Nurses' Decisions to Press Charges Against Hypothetical Patients Who Exhibit Violent Behavior

Background: Patients are the most frequent perpetrators of physical violence against nurses. In the United States, most states have established laws designating assault against nurses a felony, or serious crime. It is unknown what reasons nurses have for pressing charges or not pressing charges against patients. Purpose: The purpose of this study was to examine nurses' decisions regarding pressing charges when patients exhibit violent behavior. Methods: This study used a mixed-method, cross-sectional, descriptive design. Three unfolding case studies were presented in an electronic survey. Twelve versions of the survey were randomly assigned to participants. Each described an adolescent, adult, and geriatric patient. The narrative descriptions were identical, but the visual representations of the patients differed. Results: A total of 499 nurses from seven hospitals in the western United States responded. Most nurses indicated that they would not press charges against any of the hypothetical patients. An injury occurring and an assumption of intentionality contributed to nurses' decisions to press charges. Participants were more likely to press charges against the adolescent and adult patients than the geriatric patient. The hypothetical adolescent and geriatric patients were more likely to have charges pressed against them if presented as female than if presented as male. The hypothetical adult patient was more likely to have charges pressed against them if presented as white than if presented as black. Conclusions: There is no consensus regarding when a nurse ought to pursue legal action against a patient who exhibits violent behavior. In addition to the presence of injury and the assumption of intentionality, it is possible that implicit bias may also play a role in these decisions. More investigation into this is needed.