New Grad RN On Nights: Violence Causing Anxiety?

[NightingaleStar]

Hi all, I am looking for some thoughts here on the high-anxiety I’m facing as a new grad RN. I work in a busy inner-city ER that sees a fair amount of COVID, as well as a high amount of psych disorders in our local population; this area also serves our largest homeless population, and also  an alarmingly high rate of methamphetamine abuse. It is almost nightly that staff is either verbally or physically assaulted.

Last week it was my turn. As I calmly and politely cared for a meth-intoxicated patient, explaining what I was doing, the patient abruptly tried to attack me, and only missed because I got out of the way quick enough. I am now feeling all the feels-not only am I new to nights, but I’m a new grad, and already a bit overwhelmed with COVID and the constant flow of hostile patients.

I am trying to decide if this is all new-grad anxiety, or if this is truly an unsafe environment. It seems the staff just accepts the treatment from the patients here and the scary thing is no one is surprised at the amount of violence we are exposed to-it seems like it’s a “badge of honor” the staff accepts, so it’s hard for me to accept that this is just how it is.

Can anyone relate or share your thoughts on this?

I have terrible anxiety prior to going in every night and wonder if I made a bad choice becoming an RN. I hate seeing people I work alongside treated this way, and am becoming concerned about my safety going there. 

[TheMoonisMyLantern, ADN, LPN, RN]

Welcome to the poop show that is bedside nursing. In all seriousness, even though I loved psych and substance abuse, I had to get out of it due to the constant stress from the rising acuity. I got to the point where I was gun shy, I was afraid I would freeze up while trying to deescalate someone and that either I or a co-worker would get hurt. Eventually that anxiety just wasn't worth staying where I was out.

The potential for violence is in every specialty in nursing. Certain specialties attract it more than others, ER, ICU, Psych, memory care, all see their fair share of violence. It is NOT acceptable but it is a sad reality of nursing. You will have to decide what you can tolerate an what you can't when it comes to your job. Sometimes time and experience and being exposed to those type of situations can help you manage them when they occur. 

However, I would encourage you to stay put to get experience because no matter what job you have as a new grad, it's going to be hell for a while just because the first year always is, so as you gain experience a few months down the road your current environment may not seem so intimidating. 

Good luck!

[Davey Do]

47 minutes ago, NightingaleStar said:

I calmly and politely cared for a meth-intoxicated patient, explaining what I was doing,  the patient abruptly tried to attack me, and only missed because I got out of the way quick enough....

... Can anyone relate or share your thoughts on this?

Your approach to the patient, being calm and polite, is a good one, NightingStar. The fact that reacted quickly when the patient attempted to attack shows vigilance and coordination. Good for you.

Having been in a number of verbal and physical assaults over the years, I learned some methods of de escalating situations and of defending myself.

One of the things that helped me the most was a self-defense course I took when I was an adolescent. The instructor was a black belt in Tae Kwon-Do and leaned heavily on an Aikido method.

Basically, we learned how to channel a force against us. Instead of defending or offensing, we took the force directed at us and used that force to steer the attacker away from us.

For example, I have used wrist grabs and choke hold escape techniques several times in my career, although I was told in CPI that I could not.

I am as coordinated as the proverbial cow on crutches and these techniques have worked for this old bull.

Good luck and the best to you, NightingaleStar!

 

[JBMmom, MSN, NP]

6 minutes ago, Davey Do said:

For example, I have used wrist grabs and choke hold escape techniques several times in my career, although I was told in CPI that I could not.

The problem is that while we are "properly trained" with rules related to what can and cannot be done, no one gets the perpetrators of violence to agree to the same constraints. 

OP, you are in a difficult position, sorry for your experiences and I'm glad you're okay after your recent potential altercation. Only you can decide whether your environment is one that you will not be able to continue working in, you will certainly encounter similar events in the future. Do staff appear to be well supported by peers and management when these things happen? If you're finding yourself without the support you need, you might have to reconsider your position. The more experience you have, the more likely you will be to see a potentially dangerous situation coming, although there's always a chance for an unforeseen attack by patient, especially when working with patients with psych diagnoses or substance abuses issues. Wish I had some great advice, but sadly, it does appear to be the way of healthcare these days. Good luck to you!

