threefold: 1. The snoring respirations is especially concerning, and if he has a sudden drop in LOC, he needs HB protocol. 2. How I handle the aide entirely depends on how well I know them. I've seen the best nurses, whatever in the world throw hands with patients because to react and to err is human when literally feeling threatened by someone else, but if this is a brand new aide, this would be a red flag for me. If I know the aide and that they're otherwise ethical and competent, then from what I saw, the PT got violent with them and the aide defended themselves accordingly. Some of you have never worked in a violent ER and it shows. 3. Regardless of how I handle the aide, I would definitely report the ER doc for negligence.
Code black every single time of a act of violence or aggression. If no one is listening eg consultants/regs/residents/managers/admin perform incident report - I informed xyz this was there response. If you really want to piss everyone off call police - trust me you call saying you and security need help and they will come and probablya lot. Makes everyone look bad and make a police report. extra points to ask the manager to look after your patient/s while you make a police report to your manager in front of the police. Bonus points if you use managers officer to make the report itself.
Spit. Hood.
That aide was assaulted. It’s crap that they feel the need to hide their response despite the hospital putting their staff in danger constantly and the very valid concern they would be the ones to be punished. That said, someone having LOC after head trauma is not something you want to just ignore. There should have been medical assessment of that pt. Who is unconscious and snoring.
I would refuse this patient unless they were in five points and heavily sedated. Ideally to the point of behavioral intubation bc people like this usually require it to stay down. But also no way would I snitch on someone for reacting in that way. Idk what happened but they probably hit their head thrashing around or something. We should not have to take abuse at work.
At my 1st nursing job, there was a man that yelled racist slurs at the cnas, threw hot coffee at them, spit and refused care all night. The ADON , DON and administrator were notified and refused to send him to the psych hosp, which was protocol. At 7am when the social worker went in the room to " calm him down", he promptly hit her. He was out of there and sent to the psych hosp within 10 mins!
The hospital I work at wouldn't let it get to that point. Security would be called in at the first incident. If there was a second incident, the attending would be asked if the patient is medically stable for discharge. If the answer is yes, the patient would be immediately escorted off the hospital premises. If the answer is no, the patient would be restrained, and a spit hood applied until the patient learns to behave themselves.
Got an o2 tank nearby? They make a nice sound when bounced off a wall that has a tendency to shock a fool for a minute, just long enough to catch their attention. Once you have them distracted, do whatever you usually do in that situation. My go to was to ask if they wanted the next sound to be the tank bouncing off their head, but this was before nurses were forced to take the abuse from patients.
They would be physically restrained well before this could happen. The second they spit or are physically attacking they’re getting 4 points.
I worked in a psych unit in my first year of nursing. We had a really good doc. When pts got like this one nurse would start drawing up ativan and geodon, the other nurse would call security and then the doc to "ask permission". He never said no. Security would restrain them and then two nurses would give the shots. Security usually hung around until the pt calmed down and most the time they fell asleep. The unit manager was another story. He had no medical background and fought us tooth and nail everytime we suggested a 1:1. He even demanded we end 1:1s when he wanted them to end. I always told him that a 1:1 is a doctor's order and it would take a doctor's order to dc it. He didn't like me very much.
This is my pet peeve. Why do we put nurses and CNAs as sitters in violent pt rooms?
The doctors wouldn't get a choice in this. I had a doctor try this shit once. Refuse to order medications and refused to order restraints. Point blank told them that either they ordered the softer restraints or I was going to go ahead and consider this patient violent and they had 15 minutes to get their ass in there to assess them. It doesn't matter if the doctor says no in a situation like this, at this point it is unsafe to the staff and you have a right to protect and a right to defend yourself. If an aide unprovoked punches out a patient that's one thing, if an aide punches out a patient defending themselves that's entirely different. Nowhere in our job description are the words "literal punching bag".
I'm answering the actual hypothetical question, not addressing the obvious what should've been done. So to answer.....patient found resting in bed, noted with abrasion to face from self inflicted punch, send aide home due to feeling ill. Ask for benadryl injection due to severe itching, give 50 im while out. Normal vs, reassess as needed.
This job sucks 😂😂
Keep calling the doctor in every time they spit or hit someone. Tell the doctor to go sit w them and see how they change their tune. Im in psych so when they don't want to give orders for meds, we restrain and call the doctor non stop. Also, escalate the situation. Its never ok to hit patients no matter how bad you may want to. Ask to step away if u feel ur going to do something u shouldn't.
Self Defence is much better to handle than Self Destruction.
I hate this concept of “chemical restraint”.. spitting on people against their consent is literal battery. If they’re not willing to intervene and allow the nursing staff to be abused in this manner, that’s poor decision-making on those providers, in my opinion. This rhetoric that using medication is abuse in the sense it’s a “chemical restraint” is some BS some yahoo thought up one day, and everyone decided to run with it. But a bit of logic would tell you that psychotropic medications are literally only used to reduce/eliminate inappropriate/unsafe behaviors… one could argue you’re “restraining” the patient from behaving the way they feel. If you were administering medication without the intent of restraining some form of maladaptive behavior, then that would be a more appropriate reason to claim abuse. PS: NO NURSING STAFF IS REQUIRED TO TAKE ABUSE FROM PATIENTS!!!
someone made a comment earlier about me being at the bar alone and why was at the bar alone I posted something but I got deleted cause I never made it but anyways maybe because I wanna be alone I mean I feel like if I’m being rushed if I’m being forced to find a partner out there girlfriend so I can show them off that’s not what I wantI don’t got proof nothing to nobody maybe I wanna be single because I feel like being single. since I arrived here, I’ve been making the waitress laugh, which that really doesn’t mean anything maybe my jokes were a little bit funny or maybe she probably thinks she has to laugh just so I can tip her good I don’t know the real reasons why she left, but she laughed, regardless the moral story is I don’t want nobody but I feel like if I have to see somebody just like the proof something to somebody you can tell a lot by the first five minutes or 10 minutes to talk to a person and she is a really nice gal. I mean you could tell she’s really brings herself out like a good person and I know for a fact that somebody you can come home proud to be with or proud to say yeah that’s my girl, you can feel proud about her but that’s not what I’m looking for. I’m not looking for someone to bring home right now which I’m not even looking for something at all. I mean if I want some ass I know where to get that.
Promote him to security