Nurses and suicide patients

[leopold]

I am curious, on several occasions I have seen nurses delay or withold care for pts. hospitalized for suicide attempts -- medically hospitalized not psych. I am wondering about that. I know nurses for the most part deal with people that are struggling to live through some pretty horrendous problems and I kind of wonder how you as nurses feel about working with suicide pts.

[drriley]

From a patient care and legal/liability perspective security should be posted at the door, or in the room, of a suicide-watch pt in a med/surg setting if nursing staffing levels do not allow for an appropriate level of monitoring. And your hospital security staff should have training in this specific type of work. It is inappropriate to ask the patients family/friends to monitor the patient. In a short-staffed ICU, you would not ask family/friends to monitor the patient and come and find a nurse if the heart monitor starts going off.

I have had to assume care for suicidal pts on a few occasions..It's not fair for me nor the pt in a medical setting imo..they have been admitted to our med/surg floor until a psych bed becomes available..usually the doc orders a family member/friend to stay with pt at all times..how often does someone stay with the pt 24/7 ? rarely..q 1 hr room checks per nursing,call md of any changes/increased anxiety/threats of harm, ect....I would NEVER neglect nor delay care to any pt..reguardless of diagnosis..it's not my job to judge anyone..I do have objection /concern about taking care of these pts because of safety issues..I don't have eyes in the back of my head and cannot watch them at all times and NEVER do we have enough staff to cover one on one ..not safe , most of the suicidal pts are ambulatory and could leave at any time they felt like it and are quite smart in figuring out when staff make rounds and are busy doing meds ect, and could easily sneak out...just puts everyone involved in a sticky situation. Of course I notify MD/supervisor if no one is staying with pt..response is watch them the best you can...I just hