Nurses on the front lines: When patients attack

All nurses have stories to tell about “problem” patients. Usually, these stories are funny rather than scary. There’s one patient who finds ridiculous things to complain about. Another wanders the halls singing show tunes.

But some patients pose a danger to themselves, other patients and the nurses charged with caring for them. Here, we look at some of these tales from brave nurses who have met the challenges posed by violent patients and answered the question “What is it like to be attacked by a patient?”

Which Patients Are Most Likely to Attack?
In our informal survey, the patients most frequently reported as violent were also among the most vulnerable. Almost all were suffering from dementia, psychosis, PTSD or traumatic brain injury.

Elderly dementia patients are especially likely to lash out. Nurse Kathleen David-Cote’s story is a common example of how quickly things can go wrong: “I had a dementia patient grab my name badge lanyard and try to strangle me with it. When I ducked my head out of the necklace, she took her fingernails and scratched my arm, making it bleed. Very frightening. Her eyes were so scary.”

Bonnie Holman Erwin says she has been attacked many times. “I worked in an Alzheimer’s unit in a geriatric facility…don’t ever believe that feeble old people aren’t strong! You definitely need to be alert, quick and, most important, understanding of their condition.”

Psychiatric instability can also make patients, even young children, act out aggressively. Sometimes, nurses endure many non-life-threatening acts of anger in a single shift. Nurse Kim Ostrander Crum gives this account of what it’s like for her: “I work in a children’s psychiatric facility. I’m attacked routinely—trash can thrown at my head, punched, kicked, bitten, spit on and (my particular favorite) breasts pinched. That was all in one day.”

PTSD is another condition that can make an otherwise peaceful patient suddenly dangerous. Gina VaVerka tells this story about a patient who was a veteran: “I am an army nurse and I was working on a telemetry unit in an army hospital in Texas. My patient started screaming in the middle of the night and thrashing around the bed. I went to see what was going on. As I leaned over the bed, he grabbed onto my stethoscope and scrub top and started choking me with it. My coworkers had to pry us apart. Turned out he was having a full-blown PTSD attack from the war in Iraq. It looked like he was wide awake and looking at me. Apparently he saw me as someone completely different.”

Next: How Should You Respond to an Attack?