Question for psych nurses!

Midwest4me · Mar 10, 2012

I've been doing psych nursing for 6 years now; and ESPECIALLY in this specialty one should NEVER be alone with a patient. You put your health and your license at risk. Demand to have another staff member with you. Do you belong to a union? If so, the union needs to get involved. Have you brought up this safety issue with your supervisors? If not, do it NOW.

shakeytails · Mar 10, 2012

Never. In our facility we are not allowed to enter a patient's room without another staff member either with us or standing at the door to watch. We also have cameras everywhere. They're not generally monitored except for a couple of areas (like intake), but can be re-played to prove or disprove an incident. Psych patients are incredibly good at lying and manipulation, and some can be very dangerous physically.

Blue4me2 · Mar 10, 2012

I do not have a union where I work and I am an at will employee. I talked to the nurse manager and she says that she sees nothing wrong with the situation and it will be required that I work there. I'm expecting more of the same if I discuss this with anyone above the nurse manager as well.

Whispera, MSN, RN · Mar 10, 2012

Then, my advice to you, Blue4me2, is to quit. Seriously. Your safety, both legal and physical, could be at stake here.

I can't say this loudly enough---you are at RISK! So is the patient if something goes wrong!

phattass, BSN, RN · Mar 11, 2012

As a nurse who has spent the last ten years working in mental health, I have to say I agree with much of what Meriwhen suggests. It really depends. The same question can be generalized to being alone with ANY patient. There is a risk when you are alone with anyone you are treating. Is the incidence of assault higher on a psych unit then that of a general medical unit, yes. Is it higher then the risk on a geriatric unit, no.

I think your gut has already answered the question though. Don't ever go against your gut, it's talking to you for a reason. Trust this instinct. Even with over a decade in psychiatry, I still wouldn't advocate for any type of mental health setting that has isolated areas where staff are expected to work alone. This is especially important when you are dealing with patients who have yet to be diagnosed or not had at least one risk assessment done. If there is no collateral information, assume there is a risk factor and protect yourself by working along with another staff.

Good luck. I hope you get to experience some of the wonderful things I have working with this population.

marilyn crisp · Mar 15, 2012

TOTALLY WRONG!!!! Completely dangerous and no one should be required to do this. Would you put yourself in this same situation with any random person? Nope! You could seek guidance from the board of nursing in your state. Although they can't mandate certain things, they may have documentation on situations like this and injuries to staff as a result etc. that could be used to levy some changes. You might also contact your state labor board and see what they say. These places wonder why they can't retain employees.......

Topaz7 · Jun 5, 2012

They are still people. Can they be unpredictable? Yes, certainly they can. I've worked for 2.5 years and thank the good lord never been assaulted or attacked and I always give my Pt's the respect of speaking with them in private. I think people forget that they are human too. Is there precautions you can take to protect yourself just in case? Yes. I always sit between them and the door, however I have closed the door with many patients and it has never been a problem. I guess that is a judgement call, I have always felt comfortable to do that. Other times I will keep the door cracked open. I will even sit facing the Pt, arms length away in a relaxed posture. This has never been an issue, in fact I have never heard of anybody ever being attacked/assaulted at my job while trying to do a 1:1 with a patient. I understand policies are different as I saw on another post not every state implements CPI. My facility does use CPI, and all staff are trained in it, so in the case of a Pt trying to attack us we do have some non-violent tools to utilize that allow us to get out of the situation and get to help hopefully. We also carry buzzers on us so that if a Pt does attack us we push the button and staff hear it and come running. Usually I can tell if a Pt is up for having a 1:1 discussion or whether they are too agitated and perhaps another time might be better. Do what makes you comfortable, I just know they teach us to approach Pt's this way and it has worked very well so far. Remember please, they are people too, they are just sick, they deserve privacy, respect, and the dignity of being treated as a human being who can have a conversation, not as a mass serial killer who you can't be around alone or that they don't have their rights still.

