Nurse Safety: How Do We Ensure It? 

• Safety in the workplace is a hot topic in nursing and will not change overnight. 
• Sharing real life scenarios can help other nurses know they are not alone. 
• Realistically, we cannot make patients stop abusing nurses, but we can take steps to implement positive changes to nurse safety

Every time I hear the words ‘safety in the workplace’ I have instant memories of doing modules on the computer at work while simultaneously attempting to chart and answer the work phone or call lights. It seems like a mundane task but the idea behind it could quite literally make the difference between life or death. I think one of the most important things that needs to be asked with any education given, is how does this translate to the real world?  

In the real world, will a belligerent emergency department patient on hallucinogens or other mind-altering drugs be receptive to what is taught in our safety classes? Will a sex offender with a history of documented abuse magically not be inappropriate towards staff if we make it clear abuse is not tolerated?  

If the best education is provided to staff, it does not negate the fact that certain patients will fail to comply or respond to intervention. In the following paragraphs I am going to discuss a minor incident that happened one night on a medical surgical floor.  

A Personal Anecdote on Nurse Safety 

It was a beautiful evening as I drove to my per diem night shift job on a medical surgical unit. What would the night hold I wondered? It would be a hit or miss if I were assigned to acute medical surgical patients or the long-term patients who were unsafe to discharge, but also did not meet medical criteria to stay. It was starting to feel like I worked in a long-term psychiatric ward and every night was a full moon.  

One of the patients assigned to me had a history of threatening staff, especially female staff. I had a job to do though, and I went in to introduce myself and set a plan for the night. The patient immediately became verbally abusive and issued physical threats to harm my person. Due to the patient’s physical condition, I was not too concerned for my bodily safety.  

Does this make the threats acceptable? The answer should be a resounding no! Yet I proceeded with my care and offered medication (patient refused), charted, and set a plan for wound care.  

Because of the threats and size of the patient, I asked two coworkers to assist. With my panic button attached to my scrub top and my work cell in my pocket, I took a deep breath and went in.  

Mind you, this also took two staff members away from their duties for 40 minutes on an already short-staffed floor. When I was finished, the patient took a swing at me. Thanks to my cat like reflexes, I was able to dodge the punch. 

Navigating Nurse Safety

There are several facts in the above real-life scenario that I would like to bring attention to. The patient verbally abused me by calling me a derogatory name. The patient then attempted to physically assault me. I took the appropriate steps to protect myself as well as my coworkers by notifying security and documenting the patient’s (well known) behavior.  

I had the safety training. My coworkers were team players and assisted me for my safety. Security was quick to respond and prevented this specific patient from physically assaulting me, yet no interventions were effective at completely stopping the verbal abuse.  

But the bottom line is, the patient was abusive.  

With all the safety measures in place, this patient continued to be abusive. It is also a fact that the patient needed wound care and antibiotics to prevent further complications to his already deteriorating status.  

The question I feel should be yelled from the hospital rooftops is, how can hospital administration keep nurses in a safe environment while ensuring their nursing licenses will not be affected when it becomes physically or mentally unsafe for nursing staff to care for a patient?  

If I had refused to care for said patient in the above scenario, one of two things would have likely happened: I would have been written up for not caring for the patient, or worse, one of my coworkers would have been stuck caring for this patient, who would have most likely been verbally and/or physically abusive to them as well.  

The Bottom Line

In conclusion, serious change needs to be made. In the world we live in, nurse safety will continue to be a concern, especially in acute care settings. Although we cannot change this, we can all contribute towards taking steps to keep ourselves safe.  

Whether is it advocating for harsh felony penalties for each assault against healthcare workers, pushing for change to only admit patients with active psychiatric diagnoses or protecting nurses if they refuse to care for patients who are unsafe after interventions are implemented. The change starts with us. You can start today by joining the American Nurses Association and becoming a nurse advocate is a great first step in making individual voices heard.  

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