For anyone not in the nursing profession, the answer to this question might seem obvious. Anyone caught fighting on the job should, of course, expect to lose not only their job but their professional license, right?
With nursing, the answer isn't nearly as clear. Not all patients are grateful for the care that nurses provide. Whether it's because of substance abuse, a mental health condition, or a physical ailment that affects their cognitive abilities, it's not unusual for patients to be combative and even extremely aggressive. Stressed-out families and friends can also become violent in the health care setting. In many of those cases, nurses need to both protect themselves as well as try to protect the patient from their own aggressive actions. When a disciplinary complaint follows this kind of altercation, the Lento Law Firm's Professional License Defense Team is here to help. Call us at 888.535.3686 or use our contact form to schedule a confidential consultation to learn more about how we can help protect your license.
What Does “Fighting” Mean in the Context of Nursing Discipline?
In many cases, it's arguably unfair to use the word “fighting” to describe a physical confrontation between a nurse and a patient. It can be a question of perspective; from the perspective of the patient or the patient's family, the nurse may appear to be involved in a “fight” with the patient. But from the perspective of the nurse, what's happening is often quite different.
First, the nurse may be attempting to defend themselves from a patient who is lashing out and trying to physically prevent the nurse from providing necessary care. This can happen when the patient is not in a condition to understand why they are where they are – an emergency room, a doctor's office, a hospital room, a care facility, or even an injured on the street. The inability to understand the situation can result in the patient mistakenly believing that the nurse is attempting to harm the patient instead of caring for them; from the patient's mistaken perspective, they are defending themselves against an attacker, namely, the nurse.
Second, the nurse, in almost all cases, has an obligation to the patient to protect the patient from themselves. If the patient is physically lashing out at anyone who comes near – whether they're a nurse, a physician, an orderly, or even a family member – the nurse may need to take steps to protect the patient from coming to further harm as a result of those actions, as well as to protect others from the patient's actions.
Third, the nurse has a duty to care for patients. This can include putting the patient through necessary procedures that can be uncomfortable and sometimes painful. Something as simple as drawing blood or inserting an NPA device can result in a patient lashing out against the nurse who is performing the procedure. When the patient does this, the nurse may need to respond in a physical way that, again, protects the nurse from harm and the patient from harming themselves.
The Problem is Not Only With Patients
Nurses can also find themselves the targets of physical violence from families and friends of patients. Whether in a hospital or other type of care setting, those who are close to the patient being cared for are often under a lot of emotional distress. Studies indicate that there are a combination of factors that can contribute to these high levels of stress that result in violent behavior against health care staff, including long wait times for treatment, overcrowded care facilities, lack of information about the patient's progress or prognosis, and inflexible visiting hours. This can boil over, and when it does, the families and friends may target the nurse for abusive conduct that can result in violence.
One result of these violent confrontations? A disciplinary complaint filed against the nurse, despite the fact that the patient's family or friends were the aggressor and the nurse was thrown into a position of having to defend themselves.
Physical Confrontations Are Not Unusual
Unfortunately, these scenarios are not at all uncommon in health care. In fact, health care workers are significantly more likely to be injured as a result of workplace violence than are workers in other fields. The U.S. Bureau of Labor Statistics noted in one “Fact Sheet” that health care workers “experience the highest rates of injuries caused by workplace violence and are 5 times as likely to suffer a workplace violence injury than workers overall.” The Fact Sheet goes on to reveal that in 2018, health care workers “accounted for 73 percent of all nonfatal workplace injuries and illnesses due to violence.”
In other words, health care workers, including nurses, are far more likely to be exposed to violence in the workplace than most other types of workers. A certain number of these violent interactions are going to result in a disciplinary complaint being filed against the nurse – even when the nurse was not responsible for starting or escalating the incident but was merely trying to defend themselves.
Balancing Patient Care With Self-Protection
Nurses have an obvious duty to provide patients with the care the patients need. That's one of the foundations of Nurse Practice Acts all over the country and is the basic requirement for any nurse. That duty to provide care is not unlimited, however. A nurse can't be expected to risk serious injury from a patient in order to provide care to that patient. As one paper notes, “There is a level of risk that is unreasonable for a nurse to accept in the discharge of their professional duties.” The problem is deciding at what point the level of risk becomes “unreasonable.”
There is also a problem with defining at what point nurses should not have to tolerate abuse from patients or their friends and family members. While there appears to be general agreement that nurses should not have to tolerate abuse or be subjected to violence at work, “nurses regularly face violent situations that are not prevented by workplace health and safety regulations and related policies.” This leaves the nurse with the problem of deciding in that moment how to react when a patient or visitor acts in a violent manner.
The answer to this can vary from one nurse to another; a nurse who is physically strong or trained in effective self-defense maneuvers may have a completely different take on how to respond to a violent patient than a nurse who does not have the same level of strength or training. But a nurse who is simply defending themselves against a sudden attack by a violent patient or visitor can still end up being accused of abuse because there is very little downside if someone files a complaint against a nurse that later turns out not to be true.
Violence Among Co-Workers is a Different Matter
The fact that nursing is a high-stress profession is no surprise to anyone who works as a nurse. Staffing shortages, budget issues, difficult patients, and long hours all contribute to stress in a profession that is devoted to the stressful goal of providing quality health care to patients in need. When any of these factors build up, they can boil over into violent behavior between co-workers.
