Nursing Degrees, LPN-RN, RN-BSN, RN-MSN, Associate, Bachelors, Masters and more!

---

Nursing Topics, A to Z, Search Our Site or The Internet: Free Nursing E-mail, Check Your Mail

---

---

Nursefriendly.com (homepage) About Us Add URL Contact Us Gifts For Nurses Linking Policy Privacy Policy Search Our Sites Top Nursing Topics: A to Z Nursing Topics About Nursing: Certified Nursing Assistants, CNAs Disabled Nurses Impaired Nurses LPNs, LVNs Registered Nurses Advanced Practice Nurses Clinical Nurse Specialists Nurse Practitioners Ask The Nurse Associations (Nursing) Authors (Nursing) Boards of Nursing Burnout (Nursing) Businesses (Nurse-Owned) Brainteasers Care Plans (Nursing) Careers In Nursing Case Studies (Malpractice) CEUs (Nursing) Commonly Used Drugs Chat (Nursing) Clothes (Nursing) Colleges (Nursing) Consultants, Nursing Current Events, Nursing News Degrees in Nursing Discussions (Nursing) Drugs (Commonly Used) Education (Nursing) Employment (Nursing) Entrepreneurs (Nurse) Equipment (Medical) Forensic Nursing Gifts For Nurses Going Shopping Health & Wellness Health Insurance Healthcare Unions, Nursing Unions, Organized Labor History of Nursing Hospitals, Medical Centers Informatics Nurses Intravenous (IV) & Infusion Therapy Jobs in Nursing Jokes (Nursing) Journals (Nursing) Legal Nursing Consultants, LNCs Long Term Care, Nursing Homes Male Nurses Malpractice Cases Medical Centers, Hospitals Medical Equipment Medical Humor, Nursing Jokes Men in Nursing Nurse Training Nurse Entrepreneurs Nursing Associations Nursing Authors Nursing Burnout Nursing Care Plans Nursing Careers Nursing (CEUs) Nursing Boards Nursing Clothes, Scrubs, Uniforms Nursing Colleges, Schools Nursing Consultants Nursing Degrees Nursing Discussions Nursing Education Nursing Employment Nursing Entrepreneurs Nursing Gifts Nursing Homes, Long Term Care Nursing Informatics Nursing Jobs Nursing Jokes, Medical Humor Nursing Journals Nursing History Nursing Malpractice Cases Nursing News Nursing Pay Nursing Programs Nursing Refresher Courses Nursing Research Nursing Resumes Nursing Salaries Nursing Scholarships Nursing Schools, Colleges Nursing Scrubs, Uniforms Nursing Shoes Nursing Shortage Nursing Stories Nursing Students Nursing Uniforms Nursing Unions, Organized Labor, Healthcare Unions Nursing Wages Paychecks (Nursing) Prescription Drug Indexes Puzzles, Quizzes Relocation Resources Refresher Courses Research (Nursing) Resumes (Nursing) Salaries (Nursing) Scholarships (Nursing) Schools of Nursing Scrubs, Nursing Uniforms Shoes (Nursing) Shopping (Going) on the Internet Shortage (Nursing) State Nursing Boards Student (Nursing) Training (Nursing) Traveling Nurses Uniforms, Scrubs, Nursing Unions (Nursing), Organized Labor, Healthcare Unions Wages (Nursing) Work At Home Opportunities

