How to stay safe -- psych holding unit?

[flygirls2, BSN]

Ok-- I hope you all can help me with this!

I am a PCU/ED nurse and my hospital very recently built and opened a psych transition/holding unit beside our ED. I was eager for a change and got one of the positions.

First of all, I'm loving the job. Psych appeals to me so much more than I realized-- at least at this acute level. I love excitement, and thrive on adrenaline-- yet my stress levels have significantly decreased as I don't have the responsibility of keeping people alive each shift(to as high a degree).

I am seriously concerned about our safety on this unit. There is a mix of psych and medical backgrounds among our nurses as we are a sect of the ED and have tele/medical components at times. The nurses who have a background in psych are actually fearful of the layout of this unit as well- which concerns me- as they would know.. I'm dedicated to the success of the unit, and am taking precautions as much as I can. I accept that violence is a part of nursing, regardless of specialty.

My hospital has an inpatient psych/detox unit, but they do not accept patients with a high risk of violence. So this 'transition' unit has been built to contain patients either holding for our state mental hospital or patients who are not appropriate for our inpatient unit. We can take anything- from children(no age limit) to psychotic violent ex-cons.

I'm hoping some of you can tell me about the layout of your acute psych unit? Particularly if you work at a state institution or accept violent patients?

We have two RN's working at all times, and our unit has 5 beds. We are situated in an enclosed hallway with locked doors. No windows- no access. Our nursing station has one door- which 'does' lock, but we're told we are not to lock it except in emergency- as it would be better for us to run into the hallway than to hide in the nursing station. The door and the 'plexiglass(?)' windows around the nursing station could all be broken by a patient who wants access.

So here are my concerns-- please tell me if this is standard practice for a psych unit holding potentially violent patients. I hope to make suggestions to the powers that be to improve the safety of this unit for our staff(and patients).

1- Nursing station should have an alternative exit and/or we should be able to close and lock the door. We have one doorway- that must remain open at all times. Patients frequently walk up to our door to speak to us- effectively blocking us into a corner. It's very intimidating to have a large psychotic patient in the doorway- when you have no exit. Nurses know not to allow this to happen in patient rooms-- to always maintain the control and never let yourself get blocked in. On top of that, our med machine is located in the nursing station-- motivation for a patient to want to join us in there.

2- Only two staff.. I know two of us could easily get overtaken. There has to be one of us available to call for help at all times. We have portable walkie talkies as our means to call for help-- which I've learned can be difficult to fumble with when there's a patient behaving violently and you're alone with one other person. If both of us are changing a bed together, we could be overtaken and locked in a room. Obviously- we need to be proactive in thinking about these things. But-- the fact that I have one person to depend on is scary.. In one violent situation- my co-worker froze for a few seconds. I guess we have to all learn to really trust each other.

3- Our unit is one long hallway. Three rooms must be walked by before reaching the nursing station. We've already had a patient jump out of a room and pin a staff member against a wall in that long stretch.

4- According to state law- we are not able to lock anyone in their room. We have temporary lock buttons at the nursing station as well as outside each room. We have successfully been able to use these when patients have become violent inside of their rooms, but when they kick the door- it bows out(different problem altogether). But say strong young man becomes violent in a hallway, schizophrenic granny comes walking out into the hallway and then 8 year old child patient joins us. We have no control. Is it standard practice to not be able to lock someone who is known to be violent and allow them out when they ring a callbell as needed? Also- the potential for a patient to open the room to another patient(possibly a child) and assault them? The other patients really have no safety parameters in place.

5- I'd like to be carrying some kind of panic button?

I'm sure I have more concerns.. But I'm just hoping you can enlighten me to what is the standard practice- particularly on a unit that does hold violent patients. This may all be the 'usual', and I'm over-reacting as a new psych nurse. Any safety tips you can give me from your experience? I just really feel like I'm working in a jail with equivalent dangers- but no protection or weapons.