Criminal NursingAbuse by Nurses

Professional Duties of a NurseAdvocates for and protects patient’s safety

and health (ANA, 2015)Vigilance to report improper practice (ANA,

2015)Care of the patients assigned to them

Do no harm (Huston, 2014) Client protection and safety are priorities

Ugly Truth of NursingCommon perceptions

Benefactor, caretaker, incapable of harmReality

Abuse does occur by nurses Neglect Verbal abuse Psychological abuse Physical abuse/murder

Victims of AbuseAnyone patient can be abused, although;

Patients with diminished capabilities are primary targets (Lubaszka, Shon, & Hinch, 2014) Babies Elderly Terminal patients Mentally ill Comatose patients

PerpetratorsNot limited by age or

raceNurses are primary

abusers in healthcare (Lubaszka, Shon, & Hinch, 2014)

Perfect career choice to hide ill-willSnake in the grass

No one suspects a nurse

Can be anyone

Actions of PerpetratorsCultivates trust with victim/victim’s familyUtilize medical knowledge to conceal abuse

Vienna, Austria Elderly clients smothered with wet washcloths

(Lubaszka, Shon, & Hinch, 2014) Moisture in lungs raised no alarms

Small injuries can be explained away Nurses possess inherent trust (Gallup, 2014)

Actions of Perpetrators, contHumor

Brings levity to tragic situationsViewed as coping mechanism in healthcare

Allows abuser to nonchalantly relive experienceLainz Angels of Death (49 murders)

Suspicion aroused by their humor (Lubaszka, Shon, & Hinch, 2014)

Actions of Perpetrators, cont•Prolong the suffering (Lubaszka, Shon, & Hinch, 2014)

Colleen Thompson Invited widowers of

victims to her wedding

Kristen Gilbert Called victim’s family to

remind them death

Motivation of PerpetratorsPsychology

Power is most prevalent reason (Field & Pearson, 2010) Vulnerability of patients

Crave respect and control “Come to the rescue”

Makes patient ill, then “saves” them (Lubaszka, Shon, & Hinch, 2014)

Factors that Increase AbuseStress imposed by a facility

Time constraints due to: High workload Poor support from management Conflicts with patients

Leads to categorizing patients Treatment was altered to reward “good” patients

punish “bad” ones (Reader & Gillespie, 2013)

Factors that Increase Abuse, contWorkplace quality

Poor leadership and job environment cultivates: Disengagement De-motivation Low job satisfaction Worker burnout

Factors that Increase Abuse, contWorkplace quality

Work dissatisfaction Highly correlated with poor

job performance (Reader & Gillespie, 2013)

Poor job performance can lead to neglect and abuse

Worker burnout (Mayo, 2015)Questioning the value of one’s work Coupled with emotional and/or physical exhaustion.

Closely tied with physical and mental abuseHas been found to reduce empathy (Natan,

Lowenstein, & Eisikovits, 2010 )

Caused by Symptoms

Dysfunctional workplace dynamics

Disillusionment

Unclear job expectations Irritability

Feeling of lack of control Impatience

Lack of social support Low job satisfactions

Factors that Increase Abuse, cont

Factors that Increase Abuse, contSocial norms within a facility

Some nurses accept maltreatment as norm (Natan, Lowenstein, & Eisikovits, 2010) Slapping, cursing, embarrassing patients

Stress when vacillating to report or notPoor avenues for whistleblowing (Reader &

Gillespie, 2013)

Factors that Increase Abuse, contFacility size

High correlation between Facility size and maltreatment High staff turnover and maltreatment/abuse

Length of time employedAbuse vs. time employed are inversely related

Possible CountermeasuresAssessing personal characteristics in nursing

schoolGauge emotional intelligence and sensitivityTest aptitude for verbal and non-verbal cuesTeaching students to report illegal behavior

(Wolf, 2012) Implement rigorous screening processes for

applicantsQuestionnaire fed through algorithm to

determine suitability

Possible Countermeasures, contMandatory survey provided to patientsScrutinize facilities with low job

satisfactionComprehensive teaching of the subject in

facilities

ConclusionsAbuse can occur by the hands of a nurseRemain vigilant to report suspected cases of

abuseAcknowledgement and teaching of nurse

abuse is the solution

“Nursing and nurses need to acknowledge the possibility that any nurse in virtually any clinical setting could murder a patient or patients. Clearly it is exceptional. It is not impossible. Only when this is acknowledged will it become more difficult for these murderous nurses to operate […]”

- James Field, 2010

ReferencesAmerican Nurses Association. (2015). Code of Ethics for Nursing with Interpretive

Statements. Silver Spring, MD: NurseBooks.orgField, J., & Pearson, A. (2010). Caring to death: The murder of patients by nurses.

International Journal of Nursing Practice, 16, 301-309. Honesty/Ethics in Professions. (2014). Retrieved October 22, 2015, from

http://www.gallup.com/poll/1654/honesty-ethics-professions.aspxHuston, C. (2014). Professional issues in nursing: Challenges & opportunities (3rd

ed.). Philadelphia: Lippincott Williams & Wilkins.Lubaszka, C. K., Shon, P. C., & Hinch, R. (2014). Healthcare Serial Killers as

Confidence Men. Journal Of Investigative Psychology & Offender Profiling, 11(1), 1-28.

Mayo Clinic Staff. (2015). Job burnout: How to spot it and take action. Retrieved October 24, 2015, from http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642

Reader, T., & Gillespie, A. (2013). Patient neglect in healthcare institutions: A systematic review and conceptual model. BMC Health Services. Retrieved September 26, 2015, from http://www.biomedcentral.com/1472-6963/13/156

Wolf, Z. (2012). Nursing Practice Breakdowns: Good and Bad Nursing. MEDSURG Nursing, 21(1), 16-22, 36.