Well, most of you who read my previous post in december, will remember that I originally accepted a night position in pysch and then I changed my mind and declined. I told them that I did not think I could do nights but if they ever had a day position to keep me in mind. For some reason I would feel safer during the day and nights just made me nervous.
Fast forward: I just recieved a call from this facility yesterday. They have a day position open and would like to hire me. Apparently they were impressed with me during the interview. The nurse that was working this position is going to work closer to home.
I accepted and am going to meet with them on friday to go over the particulars. I dont feel as nervous this time around and I really think I will be okay with it. I know there are things that are going to make me nervous, but I am sure I will learn how to deal with the different situations.
If any of you are willing to share tips on how you deal with combative and assultive patients, these are the ones that make me the most nervous:sofahider, please share, it woud be greatly appreciated.:plsebeg:
P.S. After I got the call, which I did not put in for this position, I thought well maybe it is meant to be and this is where I am supposed to be.
I also just got my first psych nursing job! My greatest fear is also combative patient situations. Next week, I am going to a special crisis intervention training. If you are a small female like me, you will need to use common sense (ie. don't do a single person take-down on someone much larger than you are). I talked about my concerns with the behavioral health nurse educator and she pretty told me to run and get vulnerable patients out of the way.
Cheers to us!!!!!
:rckn:
Yes, I was thinking the same thing. If a patient gets out of hand and becomes violent, I will get myself and other patients out and to safety.
I had a tour of the unit I am going to be working on and they carry walkie talkies to communicate with other staff. I will be attending CPI training in March.
I just hope I dont get to freaked out when a crisis happens and that I keep my wits about me. I am sure it will take time to get used too.
Specializes in Psychiatric, Detox/Rehab, Geriatrics.
Hello,
I work in a drug and alcohol treatment center that gets alot of patients with psychiatric disorders. Always remember to never yell back at the patient as much as you might want to, this will only escalate the situation and make it worse. Also, always remember to never let yourself get corenered in a room with a patient, always know where your exits are and keep your back to those exits so you can make a quick get away if you need to.
I think you will be surprised how much you know about psych from working in the medical world. Watch the other nurses that pts want to talk to, check out the nurses style of communicating. If he or she is good you can copy some of their methods until you are sure of your own. Read and learn about therapeutic boundaries, coping mechanisms both effective and ineffective. Your toughest pts will probably be the Personality Disorders (my specialty), these are the pts that all of the staff tend to "dog" during report. They are tough pts, but they can stabalize enough to be discharged. A great book re: borderline personality d/o is "I hate you, Don't leave me". How is it going so far?
Thank you jpRN84 and Piper12 for the advice. I am looking forward to the job, but of course am a little nervous at the same time. I guess that is to be expected.
Hearing some words of wisdom for all you expierenced pysch nurses is very comforting.
Specializes in Med Surg, Mental Health & Addictions.
If you have never worked mental health before it wil take a while just like any other area of nursing to feel comfortable in. I have worked mental heath and addictions for over 2 years now and I love it. Yes there are aggressive and sometimes violent patients but remember you are never alone. Your co-workers are there to assist you. I know if I yell STAFF people come running. I can also call security if needed. You will learn to recognize when a pt is escalating. It is important that if you see a pt start to become agitated or escalate that you call the doctor then and get medication as this will probably prevent the situation from escalating to violence. I can honestly say that I really never feel scared or nervous. I am very aware and vigilant of what is going on with my patients. In most cases pt's can be verbally redirected but of course sometimes you will have to place a patient in seclusion or restraints. Like I said though remember you are never alone and your co-workers are there to help you. Good Luck and keep us up to date on how things are going!
If you have never worked mental health before it wil take a while just like any other area of nursing to feel comfortable in. I have worked mental heath and addictions for over 2 years now and I love it. Yes there are aggressive and sometimes violent patients but remember you are never alone. Your co-workers are there to assist you. I know if I yell STAFF people come running. I can also call security if needed. You will learn to recognize when a pt is escalating. It is important that if you see a pt start to become agitated or escalate that you call the doctor then and get medication as this will probably prevent the situation from escalating to violence. I can honestly say that I really never feel scared or nervous. I am very aware and vigilant of what is going on with my patients. In most cases pt's can be verbally redirected but of course sometimes you will have to place a patient in seclusion or restraints. Like I said though remember you are never alone and your co-workers are there to help you. Good Luck and keep us up to date on how things are going!
Thank you KrissyPRN,
I just love hearing from other nurses. I am hoping this will be my niche. I will commit you advice to memory so I draw upon it during my shifts. I am glad to hear you love your job. I hope it will be me someday giving new pysch nurses advice.:nuke:
I have been working in psych for several years now and I love it! Here are several things that I have learned along the way...You have to develop a "sweetie-peetie" voice for certain occasions. I use this voice when I have an older patient that doesn't want to be cooperative. The next thing is to never use the "sweetie peetie" voice with a BORDERLINE!! This is the worst of the personality disorders to care for. You have to set clear boundaries and stick to them or they will suck the life out of you. The last thing is to never show fear. When a patient is escalating or getting aggressive and talking techniques (stuff you learn in CPI) doesnt work, you cannot show your fear. Patients can sense that fear and will pray on you verbally and physically. Turning around and walking away is not an option. Get some back-up but take the lead in de-escalating the patient. Psych nurses possess a strong sense of self! Welcome to the profession.
Specializes in Med/Surge, Psych, LTC, Home Health.
