The strain abusive patients put on a nurse’s performance


“He was aggressive, confrontational. But more than that, his voice had an edge to it that, I’ll reluctantly admit, scared me.”

The above quote is from a New York Times Well blog post by Theresa Brown, R.N., describing a patient she was assigned that, it turns out, had a history of being violent in hospitals.

Brown, an author and Board Member of the Center for Health Media and Policy at the Bellevue School of Nursing, uses the remainder of the column to discuss the point at which a nurse’s personal safety comes before her job.

‘Safe’ becomes a mantra that embodies a set of values,” she writes, “and ‘that’s not safe’ is a warning phrase among nurses that can address staffing issues, medication questions, or decisions like whether a patient should be allowed to stroll to another floor, because he is frail or easily confused, or because of the IV medication he is getting.

With this patient I felt personally threatened—unsafe—which made me feel scarily distracted.

The issue of nurse safety was recently thrust into headlines after reports of nurse abuse by Robert F. Kennedy’s son, Douglas.

At the end of her column, Brown recounts that while it’s obviously a nurse’s job to take care of his or her patient—that care can be compromised when a nurse feels she is in danger.

“After all,” Brown concludes, “it’s my job to take care of patients, to keep them safe—this patient included. But I discovered it’s very hard to do that if I don’t feel safe myself.”

How hard is it for you to admit that you can’t handle a particular case on the job?

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Theresa Brown, RN

Theresa Brown, RN, lives and works in the Pittsburgh area. She received her BSN from the University of Pittsburgh, and during what she calls her past life, a PhD in English from the University of Chicago.

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4 Responses to The strain abusive patients put on a nurse’s performance

  1. kellisiochana

    I was working in home health and shots were fired in the basement of the home of the elderly lady I was seeing. She was on the 3rd floor of the home & her son was downstairs (on the 2nd floor) & someone else lived in the basement. I was there to collect a urine speciman and do some teaching about UTI. My visit was completed when the shots were fired, but I hadn’t left the home just yet. The police arrived & I left the home with the police instructing the patient’s son on appropriate actions to take. I certainly did not feel I should stay to ensure the safety of the family. My boss felt otherwise. She said I should have stayed overnight with the patient because she was a vulnerable adult. I am a single parent & would have had 3 vulnerable children in my home had I spent the night with this patient. I think there are limits to what nurses are responsible for. What did she expect me to do? How would I protect a patient from a gunshot? The police should have taken care of the situation (and as far as I know, they did). I just think that was not a reasonable expectation from my boss.

  2. laura00seven

    As a peds psych nurse, we often get cursed out, threatened or assaulted. One pt. a few years ago took this to a whole new level for me. She was a very sick adolescent and needed to receive IM medications and seclusion her 1st night. I was the one to give her the IMs. She focused on me because of that and developed an almost obsession with hurting or killing me. The next day a co worker called me to tell me she had been drawing pictures all day of shooting, stabbing and otherwise killing me. I came to work anyway and my manager ordered me to stay behind the nurses station for the whole shift… Things continued to escalate even though I did not have contact with her (had another nurse give her meds, make her calls etc.). We ended up calling 6 codes (4 for aggression, 2 for weapons) that shift. It was pretty much looked at as “what did I do to HER”? Until she focused on several other staff members and a SW. Luckily, my hospital now has a policy/procedure where if you feel that working with a particular pt or unit because of any reason (pt. is focused on you, you know them outside the hospital, or you’re just burned out) you can switch to another unit until the pt is d/c. Pretty much no questions asked. That has been a lifesaver, literally and figuratively to many of my co-workers and myself. Pts. May focus on nurses for any number of reasons, you may look like someone they dont like, they may develop an unhealthy liking for you or Anything else. Some are just aggressive because of their disease or pathology but no one has to put up with it. It’s not the nurses fault. By removing the focus or trigger for the pt (and for the nurse), the pt will recover faster and the nurse will remain able to work without threat of harm. I’m surprised by the number of my coworkers who don’t know their legal rights! If someone assaults, harasses or threatens you, you can press charges!!! I have never had to press charges against a pt but if I feel the need to I will, not depending on what the facility says, or any other issues. Pts or families of patients should not be given a free pass if they are a VIP either. If someone comes to your facility, you have the ethical duty to treat them and hold them to the same standards as everyone else. If VIPs don’t like it, then they should hire a private MD and nurse to tend to them at home.

  3. river

    I am a corrections nurse and handling a hostile offender comes with the territory. I have no trouble asking for assistance. When my safety is at risk, then they do not receive care until the situation is under control. I have found razor blades hidden in things shanks in body cavities. I have seen offenders with urine and feces on them from head to toe. We as nursing staff cannot address this unless custody is sure the situation is under control. There have been a few times that we have gone into cells and common areas without thought to our own safety. Luckily our custody staff have us covered. It is easy to forget the enviroment we are in. Oddly enough I really like my job. It is a new adventure everyday. I feel that I am one of the unusual. I work in a field that most people are afraid of. Some think that nurses that work in this field have been in trouble as a nurse but the truth is they are very strict about their nurse’s reputations and any negative history means –no job.

  4. Nurse Rene

    All it takes is ONE crazy patient/visitor/family member to totally consume a unit and a nurses’ entire shift! The amount of time and distraction that such people create is astonishing and usually the nurse gets blamed (as this latest Kennedy brat tried to do) for ‘being late with meds, charting, etc. etc.’ all because of ONE single nutcase. And it is RARE indeed for management to stick up for the rules and needs of the unit as they relate to the rights of the OTHER patients to be cared for and the rights of the Nurses to work in a safe and non-hostile environment-until someone gets hurt or killed. We actually used to get ‘special notice’ when a VIP was to be expected on the unit! I have yet to meet one who impressed me as they all look the same when naked, sick and scared!