Clinical placements

A violent encounter during a placement almost made me quit

How an incident with a patient showed the value of speaking up when something feels wrong

How an incident with a patient showed the value of speaking up when something feels wrong

Picture: iStock

During a placement in my first year of nurse training, I was caring for a patient who was being moved from an acute mental health unit in a general hospital to a less secure unit.

The patient, who was known to be aggressive towards female staff and patients, needed to be transferred via taxi.

I was told that the acute unit was short-staffed and, although this should have been a two-nurse transfer, there weren’t enough qualified nurses available to allow two to leave the unit with the patient. 

Feeling under pressure from the unit staff to help, I agreed to transfer the patient with a senior staff nurse, even though it went against my better judgement. 

Unprepared for the situation

What I didn't know was there had been miscommunication between the patient and unit staff about where she was being transferred to, so when she asked me where she was going, my reply was not what she was expecting to hear. She got very upset and lashed out, punching me in the face. 

The patient had refused to sit between me and the staff nurse in the taxi, so was sitting to my right. This meant that the nurse was unable to restrain the patient to prevent her from attacking me. 

When the patient tried to lash out again, the nurse had to use his body to shield me. The taxi was unable to stop because of the risk that the patient would get out and flee. 

As well as being physically hurt, I was shocked and frightened by this experience. After we had transferred the patient, the nurse told me I could go home instead of completing my shift. Although I was relieved, I was also quite upset as it was my last day on this placement. 

Felt obliged to help

After making the hour-and-a-half journey home on public transport, I was so emotionally exhausted I lay on the sofa and cried. 

As I did not go back to the unit, no one followed up with me to check on my well-being. I was so upset by this experience, particularly as I felt it was my fault that the patient attacked me, that I didn’t inform my university either. 

‘I should have had the confidence to say no. But questioning the decisions of senior staff is something many nursing students find difficult’

On reflection, I realised I should not have felt under pressure as a nursing student to transfer this patient, even when accompanied by a senior staff nurse. 

I was not trained in patient restraint, or in how to de-escalate a situation such as this, and should not have been put in this position. It was also well known that this patient could be aggressive towards women, so the transfer should have been completed by two male healthcare workers. 

As a first-year student, I was supernumerary, and should not have been considered in the workforce numbers. But because I had been told that the unit was short-staffed, I felt obliged to do it.

I wanted the patient to be in the right facility, where she could receive the best care. If I had not agreed to go, she would have lost her place at the other facility. I was also frightened of the repercussions of saying ‘no’; I thought I might fail my placement or be seen as uncooperative. 

I should have had the confidence to say no, and not allowed myself to be put in a situation that made me feel unsafe. But speaking out and questioning the decisions of senior staff are things many nursing students find difficult.

The senior staff nurse who was in the taxi with me should also have taken more care, either insisting that the patient sat in the middle or sitting in the middle himself so that I was not placed in any danger. 

This experience also showed me how vital effective communication is in patient care. Had the patient been properly informed about where she was going from the outset, she may not have become aggressive. 

Lessons from a difficult experience

Although this was an upsetting incident, I learned some valuable lessons to take with me as a student and after I qualify: 

  • I am an advocate for my patients but also an advocate for myself. 
  • I am allowed to say ‘no’.
  • If something doesn’t feel right, it probably isn’t. Trust your instincts and speak up. 
  • Always keep open lines of communication with patients. 

If you find yourself in similar situation as a student, don’t stay silent and try to cope on your own. Contact your personal tutor and your well-being service at your university, and make sure to take time out for yourself. And forgive the patient. Your ego (and face) might be bruised, but they didn’t mean to hurt you. 

I considered dropping out of university after this experience, but with support from friends and family I decided to stay on the course. I am glad that I did. Last month I completed my last ever shift as a nursing student and am ready to start my next chapter as a newly qualified nurse. 

The author of this article wishes to remain anonymous

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