I'm so ****** off. We got a guy last night that was violent, fighting with family, breaking windows, ect. The family called the police and he cried suicidal and ended up with us instead of in jail. That was my first problem with the whole thing. He should have gone directly to jail. He has a violent criminal history.
So in the ER he is in 4 point leathers and continues to yell and swear. He states that if he is admited to our behaviour unit he will assault staff, steal a badge, open the doors and escape......He has done this before. He escaped the leathers, he tipped the cart, he was verbally abusive. Ativan did nothing. As I tried to give him an IM of Haldol he looked directly at the security officer and spit in his face. 100% intentional.
The psych facility refused him because he is to violent for them to handle. We called the police because psych, the MD, and I are all feeling like that is where he belongs. Well the officer comes in and says right off the bat he will not take him to jail because he has a 24 hour psych hold. Long story short if you have claimed suicide, psych, ect you can not be arrested and sent to jail because he is not in his right mind. Security wanted to press charges and was told he couldn't. It seems to get more common lately that the police just do a 24 hour and dump them with us instead of dealing with it.
So now we have this viloent patient that I believe is 100% in his right mind and is just an *******. Psych won't take him and jail won't take him. We can't let him go. What is the solution???? When I left after having him for 6 hours. Lets just snow him with drugs and wait until morning for a pyschiatrist. I have NEVER in 10 years seen a psychiatrist come to the ER.
So frustrating, such a waste of time. We can get verbally and physically abused for hours and there is nothing we can do about it because he claimed suicidal at one point. Jail is a safe place! I guarntee they can do suicide watch and he can get a mental health eval there. All this while the kids and little old ladys are not getting the best care they can because we are so tied up with this ahole. Plus he was yelling and swearing loud enough for the whole ER to hear for hours!
What do you guys do in these situations? Can you press charges if you are assaulted? Do you get a lot of police dumps?
the hospital i do clinicals at has a special section of the er for people like that. it is a locked area with three rooms, unbreakable glass(plastic), the nurses station is separated with a big window to watch them. its like a mini psych unit. no windows in their rooms, locked garage door hiding the sink, all the psych fixings.
i have never seen anything like that around here i was shoucked to see there was a need for medel deteacters
anyway, when i did my rotation there who was homeless and this was his 4th hospital in the area hed shown up at that month stating very calmly "i want to kill myself and hurt my family". so they automatically had to place him on a hold. he was there for 36 hours when i started the day, and hadnt left by the time i went home. no psych units would take him because he was on o2.. thank god he wasnt violent like this guy, but my point is, a sectioned off part of the er for cases like this would be useful in most hospitals me thinks.
if he was homeless how could you tell what hospitals he been to ? was he bragging about doing this ?
i saw a lot of inmates and the er after my car wrek i was at a loss as to why they where there i know the jails have doctors /nurses and even small hospitals . maybe it was inmate day
hehe that's exactly what I wanted to do!!!! I did try hard with him. I took him drinks of water, I tried to reason with him, ect. It would work for a short time then he would escalate again. I do need to just let it roll off and start fresh tomorrow. Thank you for your kind words!
I wonder why psych units would refuse a psych pt. Arent they suppose to deal with this. Anyways I dont have any advice for you as i have never dealt with this but i do know my hospital have rooms for pt that have violent and psyche issues. There's basically nothing in the room but a bed
Specializes in med-surg, psych, ER, school nurse-CRNP.
I used to work in a locked psych facility. A patient there threw an older nurse down and kicked her in the head because she would not let him out to smoke whenever he wanted. She pressed charges, the judge threw out the case because the man was a psych patient, even though the man stood there and said (please pardon the language) "That b**** wouldn't open the door, she got what was coming to her."
The case was dismissed, the hospital fired the nurse after several months of health issues stemming from the assault, and to my knowledge, that man is still breathing the free air.
Send him to the neuro floor with 1:1 orders - meaning that a nurse will be pulled off the floor to babysit, (because of course night shift doesn't need an aide) and split her other 6 patients with the remaining 4 nurses. Happens to us all too often! Extremely frustrating!
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
The big problem is that these people cost everyone time and money. Whoever is stuck with him has to have extra personnel and even then he would be disruptive in the jail, the psych unit or the ED.
If he does have a legitimate psych illness he is not compliant with treatment so continues to be a problem for everyone. Too many mental health "advocates" are making the rules, the result is that everyone suffers. Even the patient. Even if his behaviour is deliberate, you know he's not enjoying himself. He needs a secure room, a goodly dose of neuroleptic and a good behaviour mod program. Good luck getting that anywhere.
Specializes in Flight, ER, Transport, ICU/Critical Care.
I feel your PAIN.
As for being assaulted and who knows what ( did this dude have any communicable disease when he spit in the nice security officers face?) and the POLICE OFFICER did not want to take a report - REALLY?
OK - irony doesn't play well online - so, I will get to what worked for me.
I have been spit on, cussed out (and called a bunch of things) verbally abused - but when it rises to billybad@$$ doing threats and physical assault - well, that does not play well with me.
