How do we COMBAT workplace violence???

jfm · Apr 12, 2001

Hello,

I work in forensic psychiatry and we have a list of contrabands that are not allowed on our unit. It ranges from plastic cutllery to almost anything metal or plastics(bags included)that can be molded.we use a portable metal detector and pat down the clients coming in, this includes visitors.

We have strict policies about contraband and count cutlerry being dispensed at meal times.

staffing is occassionally short but we sacrifice our breaks sometimes. Morale is high as we all work quite well together.

jimbob · Apr 20, 2001

Greg - this is a major concern for all who work in the mental health field, and I too share your sorrow that someone has had to lose their life because of poor administration leading to shortages of staff, resources, proper care, etc. However, my comments may (or may not, depending on how good your team of staff are) offer some balance to your outlook.

I have worked in in-patient facilities on and off (more off than on, for reasons I'm about to illucidate)since the early 1980's. In all that time, I have to say that I've most commonly seen the most appalling treatment of people with psychiatric illness than I would ever dare to "nightmare" (as opposed to "dream") I would ever see any other patient receive.

Good mental health staff are few and far between (in my experience). I don't know why this is, either.

It is not the norm rather the exception (at least here in NZ) for the patients to be treated with

a) dignity

b) respect

c) courteousness

d) aroha (what the NZ Maori people call love, but it is professional rather than emotional and encompassess all of the above)

I guess my point is simply that I found for the majority of the "incidents" I have observed (as in the ones that require an "incident form" to be completed) the staff member involved in the incident played an active, and often highly provocational role in the conflict. I know this makes me sound highly critical of my colleagues, but sadly, I can only speak my truth. I have the utmost respect for some of mental health nursing colleagues, but as I am labouring the point, they are few and far between. These people know how to demonstrate key nursing skills (let's call them the "three P's of the Treaty of Waitangi)

1. Protection

2. Partnership

3. Participation

As a baseline of care, these would be a good start. Maybe if the staff concerned are given the training they need, if the supervisory staff were given the skills they need to be able to confront shortfalls in nursing care, (but still using the three P's formula), if the management knew how difficult it was to work in these environments... if, if, if, if, if.

I guess you're probably hearing my message by now Greg? Let's hope that no-one else has to die, but I not putting any money on this gamble... Would you?

All the best Greg, and if you read to the end - good on you, for keeping on with my ramble!!!

:-)

barrettak9 · May 20, 2001

we can never combat violence and aggression but we can be proactive and make an attempt at limiting it.

I work in a medium secure environment in the UK for mentally disordered offenders and have experienced many aggressive situations - more often than not not I end up bruised but thank god not suffered any serious damage (same goes for all our staff).

We too have lists of contraband items, which extends to everything that could cause damage. We have a named security nurse who is responsible for the counting of risky items on the unit (ie cutlery (metal); razors; garden tools etc) They also are concerned with the environment and make regular checks and ensure for example that items have not been pushed under the fence etc. Clients on unescorted leave are also pat searched on return etc.

Staff are trained in control and restraint techniques and carry alarms which connect with radio signals when pulled and alert the response team that there is a problem. This system is backed up with a walkie talkie system throughout the hospital and attack / alarms if all else fails. it has its down falls but more often than not it has been effective.

The unit it self is locked and access to any area (other than the clients bedroom) is with staff escort.

Yes we do have incidents that are serious and have resulted in staff or clients being taken to hospital but probably could be counted on one hand since we opened two years ago.

We are very lucky to have a supportive team that looks out for you at every turn. I love my job and wouldn't change it for the world.

Anna

Amy_psychrn · Jun 24, 2001

I work as an RN on a 14 bed adolescent psychiatric unit. We too have all the safety measures; belongings search of new admissions, no contraband(pt's can't even wear shoes), silverware sign out, etc.

However, it is unfortunate for me to say that I too, have experienced work place violence. Almost a year ago, a co-worker was sitting with a constant visual obs pt. who was displaying S&S of psychosis. It was after 9p.m and there were only 2 staff on due to our census. This staff person was attacked, punched and kicked several times before the 2nd staff could come to her defense. Still, there was 15 minutes that went by before they could restrain this pt. and get to the phone and call for help.

