Self-Defense in Healthcare, Part 4: Fair Analysis of the Organization

As in Part 3, let's say the incident has happened. The patient attacked the nurse, the nurse fought back, everybody is being taken care of and it's been a couple hours.

To investigate and analyze the situation thoroughly and fairly from the organization's perspective, the below questions must be considered.

Spoiler alert - there's many more questions than those posed for the employee. There's reasons for that, but the overarching theme is that the organization is responsible for providing a work environment that is safe from known hazards, which includes violence (OSHA's General Duty Clause).

The overarching question for the organization is, Why was this caregiver in a position where physical self-defense became necessary?

1. Have Risk Management, HR, and Legal been notified?

2. Is a 48-hour discipline hold in place? Meaning, no hurried employment decisions until an investigation is performed.

3. Has the scene been preserved appropriately?

4. Does the organization have an incident response protocol for use-of-force events?

5. Will this incident require regulatory notification (OSHA, state health dept)?

6. Was the aggressor a patient with a documented psychiatric diagnosis, cognitive impairment, dementia, or substance intoxication?

7. Was the violent behavior a known or foreseeable symptom of the patient's condition?

8. Was the violence purposeful and directed, or a reflexive/uncontrolled physical response (e.g., seizure, post-ictal state, medication reaction)?

9. Was the patient legally competent to be held responsible for their actions?

10. Was the aggressor a visitor rather than a patient — and if so, what was their relationship to the patient?

11. Were weapons involved — improvised or otherwise?

12. Was the patient's/visitor's violence risk formally assessed on admission or during the encounter?

13. Was there a behavioral care plan addressing potential violence — and was it communicated to the caregiver?

14. Had the patient exhibited prior violent behavior during this encounter or in previous admissions?

15. Was the violent act spontaneous and unpredictable, or did it follow an escalating pattern with warning signs?

16. What was the severity of the threat — risk of minor injury vs. serious bodily harm or death?

17. Was adequate security staffing present or accessible in a timely manner?

18. Were panic buttons, call systems, or other safety mechanisms available and functional?

19. Was the physical layout of the area designed to minimize violence risk (clear sightlines, no entrapment zones, accessible exits)?

20. Was the caregiver working alone, understaffed, or in an isolated area at the time?

21. Had there been prior violent incidents in the same unit — and had the environment been modified in response?

22. Was adequate security personnel present or available?

23. Was the patient/visitor's violence risk assessed and documented prior to the incident?

24. Was the environment designed to reduce violence risk (sight lines, panic buttons, escape routes)?

25. Was staffing adequate for the acuity of the patient population?

26. Was an Emergency Response protocol in place — was it activated — did it fail?

27. Had there been prior violent incidents in this unit that went unaddressed?

28. Did the organization have a clear use-of-force policy that defined what constitutes lawful defensive action?

29. Does the policy distinguish between prohibited aggression and lawful self-defense?

30. Was the caregiver trained in de-escalation AND in recognizing when de-escalation has failed?

31. Are caregivers explicitly told what they are authorized to do when they face an imminent threat?

32. Was the caregiver following, deviating from, or acting in the absence of an established policy?

33. Does the organization's "zero tolerance" policy inadvertently penalize defensive force?

34. Has the organization historically conditioned caregivers to absorb violence as an occupational norm?

35. Has the organization previously disciplined caregivers for similar defensive actions — creating a chilling effect?

36. Has the organization clearly communicated that the caregiver's life and safety has equal moral worth to the patient's?

37. Does the organization's response to this incident reflect its stated commitment to staff safety?

38. Will the organization stand behind the caregiver legally if the patient or visitor pursues civil action?

39. Does applicable state law recognize a public policy wrongful discharge claim for self-defense? (cf. Ray v. Wal-Mart, Moreno v. Circle K. Stores)

40. If termination is being considered: did the caregiver have a realistic opportunity to withdraw? If not, termination may constitute wrongful discharge.

41. Is the discipline being considered consistent with how comparable incidents have been handled across the organization?

