Nurses never know what the next shift will bring so we aim to turn up well-rested, caffeinated, ready to hit the ground running.
Recently, listening to details of my patient allocation I felt a bit scared. “History of physical violence” and no sign of security?
Debating strategy with my team leader, stating concerns, in walked exactly who we needed, a kind, authoritative, don’t – mess – with – me Clinical Nurse Consultant used to dealing with this type of patient.
She marched up to him, firmly stating what would and wouldn’t be tolerated, predicted outcomes depending on his choice of behaviour and cooperation. Her authority and confidence had the desired effect. He had capacity, choices, a plan was made to keep him and us safe, our duty of care fulfilled, no one hurt. Phew
Doesn’t always work this way , sometimes we need the familiar black and blue uniform of security, their bulky physicality a comfort to us and a warning to patients.
Security and police are part of the furniture in emergency where the verbally aggressive intoxicated are frequent flyers, often can’t remember their behaviour next morning , shamefaced, embarrassed, sometimes with a physical injury. Others wake up worse for wear, no shameface, lashing out, time-consuming, upsetting for all around.
We deal with swipes from normally sweet surprisingly strong elderly people with delirium or dementia , with shouty worried types, anger their go-to emotion.
The only time I’ve ever been on shift when physical harm was inflicted patient-to-nurse was years ago on a head injury rehab ward. Most patients were young blokes, many with damage to frontal lobes and personality changes as a result, prone to violent outbursts.
Will never forget the face of the foul mouthed bloke with the bright red hair who punched my tiny colleague , will never forget her face, her black eye , her distress
Thankfully violence to staff in maternity and gynaecology (where i work often) isn’t common , usually easy to mitigate and control.
Domestic violence escalates in pregnancy, midwives screen on the first antenatal visit ask women a series of questions while her partner waits outside. We’ve a heightened radar for subtle signs of disrespect, control and unkindness in a partner. Might mean he’s an arsehole not a perpetrator of violence but if warranted we ask direct questions. Does she feel safe with him? Does he frighten her? Ever physically harm her?
Social work can be involved immediately, a private interview attempted or phone follow up. Early intervention helps, safety plans can be made , numbers given to the women, who to call if the shit really hits the fan. Trying to prevent her becoming one of those awful statistics
I’ll never forget as a young midwife back in Scotland , discharging a woman who’d been an inpatient with bleeding. She was quiet during her stay and as I gave her discharge papers tears came and the story of her miserable marriage to a well respected doctor , a GP , pillar of the community type , who controlled the finances , belittled her continually, wasn’t physically violent just horrible to live with , she hating the thought of going back home to him, having two small children and another on the way , hadn’t worked in years , felt trapped no where to go.
I set some wheels in motion for her , no idea what the outcome was for her, hope she got away from him eventually, was a situation that would never improve
Another snapshot of the nurse/ midwife life. I understand what nurse and author Christie Watson meant when she said …
“I don’t think nursing is that unusual a day job at all for a writer, because the two cross over massively. They both involve thinking about life and death, and what makes us human; they both involve the big questions.”
Lindsey Crossan Registered Nurse/Midwife