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Private Fears of Healthcare Workers

I saw the tweet shoot across my phone during a meeting.  Someone had walked into Brigham and Women’s Hospital and shot a surgeon.  I did not know the story.  I did not need to read the details to feel the familiar terror creep into my heart.  It is not something that nurses often talk about.  In the privacy of break rooms, during whispered conversations and in our own minds we admit that patients sometimes scare us.

Death, birth, illness, surgery, dementia, sleep deprivation, drug induced psychosis, and alcohol withdrawal are examples of the dangerous landscapes that healthcare workers navigate each day.  I have been a nurse in many different situations and types of patients.  Labor and delivery is one of the most volatile units in a hospital.  Emotions run high when mothers and babies are involved.  Babies do not always go home with their mothers.  When child protective services is taking custody of a newborn, there is a palpable stress on the unit.

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Nurses are an easy target for angry parents.  Nurses are blamed, by parents, for reporting mothers who test positive for illegal drugs.  Threats against nurses and doctors are common in these type of situations.  Threats can lead to actual violence.  I have been physically hurt by angry patients.  I have seen nurses punched in the face, choked and pinned against walls.  In the back of my mind I am always planning my escape route.  My internal alarm goes off when I see a father stomping across the unit.  It makes me uncomfortable to see the poster banning guns from the hospital grounds.  Its a daily reminder that we are defenseless against a shooter that disregards that posted warning.

Hospitals practice disaster drills, one of which is an active shooter drill.  We prepare for the worst.  We hope we never have to face what Dr. Michael Davidson did on January 20th.  The investigation in the Brigham and Women’s shooting is still ongoing.  We do not know the relationship between the doctor and the shooter.  Regardless of the relationship, it will not decrease the worry and fear that healthcare workers live with in order to do their work.  Our mission and passion is to care for patients.  Patient safety is our top concern and what we base all care around.  On days like today, we are reminded that we need to also worry about our own safety.

As I was writing this post I recieved another tweet.  The surgeon has died. Dr. Michael Davidson, your colleagues around the nation are thinking about you tonight and mourning your loss.  Our thoughts and prayers go out to his family in this sad time.

 

 

 

 

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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.