enclosed nurse's station

danu3 · Nov 11, 2004

I work on a 13 bed acute care psychiatric unit. Our hospital seems to put the needs of the psych unit "last in line". We have a broad range of patients with diverse diagnoses. Lately, we've been admitting patients who have a history of violence and are acutely psychotic. None of our rooms have video monitoring and our nurse's station is wide open. We've had angry psychotic patients come in and throw our computers at us, march into the med room and demand medication, one of our physicians was knocked down, two nurses have been assaulted, etc. Our director says JCAHO standards do not allow for enclosed nurse's stations as it separates us from our patients too much. Have any of you ever heard this? I've caught my boss "glossing over the truth" before and wonder if this truly is a JCAHO standard. How are the units set up where you work?

I don't know about JCAHO, but I've visited more than two psych wards and they all have enclosed nurses stations. This is in Ca.

-Dan

TitaniaSidhe · Nov 12, 2004

NJ in a VA Hospital & yes we have an enclosed nurses station.

Nurse Ratched, RN · Nov 12, 2004

We have three psych units and none of them have enclosed stations. However, another I had occasion to visit did.

StuPer · Nov 13, 2004

I too have seen only enclosed stations for nursing in acute psychiatric wards, it seems ridiculous to expect you to work under such stress, I can't speak for JCAHO as I work in a different country (Australia) but I did find their contact details http://www.jcaho.org/contact+us/index.htm

Why not contact them and ask from the horses mouth, rather than someone who may have a vested interest in keeping you ignorant?

regards StuPer

EarthChild1130 · Nov 13, 2004

Just a student here...when we did clinicals, we were at a state inpatient facility with short term acute care floors and a long-term care building. All three floors in the long-term care building had enclosed stations. In the short-term building, only the top 2 floors had enclosed stations...the lower floor was for patients who were for the most part stable and almost ready to be released, and the station was open.

margo123 · Nov 14, 2004

Thank you for the link! I had looked for it without success. I appreciate the input from all who have replied. Our security guards have voiced their concerns about this to our director and she has pretty much "poo pooed" them as overreacting. The nursing staff on our unit are getting real tired of being so vulnerable to patients who are so escalated for one reason or another. We have an excellent staff who really care about seeing our patients get better and do everything in their power to foresee trouble brewing. Our training in deescalation tactics has been thorough and most of the nurses have really good intuition in using the right approach whether it be a prn in time, good verbal interaction, or simply backing off and allowing the patient to "chill out". Of course, as we all know, sometimes things go awry anyhow. This is where the enclosed nurse's station can add such a crucial measure of safety.

I too have seen only enclosed stations for nursing in acute psychiatric wards, it seems ridiculous to expect you to work under such stress, I can't speak for JCAHO as I work in a different country (Australia) but I did find their contact details http://www.jcaho.org/contact+us/index.htm
Why not contact them and ask from the horses mouth, rather than someone who may have a vested interest in keeping you ignorant?
regards StuPer

autumn-moon · Nov 18, 2004

No enclosed nurses station here. I work in an acute care state psych hospital and my unit has a cap of 26 pts (although at times we have been so full that we've had to take in an additional pt. or two). We do have a small room behind the nurses' station and a chart/conference room behind that where we can get some work done. We have several patients who are SPU "graduates" and *at least* half of our unit's population have a history of violent behavior. It's probably a bit more stable than an admissions unit, in the sense that the pts. have been somewhat stabilized R/T their med regimen, however, they are also extremely sick or they woundn't require extended care. We do have great mental health workers who work hard to keep the RNs protected when a pt. becomes agitated. Pt's are encouraged to come to the desk when they have a legitimate need, but are generally discouraged from "hanging out" at the desk excessively.

The open atmosphere makes us very accessible to the pts, and also helps us keep our ears/eyes tuned to the atmosphere on the milieu. However, it's very difficult to find time to do charting, paperwork, etc, because the pts can see directly into these rooms and will be constantly interrupting these activities with calls for "NURSE!!"....if not the patients, it's the MHWs. Very hard to have a few minutes of quiet to get ones thoughts together and do charting.

midnitelpn · Nov 19, 2004

our acute unit & ltc units were recently remodeled...removing the enclosures. the "open" portion is a long counter spaning approx 20ft. it is very high..i'm 5ft tall, and i can just rest my chin on the counter. that doesnt stop a body. fist, chairs, spit etc from entering the nsg st, but it impedes a whole body. the furniture in the dayrm is weighted (never stopped a chair from being thrown by someone intent on throwing it) and the chairs have been removed & replaced by loveseats & sofas. the dayrm is also slightly off set from the nsg st, so that you can see all that is going on in the mileu, but you are not dead center to it. you can hear & see everything, hopefully de-escallating a potential issue, before it gets into the nsg st. also the old dutchdoors to the nsg st. have been replaced by solid doors, that are locked. no pt is allowed in the nsg st., ever. we lost a 3-way view, you could see up 2 halls & in the dayrm before the remodel, which is a distinct disadvantage, but we have had those security mirrors placed in strategic locations, so we can see up the halls alittle better now.

Orca, ADN, ASN, RN · Nov 20, 2004

I have worked in both types of environments. One facility I worked in had an enclosed nurse station with Lexan panels. The entry door to the nurse station was a Dutch door so that the top half could be opened for dispensing medication without opening the entire station. The hospital put this in after we had a couple of incidents of patients coming into the nurse station and trying to take charts, grab medication (our Pyxis was in this area too) and other problems. It obviously isn't JCAHO mandated that it be open. Your facility is likely using this excuse in an effort to quell any future discussion because they don't want to pay the expense of keeping you safe.

In the units I have worked on with open nurse stations, it has led to a multitude of problems. Patients coming in and having to be forcibly removed, patients attacking staff, patients harassing staff and so on. There is also a confidentiality issue, in that staff need a place to discuss acute problems on the unit. You cannot reasonably maintain confidentiality if your only work area is wide open, and charts are there to be grabbed and conversations to be eavesdropped upon by anyone who happens by (patient, visitor or even ancillary staff).

The worst situation I was ever in was on a geropsych unit with an open nurse station. We had a patient who was a sociopath, 68-year-old male, strong as a mule. He deliberately injured several staff members. Before he went on a rampage, he would reach over the desk and pull the phone out of the jack, leaving us no way to call for assistance. He would then threaten staff and patients and he assaulted anyone who tried to stop him. Every day was a takedown situation. After he was discharged, I asked that a panic button be installed so we could summon help if there was no telephone. I was told "You will probably never get another patient like that one." Nothing was done. Indicentally, the unit I worked on with the enclosed nurse station also had a panic button.

PRNMEDS · Nov 22, 2004

My hospital has closed nurses stations, but when JACHO came it was something they were not thrilled with. Felt we should be able to see everything and easily interact (despite fact that unit is on 3 floors). But they did not make us tear down walls and doors, just suggested more openess.

Hukilau · Dec 2, 2004

I have worked in many different psych units and have often found JCAHO cited as the authority behind someone's personal preference! There is no JCAHO requirement regarding colsed nurses stations, period...

You may get individual surveyors who express personal concerns or suggestions, but unless they make it official in your results, you can take it or leave it.

Generally, JCAHO tells you to have a policy and then checks to see if you're following your own policy! They don't generally dictate the details of the policy.