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Nursing is notorious as being one of the most violent occupations, but for a field that is devoted to healing and caring, why would there be any reason to resort to violence?
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Seattle Times (2011, July 12) published a feature by reporter John Ryan, of KUOW News, stating that nurse’s aides have the most violent jobs; in particular, those who work at Western State Hospital and care for psychiatric patients with a criminal history. Although most nurses will never work with patients from this demographic, there are other patients that predictably resort to violence. Such patients include:
- Those that are confused either due to memory loss or a physiological imbalances such as low blood sugar
- Intoxicated or drugged patients
- Situationally angry patients or family members
Of all medical professionals, emergency room (ER) staff see more patients that exhibit aggressive tendencies than any other medical specialty. The American College of Emergency Physicians (Fact Sheet, n.d., para. 3) attributes this imbalance to several reasons, most of which are due to the primary function of an ER; acute care. Reasons listed include, “increased numbers of gang members in urban areas, increased use of alcohol and other intoxicating agents, and increased use of Emergency rooms for temporary holding of psychiatric patients.” In a study conducted by Fernandes et al. (1999), “over 50% of emergency department health care workers report being physically assaulted in the course of a year and 90% had been verbally abused at least once a week.”
For the above reasons, many hospitals and emergency departments have implemented training as a way for employees to recognize the initial signs of aggression and learn how to handle violent situations. The Centers for Disease Control and Prevention (Workplace Violence, n.d.) has a nice online training module that teaches important strategies to avoid and reduce workplace violence. Ways to stay safe include removing jewelry that can be grabbed, facing patients at all times, and knowing all exit options. Also, learning how to diffuse situations of mounting tension is an important strategy for this and most training modules.
In my own experience as an emergency room nurse, I have received training to avoid and protect myself from violence. Some of my training included:
- Safety in numbers. People who are on the verge of becoming violent often back down when they are outnumbered.
- Violence begets violence. Do not argue with someone who is losing control. It is unproductive and unhelpful.
- Assume the worst. Until rapport has been established, every patient could be potentially dangerous. Know your patients and pay close attention to characteristics that may jeopardize your safety.
- Watch yourself. Some patients, when scared, become hitters, biters, spitters, and kickers. Remain vigilant and keep a safe distance when possible.
In summary, although I found training helpful, experience is still the best teacher. In my experience, I found that the most common form of physical violence stems from elderly, confused patients, who suffer from a form a dementia. These patients, in particular, need a calm environment and extra time to help them keep control. When placed in an unfamiliar, chaotic setting, they can become scared and sometimes, resort to lashing out. Fortunately, not all patients with dementia act this way and even patients who are fully cognizant, often need short amounts of information, with repetition if necessary.
Lastly, and most importantly, for patients who cannot maintain control, medical workers need to recruit the help of others so that medical care can be provided and injuries can be avoided.
References
Fact Sheet. (n.d., para. 3). In The American College of Emergency Physicians. Retrieved from http://newsroom.acep.org/index.php?s=20301&item=30010
Fernandes, C. M., Bouthillette, F., Raboud, J. M., Bullock, L., Moore, C. F., Christenson, J. M., & ... Way, M. (1999). Violence in the emergency department: a survey of health care workers. CMAJ: Canadian Medical Association Journal = Journal De L'association Medicale Canadienne, 161(10), 1245-1248.
Workplace Violence Prevention for Nurses. (n.d.). In The Centers for Disease Control and Prevention. Retreived from http://www.cdc.gov/niosh/topics/violence/training_nurses.html
Seattle Times ( July 12, 2011 http://seattletimes.com/html/localnews/2015584122_apwaworkplacesafety1stld.html)
John Ryan, KUOW News.
