When Combative Patients Pose a Threat: Can Nurses Refuse to Care for Them?

Compassion and empathy are the foundation of nursing practice, but there are serious scenarios where patient behavior poses a direct threat to the nurse's safety. This article explores the ethical and practical considerations when dealing with combative patients and the options available to nurses in these situations.

Understanding the Threat

A nurse’s primary responsibility is to provide care and ensure the well-being of their patients. However, when a patient becomes combative and a danger to themselves or the healthcare team, the nurse’s safety must come first. According to the Best practices for nurse safety, nurses are instructed to prioritize their own safety under these circumstances.

Legal and Ethical Considerations

Clearly, if a patient is acting in a combative manner, the nurse is not legally obligated to continue providing care if this action poses a direct threat to their safety. It’s an accepted practice that requires the nurse to utilize security protocols in place to subdue the patient until sedatives can be administered or law enforcement can be involved.

Reporting and Security

In situations where a nurse encounters a combative patient, it's crucial that immediate steps are taken. The nurse should:

Contact security and call law enforcement if necessary. Seek assistance from coworkers and male or female colleagues. Ensure both their immediate and long-term safety by staying at a safe distance.

Refusal of Care

Sometimes, a nurse may choose to refuse care to a combative patient. This decision is often based on the safety risks and the possibility of the patient harming the nurse or others. Here are some scenarios where a nurse can refuse to care for a combative patient:

Personal Safety First

Nurses should not be afraid to request an alternative assignment if they feel that the situation is unsafe. This is a reasonable request and is often supported by healthcare management.

Reporting Assault

If a nurse is assaulted by a combative patient, they should file a report with local law enforcement and the hospital administration. Regardless of what the supervisor says, the nurse should prioritize their safety and well-being. This includes pressing charges if necessary.

Invoking Healthcare Team Interventions

A healthcare team can intervene to ensure the patient’s safety and the nurse's well-being. This may involve:

Administering sedatives as prescribed by a physician. Bringing in law enforcement or security to ensure a safe environment. Offering interventions such as antipsychotic medications.

Case Study: Handling a Combative Patient

A real-life incident highlighted the complex nature of dealing with combative patients. One nurse encountered a patient who threw a punch and barely grazed her cheek. The police were present, and the incident was documented. Despite minor injuries, the nurse did not press charges, and the district attorney sought her testimony. The case resulted in an additional 5-year sentence for the patient, and a letter of apology was required before the young man could be released. Seven years later, the defendant’s case was reopened, and the nurse's willingness to accept the apology was acknowledged.

Conclusion

The care of comatose patients requires a combination of compassion and professional judgment. Nurses have a responsibility to ensure that their actions prioritize both patient and staff safety. While it may be challenging to refuse care in some cases, it is ultimately an acceptable practice when the safety of the nurse is at risk. By reporting incidents, involving the healthcare team, and seeking alternative assignments, nurses can navigate these situations to ensure everyone's safety.