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.
Wow. No, you're not wrong to feel pissed off at them.
But, this sounds like more than just incompetent or cowardly coworkers. This sounds like a systemic or system issue that needs to be assessed, reviewed, and changed, from the top down.
In other words, it sounds like facility policies, systems, regulations, and even structural engineering, MUST BE REVIEWED & CHANGED.
I would also seek EAP or similar services at work, and DEMAND that a group/unit EAP session (or two) takes place so that all on the unit and certainly those who froze, are able to work through this situation. Remember, you all still have to work together and be able to trust and rely on each other everyday.
I wish you well and I pray for healing, hope, rebuilding, and necessary changes, not just from the facility, not just on the unit, but, between you and your colleagues, and certainly within yourself.
Some have security on the unit but that is very rare. I have a panic button but respond times are approximately 2 minutes. It's pretty unsafe at times, but it comes down to money. Most places aren't willing or able to spend the money for safety when flare ups may not happen daily.
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?
I accept it because I love acute mental health and I'm good at it. I can usually deescalate my pts. Sometimes not, but honestly I love what I do and can't imagine doing anything else!
Money should never be the reason for not minimizing harm to staff or anyone else. It sounds as though your security system is outdated and doesn't meet requirements. I'm amazed how much clinician's will put up with and justify poor safety practices and systems. It doesn't matter if there is only one incident per year; the safety of staff is paramount. It costs a lot more to settle legal claims! Also, I believe that this type of behavior by organizations shows their lack of respect for their employees when they increase risk not not providing the tools to safely protect their staff. Luckily, I have never had to work in this type of unsafe environment, so I think I am lucky! Perhaps that is the way it is in the US?
Do you use manual restraints in the US, as is often seen on the TV? It's extremely rare in the UK, Australia and New Zealand.
Yes, we use manual restraints in my facility, but its pretty rare compared to the last facility I worked at.
It is always about the budget. No matter what kind of sugar someone spoons out, it always comes down to money. Everyone has to work within a budget.
Safety is big, but it can be difficult to balance both.
Is the system outdated? It is what it is. How many police would be enough on my unit? What would they do on those days when everything is status quo? It's tough to balance safety with need, and that darn pesky budget.
What type of manual restraints do you use. I've never used them and consider them a bit barbaric. I'd rather use seclusion and medication than tie someone up like an animal!! Nobody deserves that. Are most of the units privately run? I know that there are state hospitals in the US. Are they well funded or are they also run on a tight budget? What do the unions do in support of their members? It all sounds a bit archaic to me!!
What type of manual restraints do you use. I've never used them and consider them a bit barbaric. I'd rather use seclusion and medication than tie someone up like an animal!! Nobody deserves that. Are most of the units privately run? I know that there are state hospitals in the US. Are they well funded or are they also run on a tight budget? What do the unions do in support of their members? It all sounds a bit archaic to me!!
We use a 5-point restraint system with padded straps on the wrists, ankles, and one across the waist. What do you do for patients that are intent on harming themselves? Are your seclusion rooms completely padded? Most states do not have unions in nursing. I know California does but that is the only one I know of. Most of our hospitals are privately run. The U.S. went to mostly privately run hospitals starting in the middle of last century when we started deinstitutionalization (I believe, but if someone can correct me on this, please do).
There are pros and cons to both socialized medicine and private medicine. Personally, I enjoy the higher pay for medical professionals and being able to get services in a reasonable time as opposed to having to wait, sometimes for months, for an MRI that one may find in a socialized system. It costs money, but I prefer to be able to decide my future. If this is healthcare in countries with socialized medicine, then I will pay a little more...
We have 4 point restraints and use them as a last resort. What do you do when you place a pt in seclusion and they begin to self harm? And refuse prn medication? We use them for the briefest amount of time necessary. Nobody likes placing someone in restraints.
Unions are no longer strong here in WI, so I don't expect anything from them.