42. Has legal counsel reviewed the decision before any termination is issued in a self-defense case?

43. Are all witnesses, video reviewed, and environmental factors documented?

44. Is the behavior classification documented with supporting reasoning — not just a conclusion?

45. Are all organizational failures documented alongside the caregiver findings?

46. Is the documentation trail sufficient to demonstrate a non-arbitrary, consistent decision-making process?

47. Has the organization applied this same level of review to prior similar incidents?

48. Is the caregiver being treated with the same procedural fairness afforded to other employees in disciplinary matters?

49. Is the organization documenting its own accountability findings with the same rigor as the caregiver's behavioral review?

50. Has the finding been communicated directly and in writing to the caregiver with a clear explanation of the reasoning?

51. Are there patterns of violent incidents on specific units, shifts, or with specific patient populations?

52. Has this type of incident occurred before — and were systemic changes made?

53. Is workplace violence being accurately reported — or is underreporting masking the true scope of the problem?

54. Has the organization benchmarked its violence rates against OSHA/NIOSH data for comparable facilities?

55. What systemic changes are indicated to prevent a recurrence of the conditions that led to this incident?

56. Has the use-of-force policy been reviewed and updated to reflect lessons from this incident?

57. Has training been updated to explicitly address the threshold at which defensive force is legally and ethically justified?

58. Have environmental modifications been made to reduce entrapment risk and improve security response time?

59. How will the findings of this review be communicated to the involved unit and leadership — without compromising the caregiver's privacy?

60. Has the organization publicly affirmed that caregiver physical safety is of equal value to patient safety?

61. Does the organization's communication after this incident reinforce or undermine caregivers' confidence in their right to self-defense?

62. Has this incident been included in quality/safety reporting infrastructure for organizational learning?

Self-Defense in Healthcare, Part 3: Fair Analysis of the Employee's Actions

Let's say the incident has happened. The patient attacked the nurse (or tech, CNA, doctor, etc.), they fought back, everybody is being taken care of, and it's been a day since the incident.

The investigation and analysis of the event must be thorough and fair. When considering the the employee's perspective, the below questions should strongly be considered.

1. Is the caregiver physically injured and receiving care?

2. What is the caregiver's current psychological state?

3. Has the caregiver been offered immediate psychological first aid?

4. Was the caregiver acting within the scope of their employment at the time of the incident?

5. Is the caregiver being treated as a witness and subject of support — not as a suspect?

6. Has the caregiver been clearly told what the investigation process will look like?

7. Was anyone physically harmed — caregiver, patient, visitor, or bystander?

8. What type of force was used (blocking, restraining, striking)?

9. When and where exactly did the incident occur (unit, time of day, staffing context)?

10. Were there witnesses present? Have they been identified and preserved?

11. Is video surveillance coverage available for the area and has it been saved for evidence and further analysis?

12. Is there body-worn camera footage available and has it been saved for evidence and further analysis?

13. Was an emergency response activated — and did it arrive in time?

14. Was there an objectively reasonable belief that bodily harm was imminent?

15. Was the threat directed at the caregiver, a colleague, another patient, or a visitor?

16. Was the threat verbal only, or had it escalated to physical contact or a weapon (even an improvised weapon)?

17. Was the level of force used proportionate to the threat perceived?

18. Did the use of force cease once the threat was neutralized?

19. Was the caregiver trained in de-escalation techniques?

20. Was the caregiver trained in recognizing when de-escalation has failed and a physical response may be warranted?

21. Had the caregiver received training in defensive techniques or breakaway techniques? If so, how often did they receive the training?

22. When was the caregiver's last violence prevention training — was it adequate for this clinical environment?

23. Did the training explicitly address what constitutes an appropriate, lawful defensive response?

24. Was the caregiver working alone, understaffed, or in an isolated area at the time?

25. Was there a safe and realistic path of retreat available to the caregiver?

26. Was the caregiver physically cornered, restrained, or otherwise unable to withdraw?

27. Was withdrawal attempted — and if so, is this corroborated by witnesses or video?

28. Was calling for help a realistic option given the speed of the escalation?

29. If the caregiver did not attempt retreat, can they explain why — and is that explanation plausible in context?

30. Did the caregiver intend to use force, or was it a reflexive, unplanned response?

31. Was the caregiver aware at the time that alternatives to physical force were available?

32. Did the caregiver consciously choose force despite knowing it was unnecessary?

33. Did the caregiver express any intent to harm the patient/visitor prior to or after the incident?

34. Is the caregiver's account of events internally consistent — and is it corroborated by available evidence?

Now, to tee up Part 4 with a question:

Is the organization applying the same scrutiny to its own failures as it is to the caregiver's actions?

