enclosed nurse's station

Tracyhbrn · Dec 2, 2004

Both the adult unit and the child/adol unit where I work have a glass enclosed nursing station. Never have I heard of JCAHO standards stating that a enclosed nursing station is not acceptable. If that were true, we would not be accredited....

Hmmmmmm????

marylyn_91604 · Dec 23, 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 work in a 20 bed Acute Psych unit in Nevada.The entire station is open,

but the med room can be locked.However we do take the cart out to the edge of the station to give meds.Our computers are secured below the counter so not accessible.It is difficult at times a few patients have walked in and helped themselves to stationary or toiletries-but overall the patients respect the space by repeated redirection.I dont know if its a JCAHO requirement,but our visiblity is better-we do have a couple rooms w camera.

I think it feels better,but yes its less secure for us.We are also in Nevada trying to decrease Seclusion and Restraint,and had only 6 S&Rs's in 6 months.

So we are dealing w a culture shock,trying to negotiate,give prns,set limits all w no reecourse to using Seclusion,only as a LAST resort and I mean last.

I recommend you try to make your station very secure,and open.Get your med area locked,meet w your colleagues and support each other.This seems to be the wave of the future.And I know its hard-I've been in psych for years.Hope I was helpful.

Marylyn_91604

ArleneG · Dec 23, 2004

Our nurses station is fully enclosed. We just had a JCAHO inspection this summer. It was not raised as an issue. I would not work in a psychiatric facility with an open nurses station as I feel it is totally unsafe.

margo123 · Dec 23, 2004

I wouldn't mind having an open nurse's station if we handled the types of patients that are usually seen on our unit. I do get uneasy when we have antisocial personalities. Some of these people have done some very bad things in the past. Unfortunately, our little unit is not equipped to handle these patients. They slip by our admitting docs because the history is taken by phone from the other doctor requesting the admission and isn't usually very accurate. I guess you could say they "bend the truth" a little to get our docs to say yes. Believe me, I feel better in an enclosed station when dealing with them. Then you have the borderlines who are constantly scanning the environment to get something to hurt themselves with. They can be very crafty at reaching over to grab a pen or paperclip or whatever. If I had my say, we'd go back to having a closed station. We are forced to work with a staff of two at times and this would lend a small measure of safety for the staff. We are also very proud of our restraint and seclusion records. I think some of the new antipsychotic meds are so effective that usually some verbals and a prn are all you need. Thanks for the letters. I love hearing how the rest of the country is doing it!

I work in a 20 bed Acute Psych unit in Nevada.The entire station is open,
but the med room can be locked.However we do take the cart out to the edge of the station to give meds.Our computers are secured below the counter so not accessible.It is difficult at times a few patients have walked in and helped themselves to stationary or toiletries-but overall the patients respect the space by repeated redirection.I dont know if its a JCAHO requirement,but our visiblity is better-we do have a couple rooms w camera.
I think it feels better,but yes its less secure for us.We are also in Nevada trying to decrease Seclusion and Restraint,and had only 6 S&Rs's in 6 months.
So we are dealing w a culture shock,trying to negotiate,give prns,set limits all w no reecourse to using Seclusion,only as a LAST resort and I mean last.
I recommend you try to make your station very secure,and open.Get your med area locked,meet w your colleagues and support each other.This seems to be the wave of the future.And I know its hard-I've been in psych for years.Hope I was helpful.
Marylyn_91604

windynights · Dec 23, 2004

Our nurses station is fully enclosed. We just had a JCAHO inspection this summer. It was not raised as an issue. I would not work in a psychiatric facility with an open nurses station as I feel it is totally unsafe.

If you are fearful of working in a psychiatric facility with an open nurses station, how do you feel about being out of the nurses station, interacting with the patients? I don't understand how you could be uncomfortable in the nurses station and not uncomfortable being in the milieu with the patients.

DutchgirlRN, ASN, RN · Dec 23, 2004

I How are the units set up where you work?

We had a "thick" glass enclosure put up about 2 years ago. We were told it was mandatory due to HIPPA. Makes sense to me.

margo123 · Dec 24, 2004

I've asked myself the same question about HIPPA regs. The patients who are prone to hanging around the desk can hear everything we say, even if we keep our voices low. I've even seen patients run and tell other patients what we've said in re to their case. A case in point would be an instance where the social worker had taken a call letting us know a bed had opened up at a state facility. The patient who was going there actually heard it from another patient before he could be informed by staff. This is not fair.

