Maximum Security versus Medium/Minimum Security psych

[MissNursieNurse]

Do you feel more safe working in a maximum security setting versus a medium/minimum?? I have tried both and have found there to be both pros and cons to each setting. I'm wondering if anyone has had experience with either.

[GalRN]

How would you define maximum vs moderate or low security? I've always categorized psych units as locked or unlocked....

[MissNursieNurse]

Maximum is security at all costs; medium and minimum are not. An example: medium/minimum would have a locked door to the floor, where as in a maximum there are various gates to get in and out of; different security measures etc

[CharlieRN]

We briefly toyed with a unit that was intended to house "difficult" and forensic patients. We set it up so that any room could be locked, there were several rooms with observation windows so that a person could be contained yet be under constant observation. All clients were checked q 15mins per routine and the clients were fed on the unit, not taken to the cafeteria. The nurses station was made less accessable to the patients.

We found that there was no need for that many beds at that level of acuity, and the less sick clients that we had to place on that unit, objected to the additional restrictions. Since their complaints rapidly got back to our referers there was significant pressure to relax the restrictions. The forensic unit lasted 2 months.

[Sheri257]

I just finished a clinical rotation at a psych facility for the criminally insane. I guess it was maximum security, but it was anything but safe. An RN was stabbed by a patient just last week. Other past incidents include: A doctor had his jaw broken. A psych tech was choked to the point of brain damage. Staff are routinely attacked and it's considered "part of the job."

They have corrections officers at the gates, hospital police who patrol the units only occassionally, barbed wire fences and the units as well as the nurses' stations are locked but, it doesn't seem to do anything to prevent these incidents from happening. The problem seems to be that nearly a third of the "patients" are really malingerers who belong in prison but, unless they commit a new crime and you can convince the DA to prosecute (which, apparently, is very difficult), there's nothing the staff can do about it. A lot of these malingerers can also legally refuse their meds which, makes the staff even more vulnerable.

I have a real problem with this. I just don't understand why people who commit murder get to walk around, swim in pools, garden and roam the grounds which provides them many opportunities to attack the staff. Plenty of people have the same illnesses these people have, but they haven't murdered anybody. Why should they be treated differently from inmates?

And when the staff tries to protect themselves by putting the really dangerous patients in restraints or forcing medication, then they're criticized for not being compassionate and violating patients' rights. I guess I just don't understand how our society came up with the concept that if you're declared "mentally ill," you can pretty much attack anybody without consequence.

:typing

[Meerkat]

I just finished a clinical rotation at a psych facility for the criminally insane. I guess it was maximum security, but it was anything but safe. An RN was stabbed by a patient just last week. Other past incidents include: A doctor had his jaw broken. A psych tech was choked to the point of brain damage. Staff are routinely attacked and it's considered "part of the job."

They have corrections officers at the gates, hospital police who patrol the units only occassionally, barbed wire fences and the units as well as the nurses' stations are locked but, it doesn't seem to do anything to prevent these incidents from happening. The problem seems to be that nearly a third of the "patients" are really malingerers who belong in prison but, unless they commit a new crime and you can convince the DA to prosecute (which, apparently, is very difficult), there's nothing the staff can do about it. A lot of these malingerers can also legally refuse their meds which, makes the staff even more vulnerable.

I have a real problem with this. I just don't understand why people who commit murder get to walk around, swim in pools, garden and roam the grounds which provides them many opportunities to attack the staff. Plenty of people have the same illnesses these people have, but they haven't murdered anybody. Why should they be treated differently from inmates?

And when the staff tries to protect themselves by putting the really dangerous patients in restraints or forcing medication, then they're criticized for not being compassionate and violating patients' rights. I guess I just don't understand how our society came up with the concept that if you're declared "mentally ill," you can pretty much attack anybody without consequence.

:typing

Very Good Post.

My thoughts exactly.

[Thanet]

In the UK it is a bit different.

Maximum security = A prison hospital basically.

All doors are locked, the nurses always walk in pairs when with the Patients...staff to patient ratio is very high

There are camers recording movement... all doors are locked needing two staff to open them Via close curcuit cameras

The tap (faucet) handles are kepted locked up,

no sharp tools allowed including pencils, cutlery, crockery etc.

shoe laces, belts ties and in severe casis no clothes either (they have paper clothes) - not too sure what they are called in USA.