Self-Defense in Healthcare, Part 2: What is Self-Defense?

In an interesting update, the Colorado Supreme Court (just like the Utah Supreme Court) recently recognized that there is a right to self-defense in the workplace for which employers may not terminate workers as long as self-defense is lawfully used. The case was Moreno v. Circle K Stores, Inc. and the majority opinion was that the right to self-defense stemmed from pre-statehood days.

"It makes no sense to suggest that everyone has an inalienable right to defend themselves if faced with imminent danger, unless they are at work," wrote Berkenkotter [one of the justices]. "Rather, the right follows the employee from home to work and back and everywhere in between."

When talking on the topic of self-defense in healthcare, I know people are thinking, "But employees need to de-escalate." Yes, there's some truth to that. But let's be real - there are limitations to de-escalation. That's a whole other topic.

Let's talk about what self-defense is.

In plain language, self-defense is fighting back when someone is trying to hurt, maim, or kill you. The goal is to reduce or stop the attacks so that you can get away alive. You can use self-defense for someone else.

But a good rule of thumb is to get out of the situation before it escalates to violence, if you can.

In Oregon...

To get more technical, here's Oregon's definition: "Except as provided in ORS 161.215 (Limitations on use of physical force in defense of a person) and 161.219 (Limitations on use of deadly physical force in defense of a person), a person is justified in using physical force upon another person for self-defense or to defend a third person from what the person reasonably believes to be the use or imminent use of unlawful physical force, and the person may use a degree of force which the person reasonably believes to be necessary for the purpose."

Here's when you CAN use self-defense against someone when they are:

• Attempting to commit a felony involving the use or threatened imminent use of physical force

• Committing or attempting to commit burglary in a dwelling

• Using or about to use unlawful deadly physical force against a person

Those limitations are:

• You can't initiate violence and claim self-defense (normally), EXCEPT if you withdraw or disengage and the other person then comes after you with unlawful physical force

• The violence is "combat by agreement"

• The violence is due to discovery of a persons actual or perceived gender, gender identity, gender expression, or sexual orientation

In Oregon, it has been required to teach self-defense in healthcare settings since 2008, which needs to include:

• The amount of physical force that is reasonably necessary to protect the employee or a third person from assault; and

• The use of least restrictive procedures necessary under the circumstances, in accordance with an approved behavior management plan, and any other methods of response approved by the health care employer;

And the employer cannot sanction an employee for using self-defense if the employee was:

• Acting in self-defense in response to the use or imminent use of physical force;

• Used an amount of physical force that was reasonably necessary to protect the employee or a third person from assault; and

• Used the least restrictive procedures necessary under the circumstances, in accordance with an approved behavior management plan, or other methods of response approved by the health care employer.

What is "reasonable force"?

It's complicated. Here are some highlights of what is taken into consideration in order for self-defense to be justified. A more in-depth article is linked below:

1. The threat must be imminent

2. The force must fit the threat

3. Reasonableness - the objective and subjective test - what you believed and what a reasonable person with the same knowledge and in the same situation would believe)

4. You can't be the aggressor - but you can regain the right to self-defense, as described above... at least in Oregon)

If you want to deep-dive into the intricacies of Reasonable Force

Self-Defense Training

Is self-defense taught in your violence prevention training? How often do staff train on the physical techniques? Does your program even teach the physical escape maneuvers or self-defense?

Training on physical skills once or twice per year is not going to develop muscle memory and the chances of successfully using a technique will be pretty low. In my opinion, we can't train our staff enough.