We had a "thick" glass enclosure put up about 2 years ago. We were told it was mandatory due to HIPPA. Makes sense to me.

margo123 · Dec 24, 2004

I'd like to comment on this. If you are moving about in the milieu when a patient is agitated, you usually take a buddy along. Hopefully, a third person is at the desk or close to a phone. Many times a nurse will be alone at the desk and it seems to me odds are that the desk is where the angry patient usually comes to make demands or to vent. I work with a nurse who was held hostage for two hrs because a pt came in the nurse's station and got between her and the phone. He actually ripped it out of the wall. Fortunately, a psychiatrist happened to let herself in the back door of the unit and overheard the situation. She quietly slipped out and made the emergency call.

If you are fearful of working in a psychiatric facility with an open nurses station, how do you feel about being out of the nurses station, interacting with the patients? I don't understand how you could be uncomfortable in the nurses station and not uncomfortable being in the milieu with the patients.

windynights · Dec 24, 2004

I'd like to comment on this. If you are moving about in the milieu when a patient is agitated, you usually take a buddy along. Hopefully, a third person is at the desk or close to a phone. Many times a nurse will be alone at the desk and it seems to me odds are that the desk is where the angry patient usually comes to make demands or to vent. I work with a nurse who was held hostage for two hrs because a pt came in the nurse's station and got between her and the phone. He actually ripped it out of the wall. Fortunately, a psychiatrist happened to let herself in the back door of the unit and overheard the situation. She quietly slipped out and made the emergency call.

What really scares me about this, is that you have so few staff. Our nursing station is always full of staff...sometimes difficult to find a chair to sit in, to do charting. My attention would go to beefing up the staffing, rather than enclosing the nurses station. I work on an acute unit, with 30 beds, and we often have patients from jail. Potentially assaultive patients are the norm for us. But I'd be more uncomfortable with an enclosed nurses station than one that's open. I want to hear what's going on.

That being said, I don't think anyone is wrong for having the preference to enclose the nurses station. Personal preference. And it must not be a JCAHO requirement, because we've had the open station for eons, and are always accredited.

I'm grateful to have the numbers of licensed staff, who are well trained in managing assaultive behavior, on my unit. From what I've heard from other psych nurses, our staffing is to be envied.

margo123 · Dec 24, 2004

You're absolutely right about staffing. I wouldn't have any reservations about an open station if we had more staff. True, we only have 13 beds but they're always full and sometimes the acuity is through the ceiling. I've had to beg to get that third person on my shift, 7p to 7a. Most times, we work with two because our gero unit (three floors down) needs her worse. Staffing is lean all over my hospital due to cost-cutting measures. I'm hanging on because I love psych and we just got a new DON who thinks we need more staff. Some new jobs just got posted, so I'm hopeful.

What really scares me about this, is that you have so few staff. Our nursing station is always full of staff...sometimes difficult to find a chair to sit in, to do charting. My attention would go to beefing up the staffing, rather than enclosing the nurses station. I work on an acute unit, with 30 beds, and we often have patients from jail. Potentially assaultive patients are the norm for us. But I'd be more uncomfortable with an enclosed nurses station than one that's open. I want to hear what's going on.
That being said, I don't think anyone is wrong for having the preference to enclose the nurses station. Personal preference. And it must not be a JCAHO requirement, because we've had the open station for eons, and are always accredited.
I'm grateful to have the numbers of licensed staff, who are well trained in managing assaultive behavior, on my unit. From what I've heard from other psych nurses, our staffing is to be envied.

TitaniaSidhe · Dec 24, 2004

This question is for Windynights, I am very curious have you ever been assaulted? I mean dead out punched in the face several times with a closed fist so as to have to be out from work for awhile? I was just wondering & am not trying to be rude so please don't take it that way.

For everyone else, I am not afraid most of the time to go out onto my unit & interact with my patients. On a rare occasion we get a patient who is extreemly psychotic & extreemly dangerous & at those times hell yes I am afraid to go strolling about on the unit. That would just be common sense. As far as having enough staff, well yes there definately are benefits of having more staff present for safety factors. I will however throw in that it also depends on WHO the staff you have working with you are & what their SKILL level is. I would rather have 3 very experienced NAs worikng with me than 10 unexperienced ones who will not know how to deal with a violent situation.

windynights · Dec 26, 2004

This question is for Windynights, I am very curious have you ever been assaulted? I mean dead out punched in the face several times with a closed fist so as to have to be out from work for awhile? I was just wondering & am not trying to be rude so please don't take it that way.

I am very curious why you would single me out with a description that feels like I've been assaulted, just to read it?