In search of a safer ER

After 22 years of employment with a local hospital, Barbara LaPierre's life changed dramatically one April night in 2010. While working in the psychiatry division of the emergency room, known as the "crisis center," LaPierre, R.N., B.S.N., endured a painful, violent injury that has required several surgeries and resulted in permanent disability and scarring.

"This male patient was not mine, " LaPierre exlains, "instead his nurse was busy caring for a true medical patient who required intubation and her full attention. I was asked by a physician to administer Haldol [used to treat psychotic disorders or severe behavioral problems such as explosive, aggressive behavior] since he was loud, screaming, and acting out."

"When I went to the bedside the patient was in restraints, shaking the bed, screaming, cursing, hallucinating. Luckily an EMS employee and technician volunteered to go to the bedside with me. A security guard was not present, but the unit is locked. When I went to give the injection, [the patient] jumped up, ripped the leather restraints, bit my left arm, began thrashing. I felt like he was never going to let go."

Immediately following the attack, Barbara quickly learned that the patient was under the influence of a drug casually known as "WET". WET is a mix of PCP with formaldehyde that is dripped onto cigarettes, smoked and has a dangerous mind-numbing effect that makes patients appear crazy, sometimes sleepy or mellow, but also extremely violent. "I wasn't aware of his entire history," she says.

LaPierre was treated in the ER, where she was tested for communicable diseases (the patient was also tested and blood specimen were already obtained as per policy). She then faced reconstructive surgery, returning to work eight weeks after the assault. More surgery is pending to repair her mangled arm.

"I have a hideous scar, I can't comfortably pivot my arm, much muscle damage," she explains.

In March 2011, LaPierre left that hospital and is now employed at a local emergency room where she feels there is a safer system in place to protect nurses. (She says her previous employer never addressed staffing ratios, offered no supportive counseling, and made little attempt to investigate her incident.) She is particularly pleased with the mandatory training offered by her current employer to teach nurses proper restraining (one arm up and one arm down), proper body language, and de-escalation techniques.

"I understand that our career puts us at risk that we can't always avoid, but we all need to be responsible for our actions. Violence is violence and no one has the right to inflict violence/assault another person in any setting. It is against the law," LaPierre says.

So what can nurses learn from stories such as LaPierre's?  "Nurses need to step up and report violence to help keep patients and visitors accountable for their actions," she says.

A psychiatric nurse with over 38 years experience who was brutally beaten, suffering a concussion, while working, told me nurses need to "be observant and know your patient's history. It is extremely important to be alert and let your peers know where you will be."

But isn't violence a part of a psychiatric nurse's job?

"Our job is to provide care, such as medicating the patient," she says, "not to be harmed. Mental health is complex but there is a whole lot than can and should be done to protect nurses."

Data from the BLS Census of Fatal Occupational Injuries (CFOI) show that, from 1995 to 2004, 154 nursing, psychiatric, and home health aides were fatally injured in work-related incidents, with 12 percent of fatalities reported as homicides.

For LaPierre, the story continues. She filed charges, but the assailant left the hospital after his involuntary admission and was never caught.

"When I went to court, I immediately knew it was the wrong guy, I identified him as the wrong suspect and my attacker remains loose."

Is our society giving permission for violence through ignorance? What reasons do nurses give for not reporting an assault? Do you feel as though hospitals don't release the information to the media with fear of it damaging their reputation? Keep our conversation going.

Please contact me if you have been a victim of workplace violence. I want to hear your stories and will respect your privacy. Please post or email me.

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