There's many differing martial arts, training styles, and defense philosophies for getting out of physical situations - some you know won't work in a truly violent situation. Getting personal, I've had 16 years of martial arts training, achieved a 4th degree black belt, and I know that I won't be able to successfully defend myself in some situations; especially if the aggressor is taller, heavier, more trained, has better leverage, catches me off guard, etc.

Some will say that you can only use the "approved" self-defense techniques that were taught in the hospital-provided violence prevention class. I'd challenge that. True self-defense should be "anything goes." If your goal is to come out alive with minimal injury, clawing skin, gouging eyes, biting, head-butting, grabbing genitals... anything is fair game. Your goal is to stop the attack, escape, and come out alive. And truly, if you only trained on those physical skills during the class, and the class was only offered once, you haven't trained on those "approved" skills enough

Summary

The aftermath of using self-defense in the healthcare space is, and will be, messy. There's going to be a lot of questions that need answers. There's going to be a lot of gray area to navigate. It's going to take time.

Next Steps

Hypothetically, the event happened. What are the next steps?

In the ideal world, the employer would ensure the safety of all parties involved and perform an in-depth investigation that is fair. The organization needs to assess the performance of the employee, and also it's own accountability. And since healthcare employers are not experts in use of force or self-defense, they may need to reach out to experts in those fields.

The next two editions will provide helpful topics and questions to consider when investigating the employee(s) involved and the organization itself.

Other readings on nurses and self defense:

• Can Nurses Defend Themselves? (Michael Davis)

Self-Defense in Healthcare, Part 1: Can Caregivers Use Self-Defense?

Imagine you are a nurse in the Emergency Department walking to a room to assess a new patient that had been brought into your pod by a triage nurse. You see a slightly disheveled female, sitting on the gurney while anxiously wringing her hands. You greet the new patient and introduce yourself. You ask her what you can help her with. She does not respond to you and stares blankly ahead. You ask her again. Still, no response. You call her by the name you see in the chart, and ask her if she's okay. She briefly glances up at you and her face contorts into wide-eyed rage. She explodes off the gurney and manages to land two blows with her right fist to your neck and cheek. She pushes you backward out of the room with one hand grabbing your scrub top while slapping your shoulder with the other, all the while shouting unintelligible words through pursed lips and spittle. Dazed, you are surprised this is actually happening. You gather some of your wits, yell repeatedly, "stop, Stop, STOP!," and push back on the patient while face to face, feeling her hot breath and the wetness of her saliva on your face. Using your body weight and leverage, you manage to get the patient back into the room, where it will be easier to contain her violent behavior. With her still clinching your scrub top, you manage to get the patient on the gurney, pushing her shoulders into the mattress. She is flailing her arm and legs now, trying to make contact with anything she can. You feel her teeth on your wrist and the start of biting pressure. You yell, STOP and reflexively slap her face with an open hand. This briefly stops the biting, but she does it again, this time with more force. You again yell, STOP and slap her again. She again stops and at the same time, a coworker comes into the room and helps to restrain the patient's legs. More staff arrive and help with restraining the patient, who violently resists. Once your fellow staff seem to have control, you exit the room to take a breather. In the bathroom, you see redness to the left side of your face and neck, with some swelling starting to develop on your left cheek. You grab some ice for your face and get back to work. Later in the shift, you fill out the violent incident report and the patient, who is now calm, apologizes for hitting you.

A day later, you are called into the manager's office. You are being placed on administrative leave so they can investigate patient abuse. When you slapped the patient's cheek while she was biting you, you left red marks on the patient's face. A coworker reported that they felt you were too aggressive towards the patient. You tell them your side of the story and that it was just you and her in the room and you were in fear of not only your own life and safety, but for the safety of others that were in the emergency room that day. No one came to help for what seemed like minutes. You felt you had no choice but to strike the patient to get her to stop biting you. Having fear of liability and a lack of policy to address situations like this, they tell you that, "We don't treat patients that way, even if they are hurting us." They add, "That was not an approved technique that was taught in the violence prevention class."