Topaz7 · Jun 5, 2012

I agree with you very much!! The risk of assault is not higher than that on a geriatric unit. I worked 8 years in geriatrics you get assaulted frequently with dementia patients, on the locked inpatient psych units I have only been attacked on the Dementia Psych unit, NEVER been attacked on the adult or child/adol units.

Jayesse7 · Jun 15, 2012

Be an agent for change Blue!!! That is if you are still working there. Investigate the hospital's policies...and investigate incident history. Even a panic alarm that you can wear on your person...not around ur neck though. And I agree with Meriwhen. "Develop your spidey senses" and never ignore them. Terrible things can and do happen. However; luckily, not very often. Patients are people and you have to ask yourself, are you safe alone and isolated with anyone you don't know? Not really. But... I advise you to think about what you would do in dangerous scenarios. NOT obsessively. If you are really fearful it's not the job for you.

When I was a cute, young and new psychnurse (a long time ago) the male patients used to occasionally hit on me. I once had a male patient follow me into the linen room. He was between me and the door and he started to close it. I yelled LOUDLY; "Dont you dare close that door Malcolm!" and I kept on shouting in a stream of exaggerated oh-my-god don't you know that is a BIG no-no here? What are you thinking! Are you trying to get us both in trouble? Sheesh! etc... ad lib. All the while I was moving quickly past him to the door, then into the hallway. And of course he began to apologize which I gratiously accepted with a smile and said "I know you didn't mean anything. It's okay but never never do that again. Sneakin up on your favorite nurse like that about to give me a heart attack." Because the thing was...I couldn't show him vulnerability by freezing and being quiet- pretending we didn't both know he had me in a bad spot and he could've done something terrible... My loud and constant exclamations served to make noise so maybe somebody would hear me and they'd know what was going on by what I was saying, BUT also I caught him by suprise and distracted him, allowing me to push past him without having to fight or challenging him to a struggle. My immediate attitude of 'no harm no foul I know I'm your favorite nurse' gave him immediate resolution and became part of my style. I don't like for patients to think I'm uncomfortable with them even when I sometimes am. I allowed him the chance to play it off like it was an honest mistake so I didn't create an air of nervousness between us in the future. Even though he did try again later to "talk to me", you know like chat me up...then I said "Malcolm...stop it. I'm your nurse. Don't make me give you my lecture on appropriate talk." But I said it playfully and warmly. Not nurse ratchet-like. I don't want to anger anyone. People who like you are more likely to come to your rescue, but you HAVE to have clear boundaries.

I got in the habit of just blurting things in moments when I was really vulnerable. A very simple trick is to just say; "What are you about to do?!" If you jump the gun you can play it off..."ok thats acceptable, carry-on then" and laugh. If you are right and they were about to move in on you or even if somebody is about to swing...with the appropriate tone and volume OFTEN you will suprise them and change the course of the whole incident.

Once, I yelled from the doorway of the unit as I was coming in, "Hey! You aren't about to hit your doctor are you?!"... and I rushed over, coat on, purse on my shoulder; to the patient: "What happened? Why are you so mad?" taking the guy's fist like I was his loving mama, pulling him over to the alcove of chairs and sat us both down...."tell me what happened." He started pouring out all kinds of horrible stuff that evil psychiatrist (haha) lied about him, blah blah blah...and that evil psychiatrist bought me lunch that day. I have used my femininity as an alternate advantage. I am not big or strong and I was NEVER a fighter. If someone starts beating somebody up I probably cant physically overpower anybody- alone. But I am the queen of immediate distraction, which will hopefully at least buy somebody 3-5 extra seconds and hopefully they will use them well and get out of the way or get to the phone...or hit a panic button or whatever.

I've also been beat up too. Doesn't always work. But 3 times in 10 years in acute psych (pretty good) and never really really bad.

I GUESS my point is... you should develop a style, ways that work for you, (if you are going to stay in psych) so that if you are in less than ideal settings, under less than ideal circumstances, you can manage the situation. Because let's face it, I don't see any governors or administrators shouting "give the psych units more staff!" "Keep our mental health care workers as safe as possible!" It's really more about damage control after the fact, these days. So you're on your own. Good luck!