Injured on the job?

[nursegreene]

Hi, I'm curious about how many psych nurses have been injured on the job. I am finishing up my training as a new psych nurse and will be on my own next week.

I've been oriented and gone through the CPI training. Any additional tips on what to look for ? What to avoid?

Any info you are willing to share is appreciated.

Thanks!

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[WillyNilly]

I've been doing this for a lonnnng time. Most injuries sustained have been from dementia patients ranging from scratches/bites to punches while care was provided.

[Mandychelle79, ASN, RN]

I've been doing this for a lonnnng time. Most injuries sustained have been from dementia patients ranging from scratches/bites to punches while care was provided.

I've often said I'd rather deal with a 300 lb psychotic pt vs a 98 lb little old lady with dementia... They are relentless

[Retired APRN, MSN, RN, APRN]

In over thirty years of working as an inpatient RN and later as an NP both inpatient and outpatient, I had one injury due to patient assault, as opposed to a couple of others due to my own idiocy.

The patient, admitted from the criminal justice system to our observation and diagnosis unit, was decompensated, paranoid and I had to give an IM med against his will. It ended up a worst-case scenario kind of thing, involving a fight and a take down by me and four colleagues. The patient landed a fist to my mouth and knocked out two of my teeth. I did give the injection, with blood running out of my mouth and down the front of my shirt. (And that, my children, is how I got a reputation as a bad-4$$ nurse.)

Debriefing from the incident, I was able to identify a number of points where my colleagues and I made poor decisions that escalated the situation. Specifically, we spoke in loud imperious terms without offering the patient a "ladder" to climb down off his high tree (a face-saving alternative). We insisted on our own time table instead of slowing down and allowing the patient a couple of minutes to accept that this was going to happen and he had no choice. Things like that.

Essentially, we acted like we were on a power trip - and perhaps we were. This was early in my career, and even in similar situations with similar patients I was never assaulted again.

Another factor is that I was fairly new in the field, not sure of my ability to handle situations and I wanted to impress the staff, who were mostly older and more experienced than I. That was my insecurity and ego sitting like a big chip on my shoulder. It's embarrassing to remember, but it's worthwhile to tell the story if it can help new nurses in psychiatry.

Please feel free to get in touch if you think this old dinosaur can be of any comfort or assistance.

[Umberlee]

The thing I absolutely like least about psych so far is I still feel completely uncomfortable as to deciding when a situation has become a behavioral code. With psychotic patients it's one thing, you know you aren't going to be able to "talk them out of it," but with patients who are just behavioral or acting up or flexing their muscles so to speak--how do you know when you've given them enough chances to just talk them down? The couple situations I've been in so far that warranted judgment calls like that, my co-worker's advice was to just treat them like a child--not in a condescending way, but in the consistency of what you tell them: you get one chance, and if you blow that chance and don't back down/stop posturing/contract for safety/whatever, then the team is on you. I hate conflict and I'm much more of a "can we work this out?" kind of person. But I have noticed this enormous feeling of relief once you're done futilely screwing around trying to "get through" to them and have started with meds/seclusion/whatever instead.

I have gotten punched, lightly, once so far. It was a DD patient. I have thus far found DD and BI patients to be the absolute most difficult. We seem to see those a lot more than little old dementia folks.

[MrChicagoRN, RN]

Umberlee,

has your team, and you, been trained in CPI? All interventions are on a continuum, from least restrictive to seclusion, or restraints. Even when calling a code, the talking continues. The presence of the additional staff represents a team effort, that no one is standing alone. It doesn't mean that now we grab the patient and drag them off after one chance. Once you do that, risk of injury to patients and staff escalates. .

Acting out behavior needs to be recognized, and acted upon early on, before everything escalates out of control. Sometimes that involves a lot of talking to the patient. You want to be in control, but you don't want them to feel powerless. That's where your clinical skills come in.

Even if you don't have CPI, or other escalation training, there are free resources on their website that you may find helpful. Crisis Prevention Institute (CPI)

[supernurse109]

People often talk about negative or "brave experiences".... they cant help it....... Don't let it influence you too much, I have been in psyc for 26 yrs and have only been injured once. If you work as a tem and treat them with respect whilst being firm but fair you cant go far wrong..... and remember to talk to them......... x