I started working on a psychiatric floor in a hospital that is pretty much "the hospital you can't fall below". They get patients that have little to no insurance, homeless, etc.
I just got out of nursing school so I do not have any hospital experience other than my rotation and preceptorship for mental health in two other hospitals.
With psych patients I noticed that they are needy and some will continually come up to the counter which I do expect since I saw that before.
I have been on the floor for only a day and in two separate instances I witnessed two different patients approach the desk where my preceptor and myself were sitting. The patients both were talking in regular voice level, not yelling etc. My preceptor would give some direction and the patient responded still talking in regular voice level, still asking for something or other. In both instances my preceptor yelled (and I mean yelled) at the patient to either go away or argued with them. I think one was asking why they could not take the medication they wanted and the other was asking to be discharged. I know that they ask the same things over and over and I understand it is frustrating for the nurses sometimes.
I would like to know what everyone's stance is on yelling at a psychiatric patient. Is it okay for me to let it go and when do you step in and say something to the nurse or your manager?
I wouldn't yell, and I disagree with those who say it might be necessary and/or is therapeutic in certain situations. I'm not in a psych hospital, I'm at a LTC/rehab facility, but I DO have what amounts to a few psych patients at any given time, and I'd get reprimanded - if not fired - if I ever yelled at one of them. I had one guy whom I wanted to scream obscenities at at least 6-8 times, but I was able to throttle that, and rarely even raised my voice in speaking to him. Part of our job is to be the 'adult in the room', hard as that is sometimes.
I am a new psychiatric nurse and I have never yelled at a patient. What purpose would it serve?
Depending on the patient, they can usually be redirected and yes, in many cases reasoned with.
The other day, I had a psychotic young woman who insisted on lying on the hallway floor and refused to take her Zyprexa. She kept saying that she wanted to leave the facility. So, I sat down on the floor next to her and calmly explained the easiest way to get out of the facility: Do what is asked of you and make your case to the psychiatrist. She then took the Zyprexa after I explained why the medication is used and got up off the floor after I suggested she must be uncomfortable lying on the hard surface.
Psychiatric patients require time and patience. Where I work, it can be difficult to find the time and patience necessary to do the job.
Thanks for all the comments and suggestions. I will definitely stick it out and see how things progress. I really want this experience because of the type of patients that this hospital serves as my first job.
Remember that what works on medical floors more than likely will not work on a psych unit. There have been times where I have literally had to say to a patient "knock this sh*t off". Would I ever say that on a medical floor, heck no. Give it time and you will come to realize your own flow of things. What they teach us in school, is not reality at all and more than likely do not work. My suggestion, make a patient feel like they are being "heard". Don't say things with "but" in them. Change the wording and say something like "I understand you are upset, and at the same time, you need to realize that your behavior right now is unacceptable". This puts accountability on them and worked extremely well with my dual diagnosis clients. Psych patients will try and break you and sometimes yelling is the only way they can have limits set.
How did the patients react? That's what tells the tale. I rarely yell at my psych patients, but I have worked with nurses and techs who do and generally the patients respond well. IMO, the most important thing is to be yourself. Patients know when you're upset with them. Staff who yell it out can be just as effective as those of us who tell them the same thing, just more quietly.
I have been working the acute psych floor for 4 years now & still keep my mouth shut & eyes wide open when another nurse is being what I may consider overly snappy, loud, yelling or mean. I stop & watch the effect it has on the patient & what happens next. I learn, I decide what I will do & won't do. I have been overly whatever at times when I am overwhelmed, tired, having a bad day - No one is perfect. I also try to do better the next time. I find myself much less "nice" & more firm & matter of fact when patients are attempting to crowd at the nurse station. Learn first, judge less & then decide how you want to proceed.
As a rule, no it's not okay to yell at a patient. In this case, however, I feel like you need more information. You don't know the history of these patients or the therapeutic relationship the nurse may or may not have with them.
What was being said? Did the nurse have narcotics out? (Counting for shift change maybe?) were these patients alert and oriented and trying to push buttons?
I'd be cautious of the situation and if it were me I'd take it all in before jumping to conclusions.
Obviously if it's truly abuse you must report it, but I'd really need more info to give an opinion.
I'm a loud person by nature and get louder as my emotions/adrenaline increase. When I meet new patients I tell them if I sound like I'm yelling it's ok, I'm just excited... now if I drop my voice low and it has a steel edge to it.... yeah not good. Effective, but not good.
I just transferred fron psych but got to put psych nurse skills to good use when dealing with a pt in DTs. Said pt responded well with set boundaries and a little humor... like me saying I don't what everyone to see your bits and pieces when trying to convince pt to stay dressed.
I have never done psych but I can say that it is never okay to yell at a patient - even if you are being yelled at. It seems that there might be some burn out happening with your preceptor. I would definitely say NOT to let this go. Not knowing the entire situation but did you ask her why she responded to the patients that way - she might not even realize she is acting this way.
As a leader in nursing - I personally would want to know that this was happening in my department or my organization. The only way things can be fixed is if leadership is made aware of it. Maybe suggest to your manager education regarding communication to patients. You can still share the experience with your manager and not give any names. I hope this helps. I am sorry that you experienced this. If anything I hope you can say that this is NOT the nurse you want to become
djh123
1,101 Posts
I wouldn't yell, and I disagree with those who say it might be necessary and/or is therapeutic in certain situations. I'm not in a psych hospital, I'm at a LTC/rehab facility, but I DO have what amounts to a few psych patients at any given time, and I'd get reprimanded - if not fired - if I ever yelled at one of them. I had one guy whom I wanted to scream obscenities at at least 6-8 times, but I was able to throttle that, and rarely even raised my voice in speaking to him. Part of our job is to be the 'adult in the room', hard as that is sometimes.