I have rights. Being a RN does not negate those rights.
Generally most cops work well with ER folks - you must have a very special breed of them. :dzed:
I had been beaten and was directly threatened by a guy (psych by cop) where this "patient" "with rights" was clear that he would follow me home and find where I lived and would be waiting with a knife and stab me to death - yep, that.
Add, that my "patient" had just been paroled out for stabbing a former girlfriend (she did not die) - yep, that.
Called the police and they asked me what I expected them to do. Really? How about your JOB!
I was refused even being allowed to make a report. Cut to ---
Call to Command Officer - explained my "situation" and asked how he would like me to proceed? Mention made of calling the state police to come do the job they refused, as well as calling the local prosecutor and the state parole office if need be --- and to hell with HIPAA - a threat had been made and there may have been real criminal intent. And as far as the f'ed up hospital that I was a travel contractor for - well, it was not an issue for discussion. Period. Maybe there is no "intent" but - I am in a high stakes job and have to make high stakes predictions and decisions. I will not gamble with my life. (I will not gamble with the lives of other unsuspecting patients either) The dude needed to go back to prison for some more "reform", as it was apparent he was not "cured".
A report was made. Charges filed and the patient got the care they so desperately still needed. 6 x 8 cell, metal bars, no windows and razor wired fence and armed guards. I did not have to worry about "that one" following me home and making good on a threat.
What to do -
Call the officers command officer. Go up the "chain of command" until you get satisfaction. It should not take too long. Remind them that a bad outcome would be a career killer. OK - that is high handed, but enough already - you have sick folks to care for.
If the hospital gives you any gruff - ask them if this "patient" harms you or worse - ask them if they think a jury will agree that you have rights. Remind them that YOU have rights and a family and that if they allow something to "just happen" to you - your grief-stricken, horrified family can find the eager beaver attorney on the back of the phone book that will know what to do next. Surely there Mr. Big Hospital you want me to have a SAFE place to work and would NEVER knowingly, willingly ignore my plea for protection? Right?
It confuses me WHY some locations put these "prisoner patients" in the direct care and security of a busy ED and staff RN - (or even unarmed security)? Has anyone there (hospital or police) considered what might happen if this "goes bad"? Imagine one of these patients assaulting or worse another patient or exposing themselves to a child "for kicks" or something or anything they can dream up to be the center of attention and cause big problems. Most of these patients have nothing to lose - and you (compassionate dutiful staff RN) have everything to lose. This practices needs some revision BEFORE the bad happens, it will - check with ENA they have some resources on Violence in the ED.
I don't see why security can't Press charges, I know psych techs who have and the charges stuck. I'm assuming security is afraid of losing the job if charges are pressed.
I think there are some insightful comments on this topic, and also a few that seem to be written by a person who doesn't really "get" severe mental illness, etc. The OP says this pt had no prior psych hx. Yet a "normal" person doesn't behave like this. A manipulative pt might, or someone on illicit drugs (bath salts, PCP) might. It may be true that many patients try "game" the system by saying they're suicidal when they're not. But there are just as many who don't, or who don't look/act like you'd expect a suicidal person to look (not crying; manic, whatever). Here's my main point, anyhow: as everyone knows, psych units are becoming fewer. And there are hardly any with medical capacity to tx pts who are unstable due to drug or ETOH abuse. They don't have enough beds for actively psychotic long-time schizophrenia patients, so they probably aren't going to take someone who is completely intoxicated and may or may not have a diagnosed psych problem. It's sad -- people fall through the cracks because they have substance abuse illnesses, but they never get intensive tx like they need. Maybe that's why they become "***holes".
It sounds to me like the OP is talking about a substance abuse pt. Maybe he has a coexisting psych dx; maybe not. Either way, sounds like the ER didn't think he needed to be there. Psych units often won't admit a pt under the influence of drugs or ETOH *unless they have a psyh history* -- so a suicidal pt would still need to be suicidal when their ETOH level was down to be admitted (IF there was a bed for him). So who keeps him? Seems like a big problem to me these days in hospitals -- and likely why we see many of these people over and over. You don't need inpatient psych tx if you are completely intoxicated. If it's medical concern, the pt must need a medical focus to their care. If they're "just" intoxicated...well, there aren't many places for them to go and be safe. Jail? Eh, maybe but not gonna be any sort of permanent solution.
It is frustrating to see this, and I'm sorry to the OP for having to endure it. But a pt who is intoxicated needs different services that inpatient psych usually will tackle -- until the person is no longer intoxicated, at the least. Lots of people are suicidal when they drink or do drugs, then aren't when they're sober. This is definitely an issue, because a. They DO need help and b. substance abuse/ mental health services are dwindling, and many think that they are ineffective. I'd argue that they are becoming ineffective because of fixable reasons, but there it is from my point of view.
Trekfan
466 Posts
if he was homeless how could you tell what hospitals he been to ? was he bragging about doing this ?
i saw a lot of inmates and the er after my car wrek i was at a loss as to why they where there i know the jails have doctors /nurses and even small hospitals . maybe it was inmate day