See also: Medical, Legal Nurse Consultants, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety: To receive each case and supporting resources by E-mail weekly, please click here. Subscriptions to the Case of the Week are Free. Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material. Summary: It would seem absurd, that if a physician admits and facility assigns a nurse to care for a known violent patient, that it has no legal obligation to protect that nurse against violence. In this case, a psychiatric patient sought admission to facility. On admission, he threatened to attack a nurse. When the patient would follow through on his threat, the nurse was denied legal recourse against the psychiatrist who could have taken precautions against the attack. The patient had a known violent history which included self- mutilation and sexual abuse. He additionally has a long history of alcohol and drug abuse placing him in a "high risk" category. "Violence is also one of the most important reasons for admission to psychiatric hospitals and the psychiatric units of general hospitals. Up to 40 percent of persons admitted to the psychiatric wards of general hospitals are violent immediately before admission. One study found a prior arrest rate of 26 percent among patients admitted to New York State mental hospitals; 8 percent of them had committed violent crimes. In another study 23 of 60 consecutive persons admitted to a mental hospital had at some time battered their wives or husbands. Over a period of three months, 8 percent of patients at two large state hospitals committed at least one assault."2 He went to the facility seeking treatment and asked to be admitted. On admission he was placed into the care of an attending physician/ psychiatrist. On admission a threat was made "to break a nurses' neck" by the patient to the psychiatrist. This was clearly documented and consistent with the patient's past psychiatric history. "The duty to protect third parties has complicated the professional lives of many therapists. Predicting violence is notoriously difficult, and the chance that a threat will be carried out is low. Therapists must evaluate and then reduce the risk, especially but not only when releasing a patient from a mental hospital. They must inquire about potential dangerousness when obtaining information on new patients or patients whose condition is becoming worse."2 The patient would later follow-through on his threat. The nurse was badly beaten that same day. "The greatest risk of violence among patients entering psychiatric hospitals is created by drug intoxication, especially intoxication by stimulants or sedatives, including alcohol. Other potentially dangerous patients are suffering from neurological symptoms, schizophrenia, and mania. Patients are more likely to be violent if they show both aggressiveness and a low level of anxiety at admission. Among hospitalized mental patients, assaults are associated not only with hostility and suspiciousness but also with thought disorder, hallucinations, excitement, anxiety, unusual thought content, suicidal or other self- destructive acts, and low blood levels of antipsychotic drugs."2 The nurse would file suit against both the patient and the psychiatrist. In review of the admission records and on obtaining expert testimony, it was charged that precautions could have been taken to protect the staff. "Most patient assaults in hospitals are directed at attendants, nurses, occupational therapists, and other patients, but psychiatrists are also vulnerable. About 40 percent of psychiatrists are assaulted during their careers."2 Despite the fact that an expert witness testified that the admission assessment by the psychiatrist was "incomplete" and that no warning was given to the staff of the patient's violent nature, the nurse's complaint was dismissed. "Patients and staff in mental hospitals have a right to be free from violent assault, but it must be balanced against the right of patients to be free of unnecessary medication and seclusion. Some staff members fear that whatever approach they take, they will be held legally liable, but both harm and legal damages are likely to be lower if they err on the side of preventing violence."2 The nurse appealed. Questions to be answered: Does the physician have a responsibility to the staff of a facility caring for his patients to warn or take precautions to provide for reasonable safety? If the patient had a known history of violence, should orders have been written on admission to deal with the verbalized threats made against the nurse. The court would note that there is no legal duty owed by a physician/ psychiatrist to protect individuals from a patient's violent attacks. According to state law, such a duty would only exist under special conditions where a "relationship" existed. The court refused to accept that this "relationship" existed between the clinician and the nurse. The argument was made that this attack against the nurse was "reasonably foreseeable" given the patient's psychiatric history. The court noted that "warning of violent potential" might not have been given to the staff by the psychiatrist. It noted also that according to expert testimony for the plaintiff the initial assessment may not have been sufficient to evaluate the patient's potential for violence. The court ruled that the above did not change the fact that no applicable "duty to protect" existed between the psychiatrist and the nursing/facility staff. It did not accept the expert testimony as conclusive that the attack could have been anticipated. This sets a frightening precedent for nurses caring for potentially violent patients. It is common for psychiatric and geriatric patients to become disoriented and dangerous. When faced with this situation on a unit that may be short-staffed to start with, the nurse is left with few alternatives but to do the "best" with what resources are available. Knowing that the facility may very well not support or defend a nurse's actions, it is ultimately the patient that will suffer. If as in this case, the beaten nurse was left with no legal means of retribution and little support, it is a wonder we step in at all. Link Sections: Clinical Charting and Documentation, Nurses Notes http://www.nursefriendly.com/nursing/directpatientcare/clinical.documentation.nurses.notes.htm Courtroom Directory: http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/courtrooms.online.htm Direct Patient Care Links Ethics: http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm Medical Legal Consulting Nurse Entrepreneurs: http://www.nursefriendly.com/nursing/ymedlegal.htm Psychiatric Nurses http://www.nursefriendly.com/nursing/directory/spec/psych.html Psychiatric Nursing Links: http://www.nursefriendly.com/nursing/directpatientcare/psychiatric.htm Violence & Violent Patients: http://www.nursefriendly.com/nursing/directpatientcare/violence.violent.patients.htm Sources: 39 RRNL 4 (September 1998) President and Fellows of Harvard College. 1991. Violence and Violent Patients. The Harvard Mental Health Letter. Retrieved August 15, 1999 from the World Wide Web: http://www.mentalhealth.com/mag1/p5h-vio2.html The Uniform Resource Locator (URL) or Internet Street Address of this page is http://www.nursefriendly.com/nursing/clinical.cases/081599.htm Send comments and mail to Andrew Lopez, RN Created on August 5, 1999 Last updated by Andrew Lopez, RN on Monday, January 25, 2010

This Page is Part of The Nursefriendly National Nursing A To Z & Consumer Health Directories

We are Incorporated in The State of New Jersey, under the name:
Nursefriendly, Inc.
38 Tattersall Drive, Mantua, New Jersey (NJ) 08051
Our Phone #: 856-415-9617, E-mail, ICQ#6116137 (www.icq.com)

We are a proud member of The National Nurses in Business Association, http://www.nnba.net

This website Is © Copyright 1997 - 2010, Andrew Lopez, RN, Nursefriendly, Inc. Please contact us for permission to reproduce.

Other products and companies referred to herein are trademarks or registered trademarks of their respective companies or mark holders, and are not owned or affiliated with Nursefriendly, Inc. or any of it's affiliated companies.