Behavioral emergency

Today I had a behavioral emergency in the psych ward. There was a patient going off and his targeted peer was buying into it, goading him on. I came out from behind the nurses station and got ready to defend the elderly client with impaired judgment from what looked to be a brutal attack from a very willing and able psychotic client.

The other nurse on the shift warned me to come back, saying that property damage is one thing but if I got hurt it was something else. I waved him forward asking him to come with me.

He hung back, went to the Pyxis, and drew some PO meds that would help the patient calm down. Fair enough, but then it was just me out there. I motioned to security to come back me up. The bottom line was that if the psychotic patient got ahold of this senior citizen it would be bad news.

After he drew the meds he became the point of the spear and talked the patient down, gave him the meds, and exited stage left. I walked the patient into a side room to use the bathroom, and then offered him that quiet space to recollect himself and relax while the adrenaline wore off. He crashed out for a while and rejoined the milieu.

My partner nurse didn't understand what I was doing by offering the patient a quiet room for a while.

It just seemed odd. He didn't necessarily do anything wrong, but I certainly got the feeling that he was OK letting the senior take a blow before he was going to do anything to stop it. A nurse came from another unit to draw blood on this agitated patient. I stood by to assist should things go sideways. I kind of disagree with drawing blood on him right then and there, that could have waited for an hour or two. The pt was vocalizing distress while she drew blood... she has more than a decade more experience than I do so I guess she knew what she was getting into... it worked out OK...

Overall I got an impression that staff weren't all that practiced in behavioral emergencies and if things went sideways it would be a mess.

I'm on contract at this hospital so I'm sure I haven't been exposed to how they deal with this kind of thing on a regular basis. They have at most three or four S/R events a year. I'm used to running a behavioral code on average once a day. When I get back to work in a couple days I'm going to work with this team again. I just have a hard time adjusting to an environment where people aren't all ready to dig in and play their parts.

There's nothing worse than telling a fellow nurse to call a code and see that deer in the headlights look. The eyes widen, eyebrows go up, the body stiffens, and I know they're not going to pick up the phone or walk out with me.