Okay...so maybe gutless is a strong word but I am having a difficult time finding another term to describe some of my colleagues after the most recent assault I was involved in. The nurses station is isolated and poorly designed to where the patient is between the door and the desk where patients come in and sit down for assessments or just to chat.
Some time into my shift a patient enters the office and is focused on some persecutory delusion. I perform some active/reflective listening. He seems okay but just flips instantaneously, screams, jumps up from his chair, slams the door, turns to me and just charges me. I am not easily frightened, but this patient outweighs me by a decent amount and you can tell by the look in his eyes that he wanted to make me pay for...whatever.
As I am slammed against the wall, I am pushing back, trying to escape using the bi-yearly, substandard escape maneuvers we are taught during orientation, I am repeatedly shouting for help only to see one or maybe two of the techs open the door, watching the patient attempting to rip my face off, only to see them close the door. I am able to work my way around the patient take two steps to the door to try a futile escape before he grabs my back and closes the door. A couple of seconds later the door opens again and I see a nurse and a tech from a different wing on my unit enter the room. He lunges at me again but I am able to side step him and guide him to the floor. As I feel the other nurse grab him, I get out of the room to collect myself and catch my breath. I was honestly glad to be alive. When something like that happens, which has never happened to me, I felt like I was going to die.
Personnel arrived seconds later from other units to assist. After the adrenaline slows down, I assess the damage. Mostly a few scratches and bruises. As a few days have now gone by, I am beginning to feel anger, not over what the patient did (obviously it comes with the job) but by the complete cowardice of the two techs on my wing who just stood by and did nothing to help, despite me shouting at the top of my lungs for help. I must have shouted it at least 15 times. Several of those times were when the techs were looking at us like a deer in headlights and several more after watching them withdraw.
Am I alone? Am I wrong to feel pissed off at them? Thanks.
Unfortunately this is common in psych. Techs and RNs will watch as staff are assaulted. I personally believe it's a two-tiered problem. One, the staff are afraid of being injured. Two, the climate has shifted to not putting hands on someone d/t liability and associated paperwork, patient injuries, and "trauma" to the patient. I have seen my fair share of people get fired because the take-down didn't go buy the book, but they never do. Only when the patient stops as soon as you grab them can you initiate a proper hold. If they resist, then that's it, it's a fight. No one wants to get hurt. When I worked in crisis and involuntary patients came in high on meth, if they went into a hold, it was a fight. Luckily my administration were pretty understanding that we tried to do the right thing and realized that nothing goes perfect.
On the paperwork side of it, I will often do whatever to avoid a hold. If I think a patient will go off because they aren't allowed to do something, I will give in because it's just not worth it. The doctors at my place are the same way. No one wants to put their name on a S&R packet. It has really become taboo. The sad part is that patients know this and exploit it.
Psych is really a disappointing field IMO. I've even seen a good number of interns say they lost a lot of respect for psych after seeing how patients are dealt with, or not dealt with actually. A good discussion of that was brought up on SDN and I agree. The avoidance of using IMs or RT when a patient is actively aggressive, resulting in other patients being traumatized just isn't right. Oh well :-/
We just had a near miss incident on my floor that strengthened our approach on dangerous patients and how to keep staff and pt safe. The biggest change was no one goes alone. No pt care, hourly checks etc without a buddy with you. Also, no buddies that aren't from that floor/aren't trained in care of the dangerous pt.
I'm very sorry this happened. I agree with seeking out EAP for ongoing debriefing and resolution. I'd also add a mediation session with you and the unhelpful techs, so that the correct education is given AND you are given a chance to speak your feelings and hopefully find resolution.
After working in mental health for the past 6yrs, I've been involved in similar situations and have a couple of comments. The first is that you are safe and alive. The second is that I could care less who is on rounds/cares, when my coworker is being assaulted and nobody is assisting, I would hope that person would have come to your aid! Third, you now know those staff members that did not help. Remember them because they will do the same next time. I give you kudos for not asking them straight out why they let you hang out there. There are very few who run towards danger, you need to know them as well. On my unit, I know exactly who will forego their own safety to help and the ones that will hide in safety and watch. I have a panic button and still respond times are approximately 2 minutes which means I'm pretty much toast.
I have also seen coworkers let someone take a beating if they don't like them or if that person is one who won't help during a violent outburst.
You now know those do not have your back. Stay safe!
Thank you to many of you for your support. Recent comments by Marigoldey, TCASII, and Chevyv are spot on. It seems it is common to have this issue in psych. For those of you worried that I may be in need of EAP, fear not. In fact, I administered meds to this same patient the following day without any fears or concerns but prepared for aggression just in case. Thankfully, PTSD is not a guarantee after every trauma. I also agree with those who have said that regardless of policy for those on safety checks, those performing the check should try something.
Since the incident I was able to observe the response (or lack there of) to the incident by other personnel on the unit. The camera records the hallway and although the incident, which occurred off camera, was not observed, I was able to see who responded and when. Although it felt like about 30 seconds to a minute, the whole incident lasted all of about 12 seconds. During that time on the camera, I saw a nurse and tech from another unit rushing to my defense while two techs who were a couple of feet from the room I was in stood there motionless. The management, who I appreciate dearly for their support, did not appear interested in viewing the footage to see how the response could have been improved (or at least not that they made me aware of). They also have not reported to me that they want to correct the inaction of the techs. I will likely choose to not work as many PRN shifts and will refuse to work on the same wing as those techs who failed to respond.