[amoLucia]

Sadly, you were the victim of a potential work-place assault. Had you NOT reacted approp, it would have been a real assault. You most rightly can be expected to have residual PTSD-type symptoms.

Seek out EAP counselling services that your facility prob offers. And if you need the time off, consider it.  If you had slipped & fell on snow in the parking lot, you could expect some considerations. You experienced a violent work-place episode.

You'll need to deal with the workplace environment and make some long-term plans. But this comes first.

[JKL33]

3 hours ago, NightingaleStar said:

no one is surprised at the amount of violence we are exposed to-it seems like it’s a “badge of honor” the staff accepts

I think this attitude is inappropriate. Sometimes it is a defense mechanism and (other times) it is some personalities that sort of get into being involved in these situations; I call that latter thing the cowboy attitude, where we're here to wrestle around with people and put them in their place and it's all good. I think there are other attitudes that are much more safe and also, frankly, more respectable/professional ways in which to treat patients even when things are bad. My primary concern is that if the cowboy attitude prevails in a place then other things tend to go out the window, such as respectful communication, for example, or taking care to  not invite extra difficulty simply by one's attitude and approach.

We all know that these situations are going to arise and/or may even be regular occurrences. However, one thing that is completely inappropriate is any new grad (or anyone new to the environment) being placed into these situations without any associated training and without appropriate back-up. I would not see a need to stay in a place where management did not prioritize these things.

[speedynurse, ADN, BSN, RN, EMT-P]

I don’t think this is being a new grad and I don’t think the ways patients are treating you is appropriate. ERs are notorious for workplace violence. For awhile, I made excuses for it....saying things like people are in crisis, it’s a high stress environment, etc. And some of that is true. However, assault and battery on the job is not OK.....we are just living in a culture that has dealt with it for so long that it is perceived as OK. The ENA really does have some good information on this and presents it in a way to an employer or other nurses that demonstrate this type of behavior or violence is not acceptable and is in fact, very unacceptable in this profession. 

However, short story, no the way you are being treated is not OK. Every time I think I miss the ER, I think about stories like this or my own experiences and that little glimpse of missing the ER is gone fast ?

[kickmeiamanurse]

I have had the police drop off a PT in handcuffs and thought he would be a problem.  He was perfect.  On the other hand, I had an 85 year old lady take what I thought was an eyeglass case out of her purse but it was a gun case and before you know it, she shot at me and a trainee but missed because we ducked and ran at the last second.  I was surprised the trainee returned to work.  I swear I have PTSD from every night of work.

[Stillcrazyafteralltheseyears]

I worked 10 years in a state mental health facility dealing with violent NGRI offenders that differing medication regimes could not stop their assaults on clients and staff. This ongoing environment without proper security and pro-act philosophy led me to a major depressive episode and PTSD. Your anxiety also compounded with being a new grad is understandable. Please take care of yourself and seek treatment when needed. I waited to long telling myself and the climate of attitude "well this is the job you chose, or pull your pants up" by supervisors  which made me doubt the reality and damage it was causing my psyche. Nurses put too much pressure on themselves to be angels of mercy. But angels have supernatural powers, we don't. 

 

[Davey Do]

23 minutes ago, Stillcrazyafteralltheseyears said:

I worked 10 years in a state mental health facility dealing with violent NGRI offenders that differing medication regimes could not stop their assaults on clients and staff. This ongoing environment without proper security and pro-act philosophy led me to a major depressive episode and PTSD.

Geez, I empathize with you, Stillcrazyafteralltheseyears!

It amazes me how some can work in this environment and still function. I doff my proverbial hat to you for lasting a decade!

Some can do it and float on through life without their mental health being affected. Rooty Payne, a psych tech I worked with at Wrongway is an example. Rooty has worked in the DOC and in psych for decades and is an outstanding individual.

My little sister Cat worked with the DD population in a Hell Hole for 30 years before she passed away. She was a great person, one that I said was "A Cat who herded cats".

When I asked Rooty and Cat how they did it, they both gave me the same answer:

"I don't let it bother me."

Wow. Just: wow.