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.
Where I work, (forensic psych facility) we would file a "working under protest" form to say that the unit is inherently unsafe due to design, specific personnel, etc.
LPC2RN Your quote "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" make my head spin!!!! My first thought - Oh helllll to the NOOOOO!! After I have gathered myself from all the red alert alarms going off in my head I can tell you this --- I would go to my Nurse Manager or Program Director immediately!!!! My unit is small, plenty of out of control, plenty of restraints - we are all well versed. When someone gets loud, a sharp noise you will see nurses & techs BOLT towards the danger! If it is delicate, we will hang back but close --- You are NEVER alone when the fur starts to fly! And to CLOSE THE DOOR???? OMG --- I am simply outraged! Psychotic can snap - all the more reason for co-workers to keep on alert while you are talking to him.... There is no excuse for not backing your team member up --- even those I would love to throw under a bus will have me next to them with violent pt. - I will not leave them alone. Incidents like that will get you killed - this is not an dramatic statement, I have a co-worker that has a wicked scar around her neck where pt. grabbed her & slit her throat - she is not dead because her team members intervened.....just sayin'! Good luck to you - I know I'd be having melt downs on my co-workers & quit if that happened to me!
Yeah, I had a patient once who was totally antisocial, not MI at all. He fought with us for 5 hours! Five hours of back and forth with a patient only because the doctor refused to allow us to keep him in seclusion for more than 20 minutes. Each and every time we opened the door it was a full on brawl. Not just acting up, but a fight. He was biting, spitting, and doing all he could to hurt us. He had two RTs with no effect, even though his eyes were red and the meds were clearly in his system. It wasn't until he started hitting his head on the floor in seclusion that we were allowed to put him in restraints. Luckily by this time the wonderful house psychiatrist gave the order to keep him in restraint for 2 hours.
He remarked later to administration that he enjoyed what he did and wanted to hurt people. He fractured one of our sweet female techs sternum in the process as well. I was heartbroken and felt responsible for this happening. She was just trying to help. Nearly everyone had strains and injuries.
So there are times where holding someone down just isn't enough. We'd been spit on and hurt enough.
Yeah, I had a patient once who was totally antisocial, not MI at all. He fought with us for 5 hours! Five hours of back and forth with a patient only because the doctor refused to allow us to keep him in seclusion for more than 20 minutes. Each and every time we opened the door it was a full on brawl. Not just acting up, but a fight. He was biting, spitting, and doing all he could to hurt us. He had two RTs with no effect, even though his eyes were red and the meds were clearly in his system. It wasn't until he started hitting his head on the floor in seclusion that we were allowed to put him in restraints. Luckily by this time the wonderful house psychiatrist gave the order to keep him in restraint for 2 hours.
He remarked later to administration that he enjoyed what he did and wanted to hurt people. He fractured one of our sweet female techs sternum in the process as well. I was heartbroken and felt responsible for this happening. She was just trying to help. Nearly everyone had strains and injuries.
So there are times where holding someone down just isn't enough. We'd been spit on and hurt enough.
Agreed. Had an episode similar. Completely A&Ox4, just an angry guy who found a sense of purpose in hurting as many staff as possible when the mood struck him. Mostly boredom, but the occasional anger flare would kick up his dander. No Psych floor or stand alone would take him d/t his previous track record of attacking staff.
Sometimes there's just no de-escalation. It isn't often but Those random times, there's going to be someone who can take every drug you throw at them, won't listen to any therapeutic discussion, who have no interest in changing their aggressive behavior. 5 pt leathers is not too much when the pt is hell bent for leather (every pun intended).
Agreed. Had an episode similar. Completely A&Ox4, just an angry guy who found a sense of purpose in hurting as many staff as possible when the mood struck him. Mostly boredom, but the occasional anger flare would kick up his dander. No Psych floor or stand alone would take him d/t his previous track record of attacking staff.
Sometimes there's just no de-escalation. It isn't often but Those random times, there's going to be someone who can take every drug you throw at them, won't listen to any therapeutic discussion, who have no interest in changing their aggressive behavior. 5 pt leathers is not too much when the pt is hell bent for leather (every pun intended).
So, what as a nursing group can you do about it? If you do nothing, nothing changes.
comment removed It wasn't very Christian, just human.
It seems that clinicians are getting assaulted and being given little support from their management. So, what as a collective group of professionals can you do about it? Will you stay and get on with it and accept that being assaulted is okay, or can you do something about it? Has anyone ever received a positive resolution to this type of issue, where workplace safety has improved?
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).
LPC2RN. The difference is that a restraint can actually be therapeutic, rather than sticking someone in a chair and restraining them and then watching them on 1:1 and doing a bit of admin at the same time. I would suggest that this type of intervention would actually wind the patient up, rather than settling them. In the USA this may be acceptable practice and standard practice. However, in other westernized countries with excellent healthcare this type of practice would not be acceptable, especially in regards to patient advocacy groups. Why does it take a specially trained nurse to check physical obs??
comment removed It wasn't very Christian, just human.
Mental health nursing can be challenging and "dangerous" if the clinician doesn't continually consider the inherent risks in supporting mentally unwell individuals through their crisis. It is often the case that clinicians do not put risk-reducing interventions in place and subsequently get assaulted, but then go onto blame management. If management are unable or unwilling to protect its clinicians, then what can the clinicians do to reduce their risk of harm?
That's an outright brawl you're describing!!! I am one who doesn't talk back to Dr. orders, but I'd be screaming at my Dr. for an IM B-52 or Geodon --- SOMETHING to slow that one down!!! If nothing else, someone - ANYONE - should be dressing that Dr. down for letting patient get that far out of hand --- Obviously not thinking of Staff & Pt. safety.
SarahMaria, MSN, RN
301 Posts
Where I work, (forensic psych facility) we would file a "working under protest" form to say that the unit is inherently unsafe due to design, specific personnel, etc.