Is Geropsych Safer?

TheMoonisMyLantern, ADN, LPN, RN · Jan 24, 2021

Eh, old doesn't mean feeble. Had an ambulatory elderly patient kick, charge, and choke a staff member recently. Police balked due to the patient's age but they were strong enough to seriously hurt someone... and I'm not even on a geropsych unit at present!

Brigi23, BSN · Feb 28, 2021

I work Gero psych, I have also worked with adults and peds. My experience is there are a small number in every category that are prone to violence. Hallucinations and delusions make them more prone to thinking you are the enemy

Peds can be very violent and OK to manage if they are 5-9. Above that you have some pretty big kids. Some built like football players. Can be terrifying when they are deluded. Adults can get very violent and are scary because they have the strength do do some damage.

I work in a gero psych where we don’t accept knowingly violent patients. With covid that has changed a little and they are increasingly more violent. There are some pretty strong seniors that have bitten, kicked, spit on, scratched and even tried to hit a nurse with a chair holding it above his head getting ready to slam it down on her

None of it is truly safe. You are always at risk of getting hurt when working on a psych floor. The good news is if you have a great staff that are trained in how to handle the situation that can defiantly help. Also seniors, at least the ones I have dealt with so far, I have been stronger than 90% and could manage them when needed.

De escalation is key but when that fails you have to have a good responsive team and management. If management tie your hands by not allowing you to do your job then that can be difficult. Or if there are unclear expectations about what should happen.

ultimately our license is on the line so it is really good to know what everyone expects while keeping the patient and yourself as safe as possible. I worked for a very good hospital and was floored that they were wavering on what we could or should do.

it’s important to have a team that has your back and management that is 100% on board with what you are doing.

Orca, ADN, ASN, RN · Mar 16, 2021

The most violent patient I ever encountered when working inpatient psychiatry was 68 years old, and strong as an ox. He sent two staff to the hospital, one with a laceration on the head from being hit with a telephone, and another who wound up having surgery for a torn rotator cuff.

heron, ASN, RN · Mar 16, 2021

Is Gero-psych safer? Whoo-boy! Don’t bet on it! I currently work in a nursing home that is now taking more residents with chronic psych diagnoses. Even when the primary diagnoses were some form of dementia, violent behaviors were often a possibility with some residents, depending on the symptoms associated with their dementia (commonly delusions and paranoia). Now, with more mentally ill residents, violent acting out is an ever-present possibility. It’s fascinating work, but you gotta stay on your toes!

AnnaCARN, BSN · Mar 17, 2021

I worked psych for a while. Adolescent and Geri-psych are the worst. I would float between 3 units. Geri-psych patients are violent and you can't medicate them like a younger patient because of their age. If you want to get bitten and kicked go work in Geri-psych...otherwise run away fast.

lilRN16, ASN, BSN, RN · May 21, 2021

I will work anywhere and I am petrified of Gero-psych!

Run as fast as you can!

Brigi23, BSN · May 21, 2021

Haha. There are different levels of acuity. My hospital takes a lower acuity. It depends on what your facility will accept too. I was more afraid of peds hospital psych and adult psych. Gero- psych patients are usually very febile and if you need to you can restrain them etc. I am a 5'5" female 160 lbs so I can hold down and restrain 95% of the patients that walk in that door on my own.

Adult unit was different, I could probably restrain 5% on my own. You never know who is going to turn and attack etc. I worked this unit for about a week and decided it was a little too dangerous for my liking. Some nurses say they have never been attacked on adult? IDK. I didn't want to risk it. My rule of thumb is if I can't handle a patient on my own, I will not work there. Because you will sometimes be left in a situation where it is you and a violent patient.

Pediatrics was a different ball game. While I felt like I could restrain the kids under 8 on my own if I really needed to ( we needed to very often at the hospital I worked at), there were kids that would come in that were 17 years old and looked like running backs for the NFL. So..... when a patient is psychotic and circling your desk and getting up in your face wanting to harm you, these are things that you have to consider.

I have been at this Gero-psych unit for almost a year now. I have been spit at once. pinched once and hit once ( not too hard). So that is the way that I look at it. I have never worked a psych unit where I felt completely safe. You always have to watch your back and your co workers backs. These people are dealing with delusions and hearing voices etc. that tell them you are trying to harm them and "not to tell the nurse things etc". You will get all types. Good luck, it has been pretty darn interesting!