shift is wild

When it goes sideways

When a patient says they might hurt someone

Because “HI, MD aware” is not a note. It is a future deposition wearing scrubs.

8 min read built on 6 full opinions updated 2026-09-20

Written by a med-surg RN, ten years, day shift. Why there is no name on it

Patients say this in different ways: during intake, while psychotic, while angry, half-casual, or as a straight threat. Your note needs to show what they said, what you assessed, who might be at risk, and what you did next.

The short version

  • Write the patient’s words as close as you can. Don’t clean them up.
  • Chart target, plan, intent, means or access, timeframe, and triggers.
  • If voices, paranoia, intoxication, dementia, delirium, or agitation are part of it, chart what you saw and what the patient reported.
  • Write who you notified, when, and what safety steps started.
  • Don’t write only HI, threatening, or contracted for safety and stop there.

What goes wrong

The usual mistake: you chart a label, not the risk picture.

Bad note: Patient is HI. MD aware.

That tells the next nurse almost nothing. Is the patient having intrusive thoughts they don’t want? Are they angry at some unnamed group? Did they name a spouse, coworker, nurse, roommate, judge, neighbor, or child? Do they have a weapon? Are they leaving in 20 minutes? Are they hearing voices? Did anyone notify the provider, charge nurse, security, or receiving unit?

HI is not the problem. By itself, HI is just your conclusion. The chart needs the facts that got you there, and what happened after.

It is not hypothetical

  • Caples v. Sinai Hospital of Baltimore, Inc., Court of Special Appeals of Maryland, 2026. https://www.courtlistener.com/opinion/10851854/caples-v-sinai-hospital-of-baltimore-inc/

Where a patient expresses violent ideation toward those in their vicinity, at a minimum, the provider or administrator must warn those to whom the patient is being discharged.

  • State ex rel. Jones v. Hoying, Ohio Court of Appeals, 2025. https://www.courtlistener.com/opinion/10332782/state-ex-rel-jones-v-hoying/

On [April 16, 2024], Mr. Jones stated that he wished to kill his parole officer. When asked if he had access to weapons, he stated “I have people on the street.”

What to write instead

Instead of this Write something more like this
Patient is HI. MD aware.1910: Pt stated: I am going to kill my brother when I get out. Pt identified brother J.R. as target, states brother lives with pt. Pt reports plan to stab him with kitchen knife at home tonight. Pt reports access to knives at home, denies firearm access. Pt pacing in room, voice loud, fists clenched. Charge RN notified 1912, psychiatry resident paged 1913, security to unit 1915. Pt moved to room closer to nurses station per unit safety process.
Pt threatened staff.2240: During medication pass, pt pointed at this RN and stated: I will break your neck if you come in here again. Pt standing 3 feet from doorway, blocking entrance. No physical contact. MHT A.B. present. RN stepped back, maintained open exit, charge RN notified. Security called to unit. Medication not administered at that time due to safety concern; provider notified 2248.
Denies HI. Contracted for safety.0830: Pt denies current thoughts of harming others. Earlier statement from night shift reviewed with pt. Pt states: I said I wanted to punch my roommate because I was angry. Pt denies plan, denies intent, denies weapon access on unit, denies target other than roommate. Pt agrees to notify staff before approaching roommate. Room assignment changed; pt remains on q15 min safety checks per order. Provider updated 0840.
Pt psychotic and dangerous.1435: Pt reports hearing a male voice telling him to hit coworker M.S. with a wrench. Pt states coworker is real and works with him at ABC warehouse. Pt states urge is 8/10 and says he has a wrench in his truck at home. Pt denies firearm access. Pt appears internally preoccupied, pauses before answering, looks toward corner of room. NP notified 1440; discharge held pending reassessment.
Family says patient threatened neighbor.1015: Pt’s sister called unit and reported pt told her by phone today that he was going to shoot the upstairs neighbor. Pt present during call follow-up and states he is angry with neighbor but denies intent to harm him. Pt reports owning one handgun kept at home in bedroom closet. Provider and charge RN notified 1022. Safety plan and disposition reviewed by provider.
Pt became aggressive.1718: Pt struck wall with right fist twice after being told discharge paperwork was not ready. Pt stated: I will come back here and hurt whoever is delaying me. No specific person named when asked. Pt denied weapon on person. Right hand skin intact, mild redness over knuckles; ice offered. Security present 1721. Provider notified 1725.

