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The Squeeze

Allen, Danielle RN

AJN The American Journal of Nursing: September 2017 - Volume 117 - Issue 9 - p 72
doi: 10.1097/01.NAJ.0000524555.11932.59
Reflections

Why is the experience of violence a commonality in nursing?

Why is the experience of violence a commonality in nursing?

Danielle Allen is an RN in California. Contact author: nursealwayswrite@gmail.com. Reflections is coordinated by Madeleine Mysko, MA, RN: mmysko@comcast.net. Illustration by McClain Moore.

Figure.

Figure.

I was leaning over my patient, listening to his lung sounds, when his hand tightened around my wrist. “Why don't you get in the bed with me?” he said.

With a complex psychiatric history and significant violence in this patient's background, I'd already been somewhat nervous about caring for him. He'd made inappropriate comments about my body earlier in the shift, and also repeatedly disregarded my safety instructions, once to such an extreme that I called security because the patient was a risk to himself. He continuously demonstrated a lack of respect for my profession, and for me personally. I knew I shouldn't have gotten so close to him—to put myself in a vulnerable position. But he'd been complaining of shortness of breath, and my desire to protect my patient won out over my better judgment.

He was breathing just fine. He'd tricked me.

Now, the bones in my wrist threatened to pop. He tugged on my arm, trying to pull me into the bed. Somehow, I managed to keep my voice steady as I looked into his face and said, “Let go.”

Thankfully, he did. What would I have done if he didn't?

I walked out of the room and found the charge nurse. My brave face bunched up, and this time my voice shook as I relayed what happened. I refused to care for the patient any longer, and went to take some deep breaths in the break room.

The reactions in response to my refusal were mixed.

“Did you try kidding around with him? Sometimes, if you lighten the situation, then patients like that will stop.”

“Just ignore him. Don't let it get to you. We used to have patients like that all the time at my old hospital. You get used to it.”

“I'm sorry that happened to you. Are you okay?”

“It really sucks, but we all have to take a turn with those kinds of patients.”

One of my male colleagues offered to switch patients with me, but with only an hour left in our 12-hour shift, I felt it wasn't fair to jostle his assignment. I didn't want to be that nurse. You know, the complainer, overly sensitive, not-a-team-player nurse.

So I took the patient back. I cared for him for the longest hour of my career, despite feeling uncomfortable.

Despite my better judgment.

Despite being afraid.

I even made a joke about the incident to the oncoming nurse on report, downplaying how I felt about the entire thing. After all, maybe I was overreacting? Besides, someone has to take care of him, right? If there's one saying that permeates nursing more than any other, I'd argue it's the patient comes first.

But as I drove home in silence, my hands started to tremble on the steering wheel. It wasn't just because of what had happened, but what could have happened.

What if he hadn't let go?

I felt abused, unsafe, and angry. And the person I was most angry at was myself, because I had begun to believe that violence is an expected and accepted part of being a nurse.

It shouldn't be.

Not long after that shift, a horrific video of a patient attacking nurses with a metal bar in Minnesota went viral, and my mind instantly went back to the patient who grabbed my arm.

What could I have done differently to protect myself? To protect my colleagues? And how can hospitals better protect their nurses from these acts of violence?

My greatest regret was making a joke to the oncoming nurse, downplaying how I truly felt when the patient grabbed my arm. I wish I had better prepared her for dealing with the patient. Violence against nurses isn't funny. I wish I'd been able to give her more support.

I became a nurse because I wanted to improve people's lives, but where is the line between providing care and putting ourselves in harm's way?

This incident wasn't the first time I'd experienced or witnessed violence in nursing, and almost every nurse I've talked to has their own story. So the question is, why is violence a commonality in nursing? And how do we collectively change that? What kind of support can we ask for? What would it mean for nurses to refuse to let violence continue to be an accepted part of nursing?

I don't have the answers to all these questions. Although preventive training and protocols for responding to violence are now common, no protocol can ever be foolproof. While health care institutions have a responsibility to protect the safety of nurses, nurses also have a responsibility to support each other. And individual nurses must take on the toughest responsibility of all—advocating for themselves.

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