After a couple days at home while anxious and worried sick about your job, you receive a phone call from HR telling you that your employment is terminated. A 25-year career of dedicated, professional emergency nursing at this one hospital; done. In a snap.

I imagine situations like this are happening pretty often. We just don't hear about them. I hear of hospitals telling caregivers that they cannot respond to violence with violence, no matter what the patient is doing to you. Some policies even prohibit security staff from touching a patient at all.

Some people might argue that the scenario above is not self-defense. Okay, I can understand. Even if the patient had diminished capacity, it doesn't change the caregiver's right to protect their own life in the moment. But let's say that an expert has reviewed the event and says it is legitimate self-defense. Let's take some time in the next couple newsletters to dig into why.

Self-defense is allowed as public policy, meaning, someone can use physical violence to stop or prevent bodily harm or death to themselves or a third person. Every state allows for this.

But can we use reasonable and proportional self-defense in healthcare?

Yes we can.

There is really no case law that sets a precedent that hospital or healthcare workers cannot use self-defense against patients or other people in the hospital. Why is that? In my experience, it is because those lawsuits against healthcare employers get settled out of court. Which, if you think about it, is smart on the employer's side because you wouldn't want to take that to a trial by jury. The employer will definitely come out looking like the bad guy. But I'm still holding out hope that one of these cases will be decided by a jury, so then we can have some solid case law.

The closest case law we have is Ray vs Wal-Mart Stores. In brief, Wal-Mart had a policy that employees were required to disengage from a violent person (with or without a weapon), withdraw, and contact law enforcement. Five employees who were terminated for using self-defense sued Wal-Mart in federal court for wrongful discharge. The Utah Supreme Court decided that the public policy favoring self-defense came from the Utah Constitution, state statutes, and common law. The right of the employee to defend themselves outweighed the employer's business interests, provided that the employee had a reasonable belief in imminent threat of serious bodily harm and an inability to withdraw from the situation.

Put into the context of healthcare, sure, hospitals don't want hyper-aggressive caregivers or vigilantism. But when you're trapped and feel you have no other choice but to defend yourself, you can. It'll get sorted eventually - but at a cost no one should have to pay just for showing up to work.

Back to the above scenario. Let's say you, the nurse, take a few months to recover physically, emotionally, and spiritually. In the back of your mind, something about the whole situation just doesn't sit right. You decide to consult a lawyer. Based on the facts of the situation, the lawyer tells you that you likely have a case for unlawful discharge. You are able to scrape together some money for the retainer fee and the lawsuit is filed. Files, records, violence data, and training materials are requested, experts are consulted and depositions are completed. The lawyers talk a couple times over a couple months. In the end, the case is settled out of court. It's not millions of dollars, but enough to tide you over for a while until you get your next job.

In the next couple newsletters, we'll discuss ways to fairly treat the employee and the organization when violent situations are met with violence within the healthcare space.

Less Tolerance for Zero Tolerance

Working in healthcare, we're constantly faced with the pressing issue of workplace violence. Although many institutions have turned to zero tolerance policies to tackle this problem, I've seen firsthand the challenges and limitations of such an approach.

Zero tolerance policies have their roots in the late 20th century, starting with the war against drugs in the 1980s. They gained prominence in education with the implementation of the Federal Gun-Free Schools Act of 1994 in the U.S., mandating strict punishments for students bringing firearms to school. This approach, characterized by inflexible and harsh penalties, quickly spread beyond education into other sectors, including law enforcement and healthcare.

In healthcare, zero tolerance policies began taking shape around the late 1990s, particularly with the National Health Service in the UK. By the early 2000s, these policies became more widespread in the U.S., often aimed at managing both healthcare worker behavior and patient violence. While initially seen as a straightforward solution to promote safety, the rigid nature of zero tolerance has raised concerns about its applicability in complex environments like healthcare.

Initially, the logic behind zero tolerance seems solid—eliminate any tolerance for violence to create safer spaces. However, the unique challenges of healthcare make these policies problematic:

Murky Definitions: One of the biggest issues is the lack of clear guidelines on what counts as violent behavior. There's a world of difference between a patient who's aggressive because they're scared or disoriented and one who's intentionally violent. Yet, sometimes the policy treats them the same.