Words that do the damage

Word or phrase Why it causes problems Use instead
HIToo vague by itselfThoughts of harming others present or denied, plus target, plan, intent, means, timeframe
ThreateningA conclusion without the words or behaviorPt stated: [exact words]. Pt stood [distance], pointed at [person], blocked [exit/door]
DangerousLabels the patient but does not describe riskSpecific behavior, statement, access to weapon, recent violence, current impulse control
PsychoticToo broad if used alonePt reports voice saying [content]; pt states belief that [person] is trying to harm him
No planWeak if you did not ask about means, access, or timingDenies plan to harm [target]; denies weapon access; denies intent; denies timeframe
Contracted for safetyDoes not show what was assessed or what changedPt agreed to notify staff before approaching [person]; safety checks/room change/provider notification documented
ManipulativeJudgmental and not usefulPt requested [item/action]; when request denied, pt stated [words] and did [observable behavior]
Calm nowMay erase the earlier riskAt [time], pt sitting on bed, voice normal volume; continues to deny/endorse [specific risk items]

What the guidance says

  • Chart the patient’s actual words, the target or possible target, plan, intent, access to means, timing, and what you did after. (NurseChartingPro, Neurolaunch)
  • Follow your facility process for violent behavior. That may mean charge nurse, supervisor, security, provider, or internal reporting when required. (NursingCenter, Neurolaunch)
  • Include safety interventions and how the patient responded. Don’t stop at the risk statement. (NurseChartingPro, ICANotes)

Copy this

Chart note

```text [DATE] [TIME]: Patient assessed after statement about harming another person. Patient stated: [EXACT WORDS USED BY PATIENT]. Patient identified target as [NAME/RELATIONSHIP/GENERAL GROUP/NONE IDENTIFIED]. Patient reports plan: [PLAN OR DENIES PLAN]. Patient reports intent: [INTENT LEVEL OR DENIES INTENT]. Patient reports timeframe: [TIMEFRAME OR DENIES TIMEFRAME]. Patient reports access to means/weapons: [MEANS/WEAPON ACCESS OR DENIES ACCESS]. Patient reports precipitating factor as [TRIGGER/EVENT OR UNKNOWN].

Mental status/behavior observed: [APPEARANCE, SPEECH, AFFECT, AGITATION, INTOXICATION, CONFUSION, PARANOIA, HALLUCINATIONS, OR OTHER OBSERVED FINDINGS]. Patient [DENIES/ENDORSES] auditory or visual hallucinations. If present, patient reports content: [CONTENT]. Patient [DENIES/ENDORSES] suicidal ideation.

Safety actions taken: [PATIENT LOCATION/OBSERVATION LEVEL/ROOM CHANGE/SEPARATION FROM TARGET/ITEMS REMOVED/SECURITY PRESENT/OTHER]. Notifications: [PROVIDER NAME/TITLE] notified at [TIME]; [CHARGE RN/SUPERVISOR] notified at [TIME]; [SECURITY/OTHER TEAM] notified at [TIME]. New orders or plan: [ORDERS/NO NEW ORDERS/PENDING EVALUATION]. Patient response after intervention: [RESPONSE]. ```

Message to provider or charge nurse

``text [DATE] [TIME]: Notified [NAME/TITLE] that patient [PATIENT NAME/MRN] made statement about harming another person. Patient stated: [EXACT WORDS USED BY PATIENT]. Target identified as [TARGET]. Patient reports [PLAN/NO PLAN], [INTENT/DENIES INTENT], timeframe [TIMEFRAME/NONE], and access to [MEANS/WEAPON/NONE REPORTED]. Current observed behavior: [BEHAVIOR]. Current safety actions in place: [ACTIONS]. Requested provider assessment and further orders. Response from [NAME/TITLE]: [RESPONSE/ORDERS/PENDING]. ``

Internal safety event report

``text [DATE] [TIME] at [LOCATION]: Patient [PATIENT NAME/MRN] made statement about harming another person. Exact words documented in clinical note. Persons present: [WITNESSES]. Target or possible target: [TARGET]. Observable behavior at time of event: [BEHAVIOR]. No physical contact occurred / physical contact occurred as follows: [DETAILS]. Injuries or property damage: [NONE/DETAILS]. Immediate actions taken: [DE-ESCALATION, DISTANCE, EXIT MAINTAINED, SECURITY, STAFF ASSISTANCE, ROOM CHANGE, ITEM REMOVAL, PROVIDER NOTIFICATION]. Patient status after event: [STATUS]. Report submitted to [ROLE/DEPARTMENT] per facility process. ``

If you remember one thing

Don’t chart only the label. Chart the words, target, plan, means, timing, and what you did next.

Read the decisions yourself

Every case below is a published decision on CourtListener. Open them. Nothing on this page asks you to take our word for what a court said — and where we only had the search result rather than the full opinion, it says so.

All the decisions behind this guide, in one page — searchable by court, year, or what happened.

What people say on the floor

Nurses talking to each other about this, quoted as they wrote it. This is opinion, not a source. It is here because it shows what the argument actually is — the rules above come from the decisions and the published guidance, not from these threads.

What everyone else says

Guidance from professional bodies, insurers and other people who write about this. Useful, but it is advice, not law — that part is above.

How would you chart it?

This is the part we cannot research. If you have a way of writing this that has held up — put it here. No account, no name needed. Nothing that could identify a patient: no room numbers, no dates of birth, no MRNs. Use placeholders, the example still works.

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