Well, most of you who read my previous post in december, will remember that I originally accepted a night position in pysch and then I changed my mind and declined. I told them that I did not think I could do nights but if they ever had a day position to keep me in mind. For some reason I would feel safer during the day and nights just made me nervous.
Fast forward: I just recieved a call from this facility yesterday. They have a day position open and would like to hire me. Apparently they were impressed with me during the interview. The nurse that was working this position is going to work closer to home.
I accepted and am going to meet with them on friday to go over the particulars. I dont feel as nervous this time around and I really think I will be okay with it. I know there are things that are going to make me nervous, but I am sure I will learn how to deal with the different situations.
If any of you are willing to share tips on how you deal with combative and assultive patients, these are the ones that make me the most nervous:sofahider, please share, it woud be greatly appreciated.:plsebeg:
P.S. After I got the call, which I did not put in for this position, I thought well maybe it is meant to be and this is where I am supposed to be.
:levcmmt:
Well, once a patient becomes combative/assaultive, it's at that time that you want to make sure that you aren't in a position where you can get physically hurt. Never ever corner a patient and never let them get you in any position where you can't escape.
If a patient is verbally assaultive and seems to be escalating, calmly ask them to take a time out in their room; give them a definate period of time (usually about 15 minutes) and be firm; let them know that they must take that time alone in their room to calm down before they may come out.
Know your surroundings. Know where your help is. Don't be afraid to call for help from your staffers, if you need it.
Once a patient becomes physically assaultive, they need to be separated from the other patients. They may need to be placed in the seclusion room with or without the door locked. I've placed patients in the seclusion room, administered calming medication, and then just had them lie down on the bed and had someone sit there with them (OUTSIDE of the room of course) until they were able to come down and verbally contract that they would not harm themselves or anyone else.
Good luck! Psych can be rather trying at times, but it's interesting and can be rewarding.
I appreciate the advice. I have CPI training on the 18th and I am looking forward to learning the steps to take to keep the patients and myself safe.
I do have to admit that I am nervous and hope that when presented with the situation of a combative/assualtive patient that I will keep my wits about me and know what to do.
everyone said that it is inevitable if you stay long enough you will get hit.
i am sure that is true. but you can get hit no matter where you work. i am sure it is more prevalent in pysch, but i guess that is the chance we take.
it pays to stay aware of your surroundings. i am very nervous, but i am sure it will get easier in time.
my intentions were not to make you more nervous and i am sorry if i did. i am a male and it doesn't bother me to get hit but on the same hand i'm not looking to for it either.
so far i've also noticed that there is usually a little warning before anything "goes down" and by that time there are usually enough people close by to jump in if needed.
the take down recently was more of a tackle and everyone grabbing an arm or leg. every situation is going to be different and it's hard to train for that. again, there are plenty of others around that will jump in and i would think/hope no other staff members would think less of you if you didn't feel comfortable jumping in.
also, i now work for a hospital that will take just about anyone. the hospital i worked for the last year (med-surg) the code yellows on the psych unit were few and far between.
i'm sure you'll be ok and, as you mentioned, just be aware of your surroundings, signs of escalations, and if something doesn't feel right ask for help or wait until some comes. best wishes:nuke:
My intentions were not to make you more nervous and I am sorry if I did. I am a male and it doesn't bother me to get hit but on the same hand I'm not looking to for it either.
So far I've also noticed that there is usually a little warning before anything "goes down" and by that time there are usually enough people close by to jump in if needed.
The take down recently was more of a tackle and everyone grabbing an arm or leg. Every situation is going to be different and it's hard to train for that. Again, there are plenty of others around that will jump in and I would think/hope no other staff members would think less of you if you didn't feel comfortable jumping in.
Also, I now work for a hospital that will take just about anyone. The hospital I worked for the last year (med-surg) the code yellows on the psych unit were few and far between.
I'm sure you'll be ok and, as you mentioned, just be aware of your surroundings, signs of escalations, and if something doesn't feel right ask for help or wait until some comes. Best wishes:nuke:
Thanks for the reply stepaukob, you didnt make me nervous. Truth is I make myself nervous:lol2:. I am nervous about starting a new job and doing well in it and hoping I really like it.
By the way how are you liking your new job? Hope all is going well with you. Again, thank you for the kind words.
I have worked in psy for 20 yrs and 17 of those were in a psychiatric ER which has the most acute psychiatric pts- brought in directly by police in handcuffs sometimes. I have never been assaulted in this setting. I think it is important to act sooner rather than later- don't wait until a pt has really escalated to address their agitation. Sometimes you have to restrain and medicate immediately as there is no reasoning with the pt. At other times you can engage the pt enough to get them to tell you what would help them regain control-"how can we help you to become calmer?" Try not to get emotional when the pt calls you old,ugly, ***** etc. Don't meet their anger with your own anger. Do thorough searches; we once had an old lady who had a revolver hidden under her wig for 1 week. And most importantly TRUST YOU INSTINCTS. Too many people look only at past history- the pt has no history of violence; if your gut tells you otherwise, listen to it. Instinct is an ancient survival adaptation that we humans possess; it is your best friend.
Little Panda RN, ASN, RN
816 Posts
Yes, I was thinking the same thing. If a patient gets out of hand and becomes violent, I will get myself and other patients out and to safety.
I had a tour of the unit I am going to be working on and they carry walkie talkies to communicate with other staff. I will be attending CPI training in March.
I just hope I dont get to freaked out when a crisis happens and that I keep my wits about me. I am sure it will take time to get used too.
Good luck to you and me:)