I've never worked private mental health but know a large private run that does use 4 points as well.
We use a 5-point restraint system with padded straps on the wrists, ankles, and one across the waist. What do you do for patients that are intent on harming themselves? Are your seclusion rooms completely padded? Most states do not have unions in nursing. I know California does but that is the only one I know of. Most of our hospitals are privately run. The U.S. went to mostly privately run hospitals starting in the middle of last century when we started deinstitutionalization (I believe, but if someone can correct me on this, please do).
There are pros and cons to both socialized medicine and private medicine. Personally, I enjoy the higher pay for medical professionals and being able to get services in a reasonable time as opposed to having to wait, sometimes for months, for an MRI that one may find in a socialized system. It costs money, but I prefer to be able to decide my future. If this is healthcare in countries with socialized medicine, then I will pay a little more...
We provide 1:1 visual observations for patients that harm themselves. No, the seclusion rooms are not padded, but only have a mattress on the floor with a blanket or two. Patients are observed every 10 minutes whilst in seclusion. A minimum of 3 restraint trained staff enter the seclusion room. Also, patients can only be secluded if they are under the mental health act. However, nurses have the legal right to place a patient under the mental health act for up to 6 hours if required, in an emergency.
We have 4 point restraints and use them as a last resort. What do you do when you place a pt in seclusion and they begin to self harm? And refuse prn medication? We use them for the briefest amount of time necessary. Nobody likes placing someone in restraints.
Unions are no longer strong here in WI, so I don't expect anything from them.
I've never worked private mental health but know a large private run that does use 4 points as well.
If a patient attempts to self-harm whilst in seclusion, then at least 3 staff go in and either offer medication or restrain the patient if that is required. Only patients who are under the mental health act can be secluded, so they are unable to refuse treatment if offered. We would offer some brief counselling-type intervention to support the patient to reduce their self-harming behavior, although I note from other posts that RN's don't ordinarily provided counselling for patients as part of their scope of practice.
If a patient attempts to self-harm whilst in seclusion, then at least 3 staff go in and either offer medication or restrain the patient if that is required. Only patients who are under the mental health act can be secluded, so they are unable to refuse treatment if offered. We would offer some brief counselling-type intervention to support the patient to reduce their self-harming behavior, although I note from other posts that RN's don't ordinarily provided counselling for patients as part of their scope of practice.
So it is barbaric to use manual restraints on a person but not to have three people enter the patient's room and physically restrain them? What is the difference? How long do you restrain them for? Just long enough to give them a B-52 (or whatever) or do you wait until it takes effect? What if the chemical restraint does not work (which happens often in those on high doses of sedatives, drug abusers, or poor responders)?
When we use manual restraints, the person is placed on a 1:1 where they have a sitter watching them constantly and charting on them every 15 minutes until they come out of restraints. A specially trained nurse also comes in to check on the patient every two hours (if the patient is in restraints that long) to ensure pulses are still palpable distal to all restraint points and performs a focused assessment. Once the patient appears to have calmed down, one point is released every 15 minutes, for a minimum time in restraint of one hour. The order for restraint has to be renewed by a doctor every 8 hours (this need to renew a restraint order rarely occurs).
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Eschell2971, BSN
1 Article; 68 Posts
Wow. No, you're not wrong to feel pissed off at them.
But, this sounds like more than just incompetent or cowardly coworkers. This sounds like a systemic or system issue that needs to be assessed, reviewed, and changed, from the top down.
In other words, it sounds like facility policies, systems, regulations, and even structural engineering, MUST BE REVIEWED & CHANGED.
I would also seek EAP or similar services at work, and DEMAND that a group/unit EAP session (or two) takes place so that all on the unit and certainly those who froze, are able to work through this situation. Remember, you all still have to work together and be able to trust and rely on each other everyday.
I wish you well and I pray for healing, hope, rebuilding, and necessary changes, not just from the facility, not just on the unit, but, between you and your colleagues, and certainly within yourself.