It is always harrowing when a patient, or anyone else, assaults a colleague. However, before you condemn the two tech's in question, one may consider that a balanced approach might be to obtain all three of the people involved in the incident's view of the events. All of you have clearly hung, drawn and quartered the two "gutless" tech's. I'm sure each person will have a different perception of the event, and you are only relying on one person's account. It's lucky that justice isn't handed out based on one person's account of the events. I'm sure that there is more to this story than meets the eye. However, don't let the facts get in the way of a good story!! LPC2RN, it's a relief that you were, for the most part, unscathed after this incident. Good Luck!!
It is always harrowing when a patient, or anyone else, assaults a colleague. However, before you condemn the two tech's in question, one may consider that a balanced approach might be to obtain all three of the people involved in the incident's view of the events. All of you have clearly hung, drawn and quartered the two "gutless" tech's. I'm sure each person will have a different perception of the event, and you are only relying on one person's account. It's lucky that justice isn't handed out based on one person's account of the events. I'm sure that there is more to this story than meets the eye. However, don't let the facts get in the way of a good story!! LPC2RN, it's a relief that you were, for the most part, unscathed after this incident. Good Luck!!
In this case, the techs' account of the story would be interesting but not necessary as the security footage showed them standing just feet away, doing nothing, while other staff members are seen running down the hall to my aid.
In this case, the techs' account of the story would be interesting but not necessary as the security footage showed them standing just feet away, doing nothing, while other staff members are seen running down the hall to my aid.
Of course feedback from the tech's would be interesting and necessary, as it may explain their actions at that time. Perhaps, you need to be brave and have a truthful discussion with them and then move on. Sometimes you just have to move forward and put it down to experience! Good Luck, Nick.
You are lucky to have had a response from staff on other units. On my unit (we are a psych unit among the medical units) and the only outside response we have is if someone thinks to call security. Working on a psych floor requires one to respond to both verbal and physical assaults that may occur against our co-workers or patients or even visitors.
There is no excuse. If someone is unable to physically respond, they can call for help. Otherwise the lack or delay of a response can seriously injured those involved. I have seen a nurse have to go out on permanent disability because we could not run fast enough to intervene. I am sure those other staff members that were involved (yes, I know they were not involved physically, but those emotions had to be rolling) need to have a debriefing, retraining, and provided with a copy of your unit's job expectations. And if those expectations do not include mandatory response to emergency situations--- look for a new job!
Security is in the hospital, but they have to be called. The previous facility I worked at, we would hit our panic alarms (alarms that progressed from looking like garage door openers to a rectangular piece of plastic with buttons that hooked on to the back of our badge). Once the panic button was pressed, other units and security were paged to help to the exact place of the occurrence.
At the new facility, we have safety badges that randomly beep and vibrate when pressed. They do not alert any other units or even security. No one is trained on how to use them , so we are unable to even pull up the software to make sure that all staff is safe and accounted for.
Security is in the hospital, but they have to be called. The previous facility I worked at, we would hit our panic alarms (alarms that progressed from looking like garage door openers to a rectangular piece of plastic with buttons that hooked on to the back of our badge). Once the panic button was pressed, other units and security were paged to help to the exact place of the occurrence.
At the new facility, we have safety badges that randomly beep and vibrate when pressed. They do not alert any other units or even security. No one is trained on how to use them , so we are unable to even pull up the software to make sure that all staff is safe and accounted for.
So why do nurses accept those conditions? Do the nursing unions get involved? Also, there must be health and safety laws that have to be abided by?
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TCASII, ADN
198 Posts
Unfortunately this is common in psych. Techs and RNs will watch as staff are assaulted. I personally believe it's a two-tiered problem. One, the staff are afraid of being injured. Two, the climate has shifted to not putting hands on someone d/t liability and associated paperwork, patient injuries, and "trauma" to the patient. I have seen my fair share of people get fired because the take-down didn't go buy the book, but they never do. Only when the patient stops as soon as you grab them can you initiate a proper hold. If they resist, then that's it, it's a fight. No one wants to get hurt. When I worked in crisis and involuntary patients came in high on meth, if they went into a hold, it was a fight. Luckily my administration were pretty understanding that we tried to do the right thing and realized that nothing goes perfect.
On the paperwork side of it, I will often do whatever to avoid a hold. If I think a patient will go off because they aren't allowed to do something, I will give in because it's just not worth it. The doctors at my place are the same way. No one wants to put their name on a S&R packet. It has really become taboo. The sad part is that patients know this and exploit it.
Psych is really a disappointing field IMO. I've even seen a good number of interns say they lost a lot of respect for psych after seeing how patients are dealt with, or not dealt with actually. A good discussion of that was brought up on SDN and I agree. The avoidance of using IMs or RT when a patient is actively aggressive, resulting in other patients being traumatized just isn't right. Oh well :-/