Nursing Notes

March 20, 2010

Violence on the Oncology Ward

I love the New York Times Well Blog.  I can’t help it; I truly enjoy reading it.  I hope you will enjoy reading this article from that blog that describes in detail how you can be simply doing your job one minute and the next you can be in a violent encounter with a patient or a family member.  This is real and continues to be an issue for nurses on the floors.

I don’t believe we should go to our workplace afraid, these encounters are not frequent, but we do need to know that they happen and we need to plan to deal with them when that happens.  As a psych nurse, we are required to train yearly in aggression management, yet even with this training, we still get sideswiped and sometimes get injured.

Please read this article and then let me know your thoughts.  If you have had any similar incidents, feel free to share them here with us.

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March 17, 2010, 11:27 am

<!– — Updated: 10:36 am –>

By THERESA BROWN, R.N.

I’ve read about hospital nurses dealing with violence at work, but I always told myself that was something that happened in the emergency room or the psych ward. In oncology, I reasoned, we have relationships with our patients, and I have always felt safe with them.

But recently that changed, all in the course of one very strange day.It began when one of my patients, a 22-year-old woman who had undergone abdominal surgery the previous day to reduce a large tumor, was given a morphine pump for pain. Her father, for no discernible reason, said he knew the pump was a fake and wanted his daughter to “get the good stuff.”

Then he recounted a conversation he’d had with a neighbor, saying he would have to “reload my gun and bring it to the hospital” if the nurses didn’t give his daughter her pills on time.

While I worked he kept talking, about how he had served in Vietnam and that President Obama was going to “take our guns away.” His manner was genial, even nonthreatening. But I left the room in a daze.

I told Mary, the charge nurse, and she called security, who took the father aside and talked to him. It might have been his idea of a joke, but I was stunned.

That should have been enough for one day — worrying about a man with a gun. But a couple hours later Mary and I were standing at the nurse’s station when we heard shouting from another patient’s room. The voices got louder as we hurried over.

The patient was lying on one of the cots we let family members use to stay the night, rather than on  his hospital bed, and was shouting, “Get her away from me!”

His wife was leaning over him, shouting, “He hit me! He hit me!” A welt was forming under her right eye, while he was getting closer and closer to falling on the floor.

Mary and I looked at each other. “Condition M?” she asked, meaning “mental.”

“Yes,” I said.

She called the condition, and the two of us tried to get him back into his bed. We lifted him up, and his legs collapsed beneath him. By this time others had been alerted, and more nurses came into the room. Four of us together held him upright and safely got him back to bed.

Then a lot of things happened at once. The patient became unresponsive, appeared to have lost consciousness and made a worrisome gurgling sound in his throat. This time we called a “Condition C” — a medical emergency, because it looked like he’d had a seizure.

One nurse hooked him up to the portable defibrillator, and his own nurse, who had left him and his wife talking calmly in the room just 10 minutes before, took his blood pressure. I yelled for a “pulse ox” to check his oxygen level, and an aide came in to get his blood sugar.

This is when the details get hazy for me, because at some point the patient’s wife lunged for him. I was standing behind him and instinctively grabbed for her, hoping to keep him safe.

She wasn’t physically any bigger than I am, but she was angry and, I found out later, drunk. Those two things made her strong. She wrenched herself around, trying to get away from me and back to attack her husband. I caught her again, wrapping my right arm around her chest from behind, fighting to turn her away from the patient and toward the door.

It was one of those spooky moments when I seemed to watch my own body from far away. Dissociation, I know it’s called, but the technical term doesn’t really capture how it feels to find oneself suddenly wrestling a violent, yelling and drunk person, step-by-slow-sliding-step, out of a small room where other people are trying to make a patient stable.

“I didn’t sign on for this,” I thought to myself during the struggle. Beyond sheer grit, I had no skills at self-defense or crowd control to draw on to help me. A male I.C.U. nurse showed up and joined me until security could get there. “Get – her – out – of – here!” I said through clenched teeth, pushing her toward the door. Security eventually stepped in and moved her out of the room.

According to the most recent statistics available from the Occupational Safety and Health Administration, nurses and health care workers are the most common victims of nonfatal workplace violence in the private sector. In a 2004 article about workplace violence in health care, the researchers, Kathleen McPhaul and Jane Lipscomb, assert that workplace violence is one of the “most complex and dangerous occupational hazards” that nurses face. There’s even a YouTube video that features pictures of bruised nurses who were assaulted on the job and ends with a call for action to stop violence against nurses.

Later that day, the patient who had been attacked by his wife was doing better.  And the father who liked to talk about guns had calmed down as well, hinting now in a friendly way about the clandestine work he had done in Vietnam.

The next day I was home and my right arm, which I’d used to grip the violent wife, ached from my shoulder all the way down to my hand. The muscles in my arm would heal in a couple of days, but regaining my peace of mind will take much longer.

Here’s the link to the original article

Here’s the YouTube video this article talks about:

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2 Comments »

  1. Love the blog; I’ve put you on my blogroll, if you want, you can put me on yours too!

    As a male, I’m currently a nursing assistant in nursing school (be LPN late summer, RN next spring). I seem to always get the alcohol detox patients… now thats a violent bunch there!

    Comment by Rick — March 20, 2010 @ 2:45 pm | Reply


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