This staff person is still suffering the consequences of the attack. Unfortunately management is still allowing us to work short staffed, even after this episode.

Thunderkat · Sep 10, 2001

I would encourage everyone to get CPI Crisis Prevention and Intervention training..... I work in a State Mental Hospital Forensic Unit..... The one thing I can say is that we have a great Staff Developement department and we truly work as a team.... We rely on each other.... We are very safety conscienous. We are constantly vigilant to our and our patients safety....We have had close calls and I have collected some nasty bruises at times, but I am so glad that my team members have been there for me. One thing is that we really try to intervene and prevent situations.

Aerolizing · Oct 17, 2001

One of the things we do to combat workplace violence is to assess patient's history of violence. It has been one of our pet projects. We ask them what they have done and how recently and if they have ever been restrained while in a hospital. We ask their legal history. This is not fool proof though as they can forget to tell staff about their legal woes.

Next, we tell them that if they are feeling themselves getting angry or feeling out of control and no one is around, it is their right and responsibility to come seek out staff, any staff, to talk to or to get a prn med.

This really seems to work. We also have a strong staff and administrative support of pressing charges against any injury or damage to property.

We have really good staffing too. There are always at least two registered nurses for a census of 20. There are always at least two staff people on the floor at a time.

We do of course have outbursts. We admitted a rapist for a double blind drug study like that was a smart idea. He held a conference room table over three nurses threatening to kill them. Nice guy. The staff followed the chain of command up to the head of the psych dept and even involved our hospital's legal dept. Our chairman is a boob so I followed him around asking questions while I wrote down his responses verbatim. Often stopping to ask him to repeat his exact wording. Seemed to work though. He changed his mind about rape being a violent offense that would exclude him from the drug study protocol.

We have had plenty of other outbursts though. Our unit is round so it is always easy to see what is going on. No hidden corners but sometimes patients steal away to have sex in the bathrooms. It is always something. Ok, I am rambling. Time for bed.

I think the point I was trying to make was that trying to be proactive helps. We do the silverware count and no one shaves without a escort for the razor. Inventory lists and belonging searches nightly and on admit.

We have often wondered about the likelihood of a visitor bringing in a gun to get a patient released. That is a frightening thought.

MHN · Feb 25, 2002

GREG IN MASS

MHN · Feb 25, 2002

greg in mass, I am fortunate that the psych unit I work in has distress alarms that all staff regardless of position are all required to wear at all times while on duty.

The alarm can be either set off in the man down postion that is the alarm goes of if the alarm is at an angle of 45 degrees (I think not sure)for more than a minute or manually triggered which then activates the emergency response team orderlies and staff .the system can track your last position and shows on a monitor in the nurses station.

Also there is an instrument we are about to trial called the Broset Violence Checklist that so far has been able to predict violence in the next 24hrs at resonable rates of success. There is a posting on the international foresic nurses web site about this or a search in the google search engine will also find it. hope this is of some help.MHN

**canoehead, BSN, RN** · Feb 25, 2002

It would be nice if the hospitals would separate clients with violent histories from those without, or those that are in with "social" issues from those with a true psychiatric disorder. Seems like that would allow more security measures and a more effective milieu for those who are most likely to benefit, and increased security and vigilance for those that have been less responsive or cooperative with the hospital treatment.

KaraLea, LVN · May 25, 2002

Here they are very big on PREVENTION!!!!! Mostly talking and de-escalating the situation before it becomes a problem.

the new girl · Jun 2, 2002

I, like Amy, also work in an adolescent unit. I work in a state mental hospital. We use CPI, and it is good, as long as you can trust that your partner is going along with you. These psych units can be so dangerous, it's scarey.... last year about this time, I was attacked, by a girl was had managed to pull her had free out of a restraint cuff (so she had BOTH hands free) during her rotation cycle, and it took 6 staff to free her hands from my throat and hair. It wasn't pretty. Not something easy to forget. She was charged as an adult, because of the severity of the crime, class D felony. She spent quite a while behind bars. Sometimes I feel like I'm in the middle of the movie of the week, when I hear all the yelling going on, it feels more like gang riots, then a mental hospital. Oh well, I do the best I can...