Emergency Department Visitor Who Refuses to Leave
At 02:10 you are the contract guard in the emergency department of a Saskatoon hospital. A 54-year-old man has been shouting at the triage desk for 10 minutes because his adult son was brought in by ambulance and he has not received an update. He has not touched anyone, but he has knocked a plastic chair over, is pacing, and is swearing. The department is full; nurses are managing a possible cardiac arrest. The charge nurse tells you, 'Get him out now.' The man says, 'I'm not leaving until I see my son.' He has no visible weapon, is not intoxicated according to your observation, and calms slightly when you make eye contact. Hospital policy says security may remove a visitor only when there is an imminent safety risk or after an authorized trespass request; clinical staff decide visitation.
1. What is your first priority, and how do you separate clinical authority from security authority in this situation?
Read the worked answer
Your first priority is safety of patients, staff, and the man himself, not enforcing a clinical decision. The charge nurse controls clinical access and can decide what information or visitation is appropriate, but the nurse cannot simply order a physical removal that exceeds hospital policy or the law. As a guard, you can set behavioural limits, de-escalate, and respond to imminent risk. Removal or trespass is a property-authority decision that must come from an authorized hospital representative and must follow policy.
Assess the immediate risk: he has knocked over a chair and is loud, but he has not threatened or assaulted anyone, shows no weapon, and responds to eye contact. That supports a verbal de-escalation attempt before removal. Ask the nurse to confirm the clinical restriction and whether a brief factual update can be given. Do not promise information you do not control, and do not physically move him unless there is an imminent safety risk. If removal is authorized and he refuses, police can assist with trespass.
2. Give a short de-escalation approach with two clear limits, and state when you would call police.
Read the worked answer
Approach from the side, keep an arm's length or more, lower your voice, and use his name if known: 'I can see you are worried about your son. I am not the person who has his medical information, but I can help you get a factual update.' Offer a specific alternative: wait in the designated area while you ask the charge nurse for a status update, or step outside for air with a planned return time.
Set two limits: 'You can be upset, but you cannot knock over chairs or block the triage desk,' and 'You cannot go into the treatment area.' Explain the consequence: 'If you continue, hospital staff may ask you to leave, and I will have to involve police.' Call police if he threatens or assaults someone, tries to force past into treatment areas, refuses an authorized trespass request, or his behaviour escalates despite clear limits. Do not call police merely because he is angry.
3. What should you document, and what should you avoid writing in the report?
Read the worked answer
Document the time you arrived, the charge nurse's exact request, the man's observed behaviour, the chair being knocked over, his exact words, your distance and approach, the de-escalation steps you tried, the limits you set, any clinical update offered by staff, his response, and the time police were called or the situation resolved. Record who authorized any removal request and what policy applied. Avoid medical conclusions such as 'He was psychotic' or 'He was drunk.' Avoid labels like 'uncooperative' without describing what he did. Avoid saying the nurse 'made me remove him' if the actual request was vague; quote the request and explain what authority was used. The report should let a reviewer see whether force was necessary and whether hospital policy was followed.