I am a Registered Nurse who has worked for the Office of Mental Health at Pilgrim Psychiatric Center for the last 27 years. The patients I care for are chronically mentally ill. I am frequently the only nurse on Ward 102 with 26 patients. Usually, I have two Therapy Aides working with me. Last year, one of my patients became agitated to the point of being out of control and unmanageable. The usual procedure when a patient’s poor behavior and lack of control escalates is to send them to a more secure ward in the facility, the Intensive Treatment Unit (ITU).

    The nurse’s station on my ward is in an open area in the center of the ward. This is where we make phone calls and have our desk. The phone calls I made that day were to the ward physician, my supervisor, and the ITU to arrange for the patient to be transferred. He was aware that I was making plans to transfer him to the ITU and he became more upset. It became necessary to restrain him before his transfer. The patient became verbally abusive and threatened, "When I get back from ITU, I will get you." One of my supervisors, the Chief of Service, told me that the patient had focused his threats on me. The Chief advised me that this patient would not be coming back to Ward 102 until he apologized to me. Several days later, when I returned from my two scheduled days off, this same patient was back on my ward. There was no apology.

    Weeks later, the patient started to decompensate and was attempting to swallow foreign objects. We asked him to stay in an open room away from such objects, where we could keep an eye on him while I made arrangements for his return to the ITU. I was sitting at the nursing station desk when he ran out of the room, past the two Therapy Aides and attacked me. He pummeled my upper back underneath my neck. A code for help was called and he was restrained and taken back to ITU. The staff of ITU notified me that he continued to make verbal threats against me while he was on their unit. I was told this patient would return to my ward even though his threats against me continued.

    The next day, I felt discomfort and soreness in the area of my back that had been beaten and a bruise became obvious. I went to the emergency room to be checked and also went to the local precinct to file assault charges. This process took five hours. The judge issued an order of protection and since that order just expired, the judge re-issued another order of protection; this indicates the seriousness of the threats against me. After being assaulted, it took eight days for me to recover and return to work.

    I believe nurses are often the target of abuse because of their visibility and decision making authority. The nurse is the part of the direct care staff who gives out the medication and makes the decision to call the doctor, the team leader, and other administrative personnel as well as a code when a patient has escalated. The nurse is more accessible to the patient than the doctor is or other staff who do not work on the ward full time. I believe the attack on me could have been prevented if there had been more staff and a clear procedure in place to safeguard staff as well as other patients when verbal threats are made.

    This patient’s threats were not taken seriously. The Chief of Service was clearly aware that this patient was focused on me. The threats were well documented in his chart; yet, he was returned to my ward (and on my day off!). The Hospital Administration is focused on surveys and appearances as opposed to being sensitive to what is really going on. There is a lack of clinical decision making and intervention. The employer does have a response team, but that’s just it – it’s a response. We need proactive measures – we need a plan to address and prevent threats and assaults before they happen! Thank you.