In over my head?

[LoveAura]

::edited for specifics::

Okay so.. on a psych unit I get that violence may be more prevalent than in other work environments

My issue is this -- I've been a psych tech for a few months now on a crisis unit trying to feel out the field to see if I want to go into nursing. We aren't a hospital, we take medically stable individuals who need short term help for a variety of disorders. They oversee their own meds and can refuse.... but if they become belligerent, until now, we've been able to discharge them. A state hospital has just announced they are downsizing and possibly facing closure. This means our 16 bed unit will start taking on more acute individuals and we have just gotten three of them, two of which are court ordered to remain here.

One individual in particular doesn't have a diagnosis but he's severely delusional and violent. He came to us unmedicated and remains so. We have no training on how to neutralize physical aggression other than to prevent it, and we have no means of segregating this individual. As someone with specialized training, it is my job to "talk him down" when he's beating on walls and screaming about how he's going to kill us all just like he killed jesus.....

But I'm almost 8 months pregnant. I feel like I have a lot to lose by engaging him, and when he acts out, at least one of the others starts off like a domino effect. The other residents don't even have a way to lock him out of their bunk rooms and they are uneasy. We usually work with three of us on the unit and most of the time we are all women and we feel pretty darn uneasy too.

I feel like our unit is unprepared and things are going to escalate in a short time. Is it time to turn in my notice?

[Davey Do]

"One individual in particular doesn't have a diagnosis but he's severely delusional and violent. He came to us unmedicated and remains so. We have no training on how to neutralize physical aggression other than to prevent it, and we have no means of segregating this individual. As someone with specialized training, it is my job to "talk him down" when he's beating on walls and screaming about how he's going to kill us all just like he killed jesus..... "

This Individual meets Criteria for an Involuntary Admission to a Behavioral Health Facility for appropriate Interventions that obviously cannot be met at the Facility where he is Currently Housed.

As far as your Decision to work in this Field while you are Pregnant, realize your Priorities and you have your Answer.

[macfar28]

The way I see it...you can always find another job but your family can't find another you or another precious newborn. Take care of yourself and your license.

[hpcat]

For this type patient, you need to know crisis prevention & intervention (aka self defense for psych nurses), you need to be able to medicate with PRN and/or stat meds, over objection if necessary, and you need to be able to use seclusion and/or restraints. Violent psychiatric patients are not to be taken lightly, you can get very seriously hurt. Not telling you to leave, but I would, pregnant or not. Your facility is not prepared for this level of agitation/aggression.

[MrChicagoRN, RN]

"One individual in particular doesn't have a diagnosis but he's severely delusional and violent. He came to us unmedicated and remains so. We have no training on how to neutralize physical aggression other than to prevent it, and we have no means of segregating this individual. As someone with specialized training, it is my job to "talk him down" when he's beating on walls and screaming about how he's going to kill us all just like he killed jesus..... "

This Individual meets Criteria for an Involuntary Admission to a Behavioral Health Facility for appropriate Interventions that obviously cannot be met at the Facility where he is Currently Housed.

Exactly. You are not equipped to provide this persons level of care, and you are not able to meet their needs.

This person needs to hospitalized, diagnosed, treated.

The staff needs to receive CPI, or other deescalation/management training.

Management needs to reassess its admission policy, staffing, and security.

[RNcashy89]

My dear god, this sounds like a bad dream. It is phenomenally inappropriate for such an individual to be treated within the facility you describe. I'm very ignorant re: international health care law, but in my neck of the woods said individual is a certain candidate for involuntary assessment, and would almost certainly be contained and medicated regardless of his consent - he sounds like he is a danger to himself and others.

[mrnightinggale]

Is your boss/management willing to get in there and restrain/do what they expect you to do with this patient? IMHO, bosses should not ask workers to do something they are unwilling to do themselves. Wonder how OSHA would view this. Sounds like an unsafe work environment.

[Whispera, MSN, RN]

When someone tells me what he's going to do, I tend to believe him...

[gardenwoman]

This sounds really unsafe, and I would also echo other's comments-this individual sounds as if there is definite need for involuntary hospitalization in an acute care psychiatric facility for safety of all . Stay safe!

[LoveAura]

Thank you for your advice, all. I was beginning to think this was the norm for psych. While I get that the behavior may be standard, how we deal with it is lacking severely, right?

My facility administrator has said that they are in the process of hiring an RN to oversee this unit and telemed with an MD for individuals who come to us without prescriptions. On hospital units or otherwise inpatient facilities, is it standard to have security, restraints, on-call for when staff calls in, is medication required, etc? We were at the point of having ONE person manning the facility this week and I don't see how that is safe at all!!

The guy I mentioned as being such a problem is now medicated and calmer, not threatening. But he is now sexually harassing staff and other residents. We "redirect" him verbally but I feel this scenario is verging on ridiculous. The only thing we can do is call the cops to come out and talk to him or take him to jail. I get that this place is going through some changes, taking on these patients, and I have one week left before I'm out on leave. Hopefully they will have gotten us some training and set protocols by the time I'm back or this job is just not going to be worth the anxiety of showing up.

[RNcashy89]

You have some options/techniques as far as redirection and deescalation of acutely psychotic or hypo manic patients - however, ultimately their level of receptiveness will depend on their own capacity for emotional regulation and rationalisation. Many who are acutely unwell, do not possess this capacity, and simply can not be reasoned with or redirected. Unfortunately, management in said instance will require containment and often involuntary assessment and treatment. To answer your question; yes - the manner in which your facility is dealing with this patient is profoundly lacking - mainly due to the fact that you are not equipped with the facilities, resources, or staff to treat patients who are this unwell.

[margotnurse21]

This individual sounds too unstable for such a facility as yours. He may need an acute inpatient psychiatric unit that is more equipped to handle such aggressive and threatening behaviors. Medications are key with aggressive patients. Giving them choices are also effective such as "You are going to receive this medication to help improve your mood and anxiety. You have the choice of where you would like me to give the medication. Right or Left arm? Right or left Buttock? Who would you like to administer the medication? (If they have a better rapport with someone else). And as for you, I don't believe there is anything quite as precious and priceless as a newborn baby. At least take some time off for now until you give birth and spend some time with your little one. These moments are priceless and very important. Sometimes finances are an issue, but there is always more to life than work!\

Peace and Love;)