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Please Don’t Hit Me

stressI have been hit, kicked, punched, slapped, had my hair pulled, scratched, spit on, cursed at, had things thrown at me and bitten. Am I in an abusive relationship? Are those memories of an abusive childhood? Am I a street fighting ninja? No. I am a nurse.

Nurses experience abuse from patients. Patients can be impaired by disease processes, medication, and stress which causes them to strike out against the hand that cares. Multiple studies have shown that workplace violence against nurses is mostly due to patients hurting nurses. Nurses have an almost universal reaction to this violence. They keep coming back to work to risk being hurt again.

Patients who lash out

Helping a person through the detoxification process is exhausting and can be dangerous for the patient and the nurse. Alcohol is the legal, easily accessible drug of choice for some adults. When a person realizes that they have a drinking problem detoxing in a medical setting is the safest way to do it. Alcohol and drugs have powerful affects on the body which are not always understood by the abuser. Cleansing the body of the substance can be difficult to endure. It is possible to die from detoxification that is not medically managed. Young male adults are particularly terrifying for me to care for while they are detoxing. A 6 foot 2 inch, 200 pound, 25 year old man having hallucinations is no match for a woman who can barely reach the pedals in a pick up truck. Thanks to physical restraints and adequate doses of lorazapam I have avoided serious injury from this type of patient.

One group of patients that I have not escaped injury from is the laboring and postpartum mother. I have had my arm pinched, squeezed and scratched countless times from doing post delivery fundal checks. I routinely preamble the fundal check my asking my patient to “Not hurt your friendly nurse.” They look at me smiling, not quite understanding what I am about to do and why I am warning them that it will be uncomfortable. As soon as I’m pressing the top of their uterus, to assess for firmness, the claws come out. My arm is the closest target. I am actually more gentle than a lot of my counterparts, but there are times that being gentle is not in the patient’s best interest. Postpartum hemorrhage is the number one reason for maternal death. A mother can exsanguinate (bleed to death) in just 10 minutes. Although I have literally had my hand slapped, I will keep putting myself at risk for the safety of my patients.

Why is the violence tolerated?

The patients are why nurses keep coming back to face the possibility of injury. We forgive and move on to the next patient. We try to make the workplace safer, but accept that due to the nature of our work we are vulnerable to abuse. We hope that when we are ill, injured, confused and angry there will be a nurse to help and forgive us.