Bullying, for example, is something that frequently happens in health care settings. A 2022 study called it “a pervasive problem in the nursing profession,” one that “threatens nurses' health and ability to work safely,” and estimated that up to 44% of nurses have experienced bullying in their professional lives. When a nurse reacts to workplace bullying by physically confronting their abuser, the problem can shift; instead of the abuser facing punishment, the nurse who reacted violently may be the one facing discipline. Defending against allegations of workplace violence can be very complicated, especially if the only two witnesses are the two parties involved in the incident.
If you are a nurse accused of fighting with a co-worker, you need the help of an experienced Professional License Defense attorney. At the Lento Law Firm, our attorneys understand what it takes to defend against allegations that you were involved in a fight with a co-worker. Your best chance at a good outcome is by working with an attorney who can fight for your rights and who knows how to defend against the allegations you're facing.
What Happens When a Nurse is Accused of Abusing a Patient?
Nurses who are involved in physical altercations with patients can find themselves accused of abuse by the patient or by the patient's friends or family members. There is very little that stands in the way of anyone filing a disciplinary complaint against a nurse, which can lead to a long and stressful investigation and disciplinary proceeding. The state agencies that license nurses typically provide multiple ways for anyone to file a complaint against a nurse, including online reporting forms, phone numbers, email addresses, and even fax numbers. In some states, complaints must be made in writing; in others, it may be possible to file a complaint against a nurse over the phone. Different states also have different policies concerning the filing of anonymous complaints against nurses.
Because each state is able to set its own disciplinary policies and procedures, there may be some variations in how nursing disciplinary complaints are handled. Generally speaking, however, if you're a nurse who has been accused of patient abuse or some other form of misconduct, you can expect the following steps to take place:
- Notification of the Complaint. Your state's Board of Nursing (BON) (or the appropriate licensing body) will notify you that a complaint has been filed against you. You'll receive information about the allegations in the complaint and will typically have a deadline by which you can submit a written response to the complaint. This is the point at which you should contact the Lento Law Firm's Professional License Defense Team. The sooner one of our experienced licensed defense attorneys is involved in your case, the better we will be able to defend you against the allegations.
- Investigation. Typically, the matter will be assigned to an investigator who will interview you and the person who filed the complaint (unless it was filed anonymously) about the incident. In a case where patient abuse is alleged as a result of a fighting incident, the patient may also be interviewed, as well as, any witnesses. Witnesses may include friends or family members of the patient as well as co-workers and possibly visitors who were present for the incident that prompted the complaint. If you are working with an experienced Professional License Defense attorney, your lawyer will prepare you for your interview and may be able to appear with you to make sure the questions you're asked are fair and understandable.
- Investigator's Report. The investigator will prepare a report of the results of the investigation. You may have a chance to respond to either a draft of the report, or to the report itself. If a response is allowed, this can be an extremely important time to provide your side of the story, as well as any evidence not considered in the report that supports you.
- Formal Charges or Closed Case. The investigator's final report will be reviewed by the disciplinary body responsible for nurse discipline, typically the BON. The BON will decide whether the investigation supports bringing formal charges against you or whether there is not enough evidence to do so, in which case it will close the matter. If it does bring formal charges against you, you will have an opportunity to respond but must do so within a certain time period. The formal charges may also propose a particular sanction to be imposed against you.
- Negotiation. You have several options once a formal complaint is made against you. You can agree to the facts alleged in the complaint and to the proposed sanction. You can dispute the complaint and take it to a formal hearing. Or you can negotiate to arrive at a resolution that is more favorable than what the formal complaint proposes. If you are working with an experienced Professional License Defense attorney, your attorney can use their knowledge of your case and their years of experience defending other nurses accused of misconduct to work to negotiate a more favorable result for you.
- Hearing. Cases that aren't dropped or resolved with an agreement will typically proceed to a hearing, with witness testimony as well as the introduction of documentary and other types of evidence, such as medical reports, photos, and videos. If you've reached this stage, you want to be defended by an attorney who has years of experience protecting the rights of nurses accused of misconduct; someone from the Lento Law Firm's Professional License Defense Team.
- Decision. The hearing will typically end with a written decision that will be issued some time after the hearing ends. If it is in your favor, the matter will be closed. If it goes against you, it will state the reasons for the decision and what the sanctions are that are being imposed on you.
- Appeal. You will typically be able to appeal a hearing decision that goes against you, although the grounds for an appeal are usually quite limited. Your attorney can counsel you as to whether an appeal may make sense in your case.
The Lento Law Firm's Professional License Defense Team Can Help if You've Been Accused of Fighting
If you are a nurse who has been accused of fighting in particular or abuse in general as a result of one or more altercations that took place on the job – whether with a patient, a visitor, or a co-worker – you deserve a strong defense. Your professional license is the key to your livelihood and to your career, and you need someone in your corner who understands the nursing disciplinary process in your state. According to a 2021 article in MedPage Today, nursing board discipline in many states has been getting more aggressive, meaning that the odds may be stacked against you if you've been accused of misconduct.
You need someone on your side who can help even the playing field. The Lento Law Firm's Professional License Defense Team includes attorneys with years of experience defending nurses against serious misconduct allegations, including for fighting or abuse, all across the US. Our attorneys understand how stressful it can be to find yourself the focus of a disciplinary investigation, and we will guide you and protect your rights from start to finish.
If you are facing any kind of nursing misconduct allegation, contact the Lento Law Firm's Professional License Defense Team today at 888.535.3686 or use our contact form to schedule a confidential consultation. You have worked too hard for too long to earn your nursing license to let it be put in jeopardy by a misconduct allegation; let the Lento Law Firm help you protect it!
