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Reporting: Patient on Nurse Violence

          There is an influx of verbal and physical abuse that is affecting nurses throughout that United States and the world.  According to the American Nurses Association in the latest survey and response to the Joint Commission sentinel event, is that “62 percent of nurses had experienced verbal or physical abuse” (American Nurses Association [ANA], 2018, para. 4).  Working on the floor myself for 26 years, until last year taking a teaching position, verbal and physical abuse is a common occurrence no matter what unit that you worked on.  Experiencing first hand the morale of the staff when it came to the effectiveness of reporting incidents to the unit managers or administration, and nothing changes.  The rationale given by nurses is that they believe that their patients are not in their right mind when they lash out at the nurse and leaves them unsure of what constitutes as a violent act (The Joint Commission, 2018).  The nurses that do report the incident usually give a verbal report of the issue to the supervisor, and since it is not in writing, the incident may not be available to pass along for policy changes (Arnetz et al., 2015).

Strategies for stakeholder participation

            Awareness of the problem and formulation of a plan is the first step in the process of creating a policy (Laureate Education, Inc. (Executive Producer), 2011).  One of the strategies for stakeholder participation is through implementing an education plan for nursing professionals and practitioners focusing on the barrier to reporting incidents.  When analyzing the structure of an organizational policy that is in place, the facility should have reported data in their system, if not then this would be the best place to start.  The goal should be finding out why there is no data that reflects patient on nurse injuries.  When nurses state that they obtained lasting injuries, then ask them if they reported it, many times they will tell you no due to “nothing being done to fix the problem.”  One reason for underreporting can include a “lack of reporting policy, lack of faith in the reporting system, and the fear of retaliation” from the organization (Occupational Safety and Health Administration [OSHA], n.d., p. 2).  Many places have a no tolerance policy when it comes to workplace violence.  However, the verbiage is mainly geared towards lateral violence and not upheld when the incidents happen.  When it comes down to be a patient safety issue, patient on nurse violence is huge.  The rationale is, if a nurse is injured, staffing is often reduced, leading to job dissatisfaction, and eventual nursing turnover.


American Nurses Association. (2018, April 18). ANA responds to the Joint Commission sentinel event alert on physical and verbal violence against healthcare workers. Nursing World.

Arnetz, J. E., Hamblin, L., Ager, J., Luborsky, M., Upfal, M. J., Russell, J., & Essenmacher, L. (2015, May). Underreporting of Workplace Violence. Workplace Health & Safety, 200-210.

Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy: Agenda setting and the policy process [Video file]. Retrieved from

Occupational Safety and Health Administration. (n.d.). Workplace violence in healthcare; Understanding the challenge. Retrieved from

The Joint Commission. (2018). Physical and verbal violence against health care workers. Retrieved from

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The Broken Path

With the increase of drug and alcohol abuse tagged with the large homeless population that we have in society today, the dynamic of a nurse’s assignment.  Some people do not understand or know the progression or living options for these individuals.  It can be a continuation of the same unless the patient chooses to change and has resources to take the necessary steps to get better.

Where do these people go?

Let’s examine the options:

  1. Home – The most ideal.  Usually at the beginning of the illness, prior to and the beginning of the addiction or the progression of the mental illness.  This patient still has a job and functional.
  2. Move in with friends – The addiction is growing to the substance of their choice to the point they need to downsize due to the cost of the lifestyle.  The reason is that the mental illness untreated or treated they had lost their job or need to work part-time due to decompensating.  If the patient is treated, will they continue their meds or self-medicate?  More times than not, they self-medicate.
  3. Homeless shelters/Tent cities – The issues (addiction & mental illness) are becoming great.  The patient may have exhausted their resources to the point that their friends and family cannot take them in any longer due to stealing, the mental illness progression, or other reasons relating to abuse and illness.
  4. The streets – Life has completely changed for this patient where they could be committing crimes to support their habit or they aren’t able to work due to the decompensation from their illness.
  5. Hospitals – In Florida, we have the Baker Act.  If you feel that you are a danger to yourself or others you or someone else can Baker Act you for a mandatory 72-hour psychiatric hold.  The psychiatric doctor can hold the patient or not and also depends on if the patient takes their medications, and cooperates with meetings or rules of the unit.  Often, the patients can refuse the medication so this delays treatment.  The other scenario is that the patient forgot to make their appointment due to their illness and ran out of medication.
  6. Jail – The patient is arrested in the community and they stay there for their sentence and released back into the community.  Some with lengthy records, including felonies.  When you have a lengthy record or receive a felony, it is difficult to find housing and a job.
  7. The cycle starts back at #3 unless they get housed in an Assistant Living Facility (ALF), group home, or Skilled Nursing Facility (SNF) as a Traumatic Brain Injury (TBI) staying across the hall from a fragile individual.  The patient may sign themselves out of the facility and go back to the streets due to having more freedom and options for continuing the same circle.