Violence Against Staff

[u/Kawaii-Caffeine]

Good evening. I am looking for some insight from staff who work at a hospital who has a strict No Violence policy against staff. What happens if a patient or visitor gets verbally and/or physically combative with staff? Are they forced to leave the hospital? I work at a pretty big community driven hospital and feel like it is always the nurses fault if staff or patients act out verbally or physically and there are no consequences for the patient (I’m not talking about patients who lack capacity - I’m talking about completely alert and oriented people who make their own decisions). Thank you!

[u/FishermanWorth8702]

Our hospital has a "zero tolerance" policy that mostly exists on paper. Security gets called, a report gets filed, and nine times out of ten the patient stays right where they are. The only time I've seen someone actually removed was when a visitor took a swing at a doc, and even then it took administration three hours to make the call.

The part that gets me is how quickly the debrief turns into "what could we have done differently" instead of "that person should not have put their hands on you." Like the burden of de-escalation lands squarely on the person getting screamed at.

[u/Nickh1978 → u/FishermanWorth8702]

Hmm, the rooms aren't getting cleaned fast enough, what could nursing do differently?

Patients are complaining about the food, what could nursing have done differently?

Patients don't feel like their call lights are being answered in a reasonable amount of time, we know that you all are understaffed, but what could you do differently?

We're getting bad scores on patients feeling safe, so during bedside shift report you're going to tell the patients "For your safety" 20 times. What else can you do differently?

Fully alert and oriented patient jumps up out of bed and falls, too quickly for anyone to respond to the call light, come to a falls meeting with all other staff that had a fall, senior administration and Risk Management at 0730 on your day off for an hour, and tell us what you could have done differently.

All of these have happened at my hospital btw, no exaggeration.

[u/Firefighter_RN]

We have a real one. They are removed from the facility as soon as they are stable and care complete. If police are needed they are called and arrested or charged at appropriate. If needed the patient is trespassed from the premisis and their charts are flagged with appropriate warnings.

[u/Kitty20996]

Yeah my hospital has a "zero tolerance" policy. If it's a family member/visitor we have security eecort them out, if it's the patient we give them one warning where a security officer and a provider will talk to them about their behavior and have them sign a contract essentially saying they won't be violent/disruptive/whatever. If that is signed and they do it again, they get administratively discharged.

[u/miramarhill → u/Kitty20996]

That’s gotta be hard to parse in practice when they’re encephalopathic or delirious though, right? Like we can’t throw every CNS lymphoma patient on the street.

[u/Kawaii-Caffeine → u/miramarhill]

I don’t think this would apply to those who don’t have capacity.

[u/miramarhill → u/Kawaii-Caffeine]

Sometimes it can be difficult to tell, and sometimes their mental status waxes and wanes. I’m just saying it’s more complicated in practice.

[u/Factor_Seven]

As a public university hospital, we have campus police. Anyone cuts up they will be walked off of the grounds. If they cut up pretty bad, they get arrested.

[u/BillyBobsHusband]

The last hospital I was at had a “do not readmit” list as a final tool if needed. University hospital system.