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Should It Be Okay to Beat Up the Nurse?
Consider This... Should It Be Okay to Beat Up the Nurse?
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onsider this. You are the charge nurse on an inpatient psychiatric unit of Philadelphia General Hospital, or the Southern State Hospital, or the Austen Pratt Private Hospital. Just before change of shift one day (you are looking forward to leaving), Rocky Rankle, a patient on the unit for 10 days, approaches you and says, “You're a bitch,” and punches you in the face. You are frightened, injured, and angry. Mr. Rankle has diagnoses of Axis I: major depressive disorder, single episode, and rule out intermittent explosive disorder; Axis II: personality disorder not otherwise specified with borderline and narcissistic traits; and Axis III: obesity. As far as you know, he has never been psychotic and certainly has not been during his current hospitalization. You return to work 2 days after the assault and read the nursing reports, the progress notes, and the team meeting note written since the attack. You decide you want to press charges. You are familiar with the literature on therapeutic prosecution (Hoge & Gutheil, 1987) and think that this is a case that cries out for this approach. Can you do this? That depends on (a) your hospital's policies and procedures; (b) your hospital's common practice in situations like this; (c) the position on the matter, and on this specific instance, held by the hospital director, the hospital medical director, the team psychiatrist, and central office personnel; (d) the cooperativeness or lack thereof of the hospital attorney, the local police, the district attorney, and/or the attorneys general's office; (e) state statutes; and/or (f ) your union. After considerable consideration, you say it is your right to press charges and you do. At trial, after hearing the evidence, the judge is leaning toward dismissal, but first she admonishes you for burdening the court with this, “It's part of your job; you should know that.” You retort, “Your honor, it's not okay to beat up a nurse. When the local policeman or state trooper adds ‘assault’ to the charges when he/she picks up a person with a history of mental illness who does little more than push the officer, do you say, ‘Hey Joe, it's part of your job?’ I think not. And you should not be saying this to a nurse when an actual assault took place by a non-psychotic patient.” The judge hesitates and indicates, “I'll take the case under advisement.” Then, you have educated another judge: Assault victim is not in the nurse's job description. This is the first time in your 25 years of psychiatric nursing that you have pressed charges against a patient. However, in rare instances, pressing charges may have a therapeutic effect, and isn't that your job? It is a thin line we walk between holding a nonpsychotic person without significant cognitive compromises responsible for his or her acts and excusing the person whose judgment, impulse control, and/or even autonomous acts are compromised such that he or she is not responsible for an assault. However, each case should be evaluated on an individual basis. Whether or not charges are pressed should be the same process as
Kris A. McLoughlin, DNP, APRN, BC, CSAC, and Catherine Kane, PhD, RN, FAAN, are the editors of this opinion column, a forum for addressing current topics affecting psychiatric nursing. We encourage your commentaries, opinions, and ideas on professional, policy, and practice issues. Responses to this column in the form of letters to the editor are welcomed and encouraged. The opinions presented in this column are solely the views of the author(s). Submissions to “Consider This…” should be no longer than 450 words. If references are used, there should be no more than three and will be included in the word limit. Please refer to “Information for Authors” for submission address.
Archives of Psychiatric Nursing, Vol. 22, No. 4 (August), 2008: pp 235–236
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EDITORIAL
deciding whether or not to modify the treatment plan. Individualized treatment applies here, too, for it is not in the nurse's job description to get assaulted.
Jeffrey Geller Editor REFERENCE Hoge, S. K., & Gutheil, T. G. (1987). The prosecution of psychiatric patients for assault on staff. Hospital and Community Psychiatry, 38, 44–49.
C
onsider this. You are the charge nurse on an inpatient psychiatric unit of Philadelphia General Hospital, or the Southern State Hospital, or the Austen Pratt Private Hospital. Just before change of shift one day (you are looking forward to leaving), Rocky Rankle, a patient on the unit for 10 days, approaches you and says, “You're a bitch,” and punches you in the face. You are frightened, injured, and angry. Mr. Rankle has diagnoses of Axis I: major depressive disorder, single episode, and rule out intermittent explosive disorder; Axis II: personality disorder not otherwise specified with borderline and narcissistic traits; and Axis III: obesity. As far as you know, he has never been psychotic and certainly has not been during his current hospitalization. You return to work 2 days after the assault and read the nursing reports, the progress notes, and the team meeting note written since the attack. You decide you want to press charges. You are familiar with the literature on therapeutic prosecution (Hoge & Gutheil, 1987) and think that this is a case that cries out for this approach. Can you do this? That depends on (a) your hospital's policies and procedures; (b) your hospital's common practice in situations like this; (c) the position on the matter, and on this specific instance, held by the hospital director, the hospital medical director, the team psychiatrist, and central office personnel; (d) the cooperativeness or lack thereof of the hospital attorney, the local police, the district attorney, and/or the attorneys general's office; (e) state statutes; and/or (f ) your union. After considerable consideration, you say it is your right to press charges and you do. At trial, after hearing the evidence, the judge is leaning toward dismissal, but first she admonishes you for burdening the court with this, “It's part of your job; you should know that.” You retort, “Your honor, it's not okay to beat up a nurse. When the local policeman or state trooper adds ‘assault’ to the charges when he/she picks up a person with a history of mental illness who does little more than push the officer, do you say, ‘Hey Joe, it's part of your job?’ I think not. And you should not be saying this to a nurse when an actual assault took place by a non-psychotic patient.” The judge hesitates and indicates, “I'll take the case under advisement.” Then, you have educated another judge: Assault victim is not in the nurse's job description. This is the first time in your 25 years of psychiatric nursing that you have pressed charges against a patient. However, in rare instances, pressing charges may have a therapeutic effect, and isn't that your job? It is a thin line we walk between holding a nonpsychotic person without significant cognitive compromises responsible for his or her acts and excusing the person whose judgment, impulse control, and/or even autonomous acts are compromised such that he or she is not responsible for an assault. However, each case should be evaluated on an individual basis. Whether or not charges are pressed should be the same process as
Kris A. McLoughlin, DNP, APRN, BC, CSAC, and Catherine Kane, PhD, RN, FAAN, are the editors of this opinion column, a forum for addressing current topics affecting psychiatric nursing. We encourage your commentaries, opinions, and ideas on professional, policy, and practice issues. Responses to this column in the form of letters to the editor are welcomed and encouraged. The opinions presented in this column are solely the views of the author(s). Submissions to “Consider This…” should be no longer than 450 words. If references are used, there should be no more than three and will be included in the word limit. Please refer to “Information for Authors” for submission address.
Archives of Psychiatric Nursing, Vol. 22, No. 4 (August), 2008: pp 235–236
235
236
EDITORIAL
deciding whether or not to modify the treatment plan. Individualized treatment applies here, too, for it is not in the nurse's job description to get assaulted.
Jeffrey Geller Editor REFERENCE Hoge, S. K., & Gutheil, T. G. (1987). The prosecution of psychiatric patients for assault on staff. Hospital and Community Psychiatry, 38, 44–49.