I am looking for 100% real advice and insight into my situation. To start I have been a nurse for 3 years but I have worked at a psychiatric facility for most of that time with one company.
I recently accepted a job at a recovery center for detoxing patients and residential. The staff is very friendly, so there are no issues there. Is it chaotic and disorganized? Yes, but that is almost every detox or psychiatric facility so I can manage that.
My issue with this is that I have been hearing that nurses have been left by themselves on the overnight shift with 18 or more patients that may be actively detoxing. They use recovery coaches (RCs) and sometimes an RN will have one RC or none at all on nights.
There is no security and it was a female RN left alone in a building with 18 male patients. To me, this is concerning because I am going to be working nights and I was not told that I may be alone on a night shift during my interview.
Is this typically the standard? Am I being paranoid about the situation?
I am just picturing a medical or behavioral emergency happening on the shift being by myself or with an RC ( they are not medically trained ). I am still on orientation (week 2) and by looking at my schedule, it looks like my orientation is ending next week. I have pondered on the thought of not continuing here based on this. When I work in psychiatric units the patient was more of a handful, but I was never alone with that many patients and I always had back up during code grays.
I've been in a couple of these situations before and I'm sort of a big guy so I never was in fear physically but I was terrified of losing my license because addicts can be quite personality disordered.
I would first make enquiries of the night shift staff who have been there a little while re there concerns, not directly addressing your concern and sees what shakes out. 2nd, I have been around legal people all my life and surreptitiously, you need to start making enquiries, beginning with the state and their license etc. Then you look locally re the township. OR, probably for under $500 you can hire a professional to do it for you. IMO, it's money well spent for peace of mind and now you have a legal record of your concerns in case things go sideways later. If you are in a union, contact them with your concerns, even if you are rebuffed. Send your concerns in a detailed email to yourself. IMO, you are possibly in a precarious situation and it doesn't hurt to be cautious. Or, you could be just over-reacting and things will be fine.
You absolutely must shut your gob though and you cannot tell anyone incl your family that is your plan.
Nurses need to realize that institutions are not there to protect them or be their friend. They will lay the blame at your doorstep in a jiff.
Specializes in Community Health, Med/Surg, ICU Stepdown.
Coming from a unit that was always at least 1/3 etoh withdrawal pts, I say run for the hills! Outpatient detox pts may be lower acuity, but some pts underestimate the amount they drink and/or the last day they had a drink, and sometimes the worst of the symptoms don't start until around day 3. I bet there are some situations where pts have to be transferred to the hospital, and that needs more than just you to do safely. These pts can go downhill quickly, have seizures, coma, etc.
Plus if someone becomes disoriented and violent, what could you do to protect yourself, the pt, and the other pts? If you are a female nurse up against a large, strong, disoriented and fearful man who may think you want to harm him, that is SUPER dangerous. I say express your concerns and quit. Just wanting you to be safe, sorry if this post sounds harsh =/
Coming from a unit that was always at least 1/3 etoh withdrawal pts, I say run for the hills!
I agree with LibraNurse27 completely. NOC shift nursing in a psychiatric or inpatient substance abuse setting should have a ratio of ~1:6. I can understand 1:8 *IF* you have support personnel like the RCs mentioned. In my opinion, the facility you are working at should have at least 2 RNs and 2 RCs overnight (3 RCs would be preferable). Any facility that is willing to leave an RN by his or herself overnight with 18 patients is a lawsuit waiting to happen.
What if a patient experiences alcoholic hallucinosis and becomes extremely agitated and attacks the RN or a peer? I know several clients with opioid dependence co-occurring with other mental illnesses that would attack or threaten staff during detox (and rehab!) if their ridiculous needs were not met (e.g. "Just let me out for an hour so I can have a smoke and then I'll be right back!").
If that facility is staffing NOC shift as you reported, RUN for the sake of your license.
Specializes in Community Health, Med/Surg, ICU Stepdown.
11 hours ago, Encarn said:
I agree with LibraNurse27 completely. NOC shift nursing in a psychiatric or inpatient substance abuse setting should have a ratio of ~1:6. I can understand 1:8 *IF* you have support personnel like the RCs mentioned. In my opinion, the facility you are working at should have at least 2 RNs and 2 RCs overnight (3 RCs would be preferable). Any facility that is willing to leave an RN by his or herself overnight with 18 patients is a lawsuit waiting to happen.
What if a patient experiences alcoholic hallucinosis and becomes extremely agitated and attacks the RN or a peer? I know several clients with opioid dependence co-occurring with other mental illnesses that would attack or threaten staff during detox (and rehab!) if their ridiculous needs were not met (e.g. "Just let me out for an hour so I can have a smoke and then I'll be right back!").
If that facility is staffing NOC shift as you reported, RUN for the sake of your license.
Exactly! If you were attacked to the point of being incapacitated, which I have unfortunately seen, coworkers knocked on the ground! How would you get help and who would take care of the other patients or even the disoriented patient attacking people? That is a lawsuit waiting to happen from a patient's family member, what if another patient got attacked by an out of control patient while you are incapacitated?
And I would be really scared for you to get injured. Like really scared. I really hope you don't take the job. You could try expressing your concerns and see what plan they come up with, but if they insist on this plan I would run. I admire you for wanting to work exclusively with this population; that takes a lot of compassion and strength. But I hope you find a more functional environment to do so = )
guest1163268
2,215 Posts
I've been in a couple of these situations before and I'm sort of a big guy so I never was in fear physically but I was terrified of losing my license because addicts can be quite personality disordered.
I would first make enquiries of the night shift staff who have been there a little while re there concerns, not directly addressing your concern and sees what shakes out. 2nd, I have been around legal people all my life and surreptitiously, you need to start making enquiries, beginning with the state and their license etc. Then you look locally re the township. OR, probably for under $500 you can hire a professional to do it for you. IMO, it's money well spent for peace of mind and now you have a legal record of your concerns in case things go sideways later. If you are in a union, contact them with your concerns, even if you are rebuffed. Send your concerns in a detailed email to yourself. IMO, you are possibly in a precarious situation and it doesn't hurt to be cautious. Or, you could be just over-reacting and things will be fine.
You absolutely must shut your gob though and you cannot tell anyone incl your family that is your plan.
Nurses need to realize that institutions are not there to protect them or be their friend. They will lay the blame at your doorstep in a jiff.