An post over at the WSJ Health Blog caught my eye:

Nurses are beaten and abused, pinched and punched by deranged and demented patients.

The rough treatment of nurses by some of the people they care for isn’t an issue that gets much attention, but it should, Illinois doc Ben Brewer writes this his WSJ.com column. “Nurses get assaulted all the time at work,” he writes. “They get assaulted in small and large ways at every hospital and nursing home in the country.”

The subject comes up occasionally in the medical literature (see this study, for example), but for the most part everybody assumes it happens and there’s not much to do about it. Nurses are the infantry of the health-care system.

Brewer rolls out one example after another. The young nurse with the long scar on her forearm, where the surgeon went in to fix tendon damage after a patient violently twisted her hand and bent back her fingers. The ICU nurse with a deformed finger and nerve damage from a patient’s bite. The nurse who got punched in the ear.

He notes that patients are restrained less often than they used to be, but he suggests that more frequent use of restraints probably wouldn’t do any good. “Usually it’s the one you don’t see coming that gets you,” he writes.

Yea? Let’s talk about this rough treatment:

Nurses and aides are:
Hit
Punched
Kicked
Bitten
Pinched
Held semi captive by hair pulling
Picked up and thrown
Targets of objects being hauled across rooms- everything from a simple hair brush to entire hospital beds.

…and otherwise roughened up and abused by our patients.

On a daily basis.

Especially the nurses and aides- and other professionals- who work in long term care settings (nursing homes, assisted living, psych wards and special dementia units). I work with brain injured young adults; I’ve also worked at the Adult Brain Injury unit at my work…I’ve seen it all, experienced it all and have the scars to prove it. Many of them.

We are trained in the ways to prevent patients from getting to a point where they feel so threatened they “fight back”; we are trained in the ways to prevent a situation from turning into a full blown crisis. We have patient centered policies and procedures. And we attend expensive workshops that educate us how to handle patients who are violent, and how to keep them and ourselves safe. All this effort doesn’t always work though.

I knew an aide who was thrown across a room, and her collarbone was broken. A nurse I once worked with is now brain injured herself, thanks to a busted off side rail hitting her, hard, in her head. Broken ribs, arms, shoulders are not that uncommon. Bruises, bite marks (and the blood borne pathogen testing that must happen after), sprained and strained muscles are the hazards of this work.

Patient care itself is hazardous. Lifting, tugging, pulling and otherwise moving our patients who cannot do these things for themselves is very hard on our body. Average weight patients take a toll on us. Now we are seeing more extremely overweight patients too.

A comment left about this, at the WSJ health blog:

As far as back injuries and lifting devices, money is indeed the reason more has not been done. The priority in the healthcare industry is not nurse (or other healthcare provider) safety, or even patient safety. It is making money for the select few at the highest levels of management. Don’t believe it? Go to your local hospital and get it’s most recent tax returns and see what compensation the CEO and others make in salary and benefits.
Nurses and other staff, especially the nurse’s aids, are considered and treated as expendable resources by the hospitals, despite shortages in both fields. Despite the high rates of back and other musculoskeletal injuries, lift devices and lift teams are rare because it doesn’t cost the employer anything if an employee goes out on worker’s compensation for a back injury. And, if the employee tries to recover reasonable medical costs or financial compensation for permanent disability, the hospital will employ any means to absolve themselves from responsibility.

Well this is a little disingenuous to say the least.

The government agency in charge of protecting us from work place hazards, OSHA, doesn’t compel/force hospitals and nursing homes and clinics and other facilities to keep nursing staff safe from patient handling hazards. OSHA tip toes around the issue with standards that are fairly loose: One person cannot lift more than 50 lbs-the GOLDEN rule. This means two staff cannot lift a patient who weighs over 100 lbs…But 3 can…no matter how awkward or difficult the patient’s behavior may be during this lift. This is when so many of us get hurt. OSHA, I heard, is about to lower the limit though, to 35 lbs per person weight.

Of course when we get hurt and when we report the injury, worker comp kicks in to cover the costs of the injury. The hospitals and other facilities face paying very high premiums if the facility has a high percentage of injuries. In spite of some of the comments left about this article, Many nursing homes and hospitals are re-designing the patient care areas that incorporate lifting devices. The hospitals in my area all have patient transport teams: Specially trained staff who use many techniques and devices to lift, transfer and move patients. More and more facilities are enacting policies and procedures that support what we call the NO LIFT FACILITY. Literally this means no staff are allowed to lift/transfer patients- no matter what their weight.

I see another problem here that some don’t like to mention: many nurses and even more aides simply do not utilize the equipment provided to them. Instead, they get a buddy aide and perform a transfer themselves…Lift machines and sit-to-stand devices are not put to there intended use. Why? Because it’s time consuming- by a few minutes and nothing more. It’s difficult to explain a back injury when one was supposed to use a mechanical lift- and you bet the hospitals and nursing homes and worker comp people are going to buck at paying the costs of the injuries associated with staff non compliance.

Those who get hurt because they refuse to use the very equipment designed for their protection deserve to be under scrutiny because it increases the premiums health care facilities must pay; and it ups the odds that every injury will come under the looking glass of worker comp claims processors. When you have even one staff who ignores safety, you’re very apt to have many. In so many ways this is self defeating: As W/C premium costs go up, the money in the pool for salary increases goes down; the loss of income resulting from an injury can be substantial; if the W/C rejects the questionable claim, legal costs must be considered too. Management must clamp down on staff abuse of No-Lift Policies.

Another comment amused me as well:

It seems to me that some of these acts hurting nurses are criminal — assault, or assault and battery. Are such incidents prosecuted? If not, why not? Are the patients kicked out, as they would be at the workplace or school for similar behavior? If not, why not? Going to a hospital does not give one license to commit mayhem.

Well for one thing the vast majority of those patients who do abuse us are not in their right mind literally. They have dementias, brain injuries, mental health illnesses and a mirage of other problems. They cannot control their actions; often their thought process is so altered they’re not aware of what they are doing. Or, the medications they are taking to help them with other problems can cause very odd behaviors.

Many of the patients will have no memory of the violence they perpetuated against a nurse less than five minutes after it occurred. It’s fine and dandy to demand that patients be held accountable for their behavior, but what do we do with those who truly cannot control it? How do you place a person with Alzheimer’s disease through the criminal justice system? Is it appropriate to charge a person with a severe brain injury with a crime that he cannot recall committing- or worse- that he committed in his own warped sense of self defense? Many people with brain injuries see the world in a very different view than we.

There are some patients who can control themselves who do harm nurses and aides. They are held accountable. The police are called, reports are taken, criminal charges are filed. The process works when its appropriate. I’ve seen patients hauled off the state medical units, where they belong; and I’ve seen really sick prison inmates be admitted to local hospitals for medical care- these patients are extremely violent- they have their own personal set of guards to protect the staff who must provide the nursing care. They are shackled to their damn beds and otherwise restrained.

Human beings are complex animals- most of us have control over who we are, what we do and how we live our lives. But there are many who are not as fortunate. Disease processes, medical conditions and psychological issues cause the most awful behaviors one can imagine. Nurses know this and aides are aware of the effects it can have.

So many of us tend to blame the hospital management, the government and anyone else for the injuries we get while on the job. We can blame the patient, yes, but we must also highly consider their physical condition and mental capacity. Nursing is not easy work and it never will be because human beings are not objects. It can be downright dangerous- this profession. Never forget to thank the nurses and aides for all they do, and for they put up with too.