Rigid Application: It feels like zero tolerance leaves no room for judgment. As a caregiver, that puts us in a tight spot between wanting to do what's best for our patients and following strict rules that don’t consider the full context of each situation.

Impact on Patient Care: Zero tolerance can unintentionally make us wary of dealing with agitated patients, for fear of repercussions. At times, this might lead to worsened outcomes for patients who really need our empathy and understanding.

The Questionable Effectiveness: Over my career, I've come across plenty of research suggesting these policies haven't really made us much safer. They're sometimes more of a symbolic gesture than a real solution to the problem.

One of the most troubling aspects of zero tolerance policies is how they handle situations of self-defense. It feels like a double bind when staff members use physical force to protect themselves or others during a violent incident, only to face scrutiny, disciplinary action, or termination due to a policy that doesn't differentiate between offensive and defensive actions. This aspect overlooks the necessity of such actions and can lead to caregivers being unfairly penalized for doing what they must to ensure safety in an emergency. Zero tolerance can increase risk due to litigation against the healthcare entity for wrongful termination, which increases costs and potentially damages the institution's reputation.

Despite their limitations, zero tolerance policies offer some benefits:

Setting Expectations: They do help by clearly stating what behavior we won't stand for, creating a baseline standard for everyone stepping through our doors.

Empowering Reporting: With clear boundaries, we're often more empowered to report when things cross the line, without wondering if we're overreacting.

From my experience, it's clear we need more than just zero tolerance to create genuinely safer work environments. Here's what I think could work better:

Emphasizing Prevention: We should focus on comprehensive violence prevention programs. Education, risk assessments, and communication can go a long way in nipping issues in the bud before they escalate.

Tailored Policies: Adopting a balanced policy approach that allows for discretion, taking into account the nuances of intentional versus unintentional aggression, including legitimate self-defense.

Listening to the Frontlines: Regular surveys to capture caregivers' insights and experiences could radically improve policy effectiveness.

Zero tolerance policies have oftentimes left us wanting more. As we push forward, let's aim to replace these rigid structures with plans that actually fit the needs and realities of healthcare. With more practical strategies and a willingness to listen to those of us in the thick of it, we can foster a safer environment for everyone involved.

What are your thoughts on zero tolerance policies?

If you want to hear more - check out this episode of my podcast:

https://youtu.be/YVuh6UgwXME

Five Tips from Law Enforcement to Combat Healthcare Violence

If you’ve read social media lately, there is a frenzy of discussion around violence in healthcare. Recent events include an ED nurse being raped and held hostage in Illinois, an ED nurse being stabbed in Massachusetts, a legal case in New York where a pregnant nurse was punched in the stomach, causing her to lose the baby and an unjust arrest of a nurse for refusing to draw a patient's blood without a legit legal reason in Utah. It’s been on people’s minds for a while, but now it has been pushed to the forefront. There are many accounts of healthcare workers responding to social media posts, citing their own experiences of being a victim of violence at work and even the lack of support from hospital administration. Included in these posts, not surprisingly, are healthcare workers lashing out at each other and placing blame on the victim. 

Our healthcare culture hasn’t dealt well with violence. And it makes sense. Most, if not all, go into healthcare to help people and receive training as such. We do not receive extensive training in de-escalation and self-defense. Some might argue though, that they took a violence prevention class, so they received adequate training in self-defense.  However, not all violence prevention classes teach self-defense. Compared to the years of medical/nursing training, we must call those few hours of violence prevention training woefully inadequate. It’s hard for healthcare to switch our mindset to a place where we might run the risk of hurting someone, even if it is necessary to save ourselves or someone else. 

After these recent events, I discussed healthcare violence with a law enforcement friend of mine and his wife, who is a nurse. The following is from our conversation. 

The bigger the agency, the less they support you – Our employers are running a business, and to them, it would be just as easy to hire another person as it was to hire us. When we retire or resign, they will replace us and the healthcare machine will march on without hesitation.  Don’t love an agency that can’t, or won’t, love you back. 

