Is it just my facility or ...........

TheMoonisMyLantern, ADN, LPN, RN · Apr 26, 2019

In my experience usually administration is useless in these circumstances. Instead I would turn towards the psychiatrists, np's, and pa's for their input and guidance. You may be up the creek depending on the laws there but if you have support from the docs these types of trouble makers can discharged quickly and go to jail where they belong.

It goes without saying to make sure your capturing the patient's behavior accurately in your documentation just in case anything goes to court the true colors of your patient will shine through.

pixierose, BSN, RN · Apr 30, 2019

Oh gosh, yes. Those magic words.

Enough that the staff injury rate has reached an all time high in the building. Not just individual units, the BUILDING. As in, send to the ED ... out for several *months* ... concussion or even a few fractures.

It’s appalling.

Like moon said, the docs/NPs are more the ones to turn to. Administration? Useless. They like to have meetings, or (my new favorite) a “town hall” where we all gather and discuss our “issues” with management ...

... only for management to say, “yes, we hear you” yet do nothing (because they’re not really listening).

But the psychiatrists/NPs have been more involved and realistic. Actually, one of our psychiatrists kicked out a patient last week for smashing the safety glass just to the right of a techs’ head (the patient wanted juice). He felt we couldn’t treat him, and had the tech press charges as he was leaving.

Document, document, document.

Kklimited · Jul 7, 2019

Yep i have noticing this as well...

unknownjulie · Jul 7, 2019

I agree. I noticed a large rise in violence when crystal meth came on the scene. Psych nursing used to be a place to hide out, but I've just seen way too many violent assaults lately. It's why I went back to Medical nursing although in my heart I will always be a Psych Nurse.

verene, MSN · Jul 9, 2019

Yes, seeing a lot of violence and a lot of high medical acuity in the facilities I float to (higher than usual). I think there are a number of factors at play, including a system wide shortage of appropriate levels of care (at all levels), which means our "sub-acute" facilities are getting a lot more individuals with dual-diagnosis actively detoxing, on court commitments, etc. rather than our voluntary acute-stabilization patients were are designed for. We are also seeing a lot who will need residential care and there aren't beds to discharge to, which is resulting in patients staying 60+ days in facilities designed for 7-10 stays.

We are under contract to the County and have had our administration and medical staff pushing back a lot, which has resulted in the county now paying for additional agency staffing out of county budget for when they force-over-ride our decision and make us take a higher acuity patient than we are really staffed for. We are also sending incident reports to County and up the chain of command with our employer every time one of these inappropriate admits causes issues. Feeling like we are becoming a dumping ground for anything and everything which is not what we are set up for. ?

Still love psych, just wish I had the staff and the resources to manage the increasingly diverse and unpredictable milieu.

allnurses Guide · Jul 9, 2019

On 7/7/2019 at 2:03 PM, unknownjulie said:
……. Psych nursing used to be a place to hide out...…

I hope you are implying that Psych nurses are hiding out rather than engaging in Real (Med Surg) nursing. Psych nurses work just as hard as any other kind of nurse.

Hppy

unknownjulie · Jul 9, 2019

Sorry if it sounded this way. I was referring to the physical demands of the job, not the mental. I did find the lifting etc to be much less in Psych, but dealing with the constant assaults now is equally physically taxing. I used to have a lot of time in the past to do groups and talk to patients. Now, I find the RN role is mostly about managing aggressive behavior and the meds that go along with that, and that is what I meant.

allnurses Guide · Jul 10, 2019

23 hours ago, unknownjulie said:
Sorry if it sounded this way. I was referring to the physical demands of the job, not the mental. I did find the lifting etc to be much less in Psych, but dealing with the constant assaults now is equally physically taxing. I used to have a lot of time in the past to do groups and talk to patients. Now, I find the RN role is mostly about managing aggressive behavior and the meds that go along with that, and that is what I meant.

IMHO physical attacks and aggressiveness has a lot to do with how staff manages patient behavior. Especially now that we can't just put someone in restraints anymore. Physical attacks are rare in our facility but our staff is tops.

Hppy

unknownjulie · Jul 10, 2019

The randomness to the attacks that I witnessed at my last Psych job had nothing to do with how the staff interacted with patients. I am glad that you and your staff have been lucky thus far.

allnurses Guide · Jul 10, 2019

I've been at my facility for almost 20 years and yes attacks are often random but most can be anticipated and dealt with proactively with proper MAB techniques. We train frequently and respond to all calls for help from all units. Like I said injuries and attacks are rare - we are an acute facility so we see all kinds/types of patients.

Hppy

pixierose, BSN, RN · Jul 11, 2019

11 hours ago, hppygr8ful said:
I've been at my facility for almost 20 years and yes attacks are often random but most can be anticipated and dealt with proactively with proper MAB techniques. We train frequently and respond to all calls for help from all units. Like I said injuries and attacks are rare - we are an acute facility so we see all kinds/types of patients.
Hppy

Hppy, I usually agree with you on most things, but you seem awfully blamey in your last two posts.

The worst feeling, the very worst feeling, is *anticipating* that violence and *knowing* you can’t stop it from happening, and wondering how you’ll make it out on the other end.

We get everybody and anybody the ED sends us. The unit I am on is “older adult,” meaning we now get *anybody* 50 and up ... could be ambulatory, MDD and polysubstance abuse scoring 5-> on a CIWA (we are med-psych, so we do IVs and can do IV Ativan) or an 80 year old, 2-assist using a rolling walker with major neuro cognitive disorder that requires frequent IMs r/t their dementia. Or that paranoid schizophrenic that has been a frequent flyer, is on visit 4 and we are now waiting for a long term placement.

The nursing staff at the psychiatric hospital that I am employed at are top notch, trained well and frequently. We are also a relatively happy bunch... until recently with the new policies hospital and system-wide (in our case, the 30-40 year age gap where we get all things psych-medical).

We can and do indeed anticipate. But you pile all these patient behaviors in close quarters with staffing such as they are (3 long term techs are out on leave due to violence from patients), and even the best of us (anticipation or not) can get injured.

I watched a 250lb man come in on a stretcher after receiving an IM 5-2-50 in the ED ... sit quietly for almost a full 30 seconds, stretch, then jump off and slam his beefy fist into the wall next to my face. I had 4 techs, two security guards, and two paramedics next to me. He was here for detox and MDD, using those magic words “I want to kill myself.”

I anticipated that he might be problematic. We worked with the ED. I worked with the patient as we let him slowly out, one 4 point at a time. I had staff. I was a safe distance. I utilized my CPI techniques.

It’s a horrible feeling, watching that quick decompensation take place. Sometimes, people don’t belong on psych floors.