Patients CANNOT refuse medication, it will be administered. As all these patients will be on a section. (our section laws are different to those in USA and Canada)

All staff, including cleaners, are trained to restrain Pts, with a yearly update. which is compulsory

You cannot even visit these places if you have any type of police record. (dang and I do so like 'walking on the moon'

Medium,or as we call it interim secure

ward doors are locked,

visiting allowed more freely.

doors inside ward unlocked at certain times

Home office permission needed if Pt wants to leave ward (depending on section)

nurse patient ratio not so high.

occupational, and physical therapy offered

cutlery, crockery counted out and in at meal times.

Patients cannot refuse medication (see above)

camera are only on the main doors.

staff trained to restrain (only medical staff)

Pts have access to a secure garden/yard

Secure ward

Main door locked 24/7

staff trained in restraint (see above)

cutlery etc as any ward.

public clothing allowed to all but high risk pts (who are 1:1 nursed 24/7)

sectioned pts cannot refuse meds

Semi secure

Main door locked

staff trained in restraint (see above)

sectioned pts cannot refuse meds

Acute Admission

Is just an ordinary psychi ward.

the door can be locked which has to be recorded each time

sectioned pts cannot refuse meds

staff trained in restraint.

Rehab wards

The only time I have locked this type of ward is to stop someone getting IN

(they were drunk)

sectioned patients now accept they need meds

staff trained in restraint.

AND now to get to the original Question ( sorry about the ramble)

I have done all but the Maximum secure, and I cannot really say which one I felt 'safe' in.. I find it really depends on the staff arround at the time.

All us psychi nurses could tell you hair raising stories...BUT I tell you this for nothing.

I would rather work in Psychi than in A&E (ER) when it comes to feeling safe.

[NPAlby]

I just finished a clinical rotation at a psych facility for the criminally insane. I guess it was maximum security, but it was anything but safe. An RN was stabbed by a patient just last week. Other past incidents include: A doctor had his jaw broken. A psych tech was choked to the point of brain damage. Staff are routinely attacked and it's considered "part of the job."

They have corrections officers at the gates, hospital police who patrol the units only occassionally, barbed wire fences and the units as well as the nurses' stations are locked but, it doesn't seem to do anything to prevent these incidents from happening. The problem seems to be that nearly a third of the "patients" are really malingerers who belong in prison but, unless they commit a new crime and you can convince the DA to prosecute (which, apparently, is very difficult), there's nothing the staff can do about it. A lot of these malingerers can also legally refuse their meds which, makes the staff even more vulnerable.

I have a real problem with this. I just don't understand why people who commit murder get to walk around, swim in pools, garden and roam the grounds which provides them many opportunities to attack the staff. Plenty of people have the same illnesses these people have, but they haven't murdered anybody. Why should they be treated differently from inmates?

And when the staff tries to protect themselves by putting the really dangerous patients in restraints or forcing medication, then they're criticized for not being compassionate and violating patients' rights. I guess I just don't understand how our society came up with the concept that if you're declared "mentally ill," you can pretty much attack anybody without consequence.

:typing

where is this place (what state)? I don't think it would be considered maximum security from what you write. I worked at a state hospital with a forensic and civil side. The forensic unit (it's own bldg) had 3 checkpoints before you got to the nurses station and then that was locked. On the unit itself there were roving security guards. If something happened you could get a response team in less than half a minute and usually there were already someone from security there. The civil side had two checkpoints and the same deal with the nurses station. The primary difference was in what was considered contraband on these two units. On the forensic side nurses couldn't even bring their cell phones pass the 1st checkpoint you had to leave it in a locker or your car. There was no staples or paper clips allowed for staff or pts. That's how strict it was. And they definitely didn't have pool time. The civil side was more lenient and had pts go out and smoke, bring in can sodas and have more physical contact with their visitors.

The main point that they drove into our heads on the forensic unit was that these patients are from prison. They come in with a prison mentality. There were very few that were there just because of their level of dangerousness to self/others. As for malingers that was our (nursing staff) biggest job. It was our job to keep an even closer eye on these pts because we had to document their behavior. Our notes were reviewed by the team and used to send the pts back to jail. And medicating these pts wasn't even a consideration. The docs were very careful who they medicated. If the pt seeemed to "improve" without meds it was probably bc they were sick of our structured environment and wanted to go back to prison where they could sleep all day and smoke.

I hated working there when I was there (as a traveler) but now since I worked at another forensic facility and "regualr" hospital I really understand the value of maximum security. That's not to say things were rosy and no one ever got hurt but I felt a lot safer there than anywhere else I worked.