We’ve heard the stories of hospitals not supporting their employees that are victims of violence. It is the easy way out. It is very easy to let someone talk us out of calling the police to report the crime (yes, intentional violence in the hospital is a crime). It is very easy to talk ourselves out of it with thoughts of, “the department is busy, I don’t have time”, “I don’t want to seen as a weakling”, “it’s a part of the job, I should just get used to it”, “I’ll probably get fired if I report it”, “I don’t want to miss work,” “the hospital won’t pay me to attend trial” or “I don’t want to make the hospital look bad”.  We could go on with the excuses, but you get the picture.

 
Since healthcare hasn’t trained itself to address violence head-on, it’s no wonder that support for the victim is lacking. We just don’t know how to deal with it. We have plenty of evidence staring us straight in the face that it is a rising problem. And yet we remain fairly passive and our training, policies and action remain anemic. OSHA is considering a standard that would mandate all healthcare and social assistance to provide violence prevention education to their employees. If we don’t do right by our people, we will be regulated to do so. Congrats healthcare, we are at that point. 

What if leadership/management discourages you from reporting violence or pressing charges? You, the victim, have the right to press charges. Management/leadership does not get to make that decision for you. It is not the hospital’s responsibility (unless it is written in policy). You have to be willing to be the victim. And unless the hospital specifically says that you cannot report the crime or press charges, there might be a case for a civil suit. Remember, you do have the right to a safe work environment.  You may have started a career in healthcare to help people, but that is near impossible if we do not take care of ourselves and our safety, first. By prosecuting violent people, we help ourselves recover and find closure from an incident. We hold the assailant accountable so they don’t do it again to someone else. And by prosecuting, we might be helping that person get back on the right track. Sometimes we’ll never know. 

What if law enforcement discourages you from reporting violence or pressing charges? Follow the chain of command. It might start with the shift supervisor, then to lieutenant and maybe all the way up to the chief (or sheriff). If you are worried about HIPAA, you can disclose some information since your attacker committed a crime. Read here to put your mind at ease.  If anything we know, nurses are persistent. Don’t give up on this.

 
What if you had to defend yourself? Expect to be questioned by law enforcement. Expect to be grilled by your leadership/management. If done correctly, law enforcement should have your injury documented and photographed, and the same done a couple days later. If you caused your attacker injury, it is suggested to hire legal counsel. It’s recommended that you don’t give details without first seeking legal counsel. It may be advisable to consult as well with your union rep, but they should not take the place of a good lawyer.  Realize that your recall of the event might improve over the next couple of days. Your self-defense should be judged from your point of view, not based on witness accounts. You might even have to appear in court. Since violence is so prevalent, an insurance policy might be helpful. NSO offers coverage for personal injury (that you might cause) and assault coverage (I am not paid by NSO).  

What is your advice for healthcare workers from a law enforcement perspective? 

1.    Change your mindset. Even though you help people, change your mindset.  What is the most important thing in your job? You; followed by your coworkers, followed by the public, followed by your employer. If you don’t prioritize your safety above all others, you may become a victim. Wrap your mind around the fact that you might have to do something you’re uncomfortable with in order to protect your safety and those around you. We have to take care of ourselves before we take care of others.

2.    Do enough to escape and get away. The intent is not to turn medical/nursing staff in to black belt cage fighters. We are talking about self-defense.  Develop the skill set to do what is necessary so that you can get away and home to your family uninjured.

3.    If it’s a fair fight, change tactics. Think dirty. Cheat. Your goal is to do number 2 above. Remember, this person tried to hurt you. You did not ask for this confrontation, and it was most likely forced on you. 

4.    Know how to observe, be aware and be proactive.  Training for the worst situation can often help you avoid it. Sometimes it is simply teaching people how to identify a bad situation so they can step back before it gets out of control. 

5.    Realize when we are stressed, we do not always rise to the occasion. We fall to our lowest level of training. Don’t fall into the trap “this won’t happen to me.” You won’t be prepared when a volatile situation rears its ugly head. 

This is not, nor should be considered,  legal advice. Nor does this advice supersede your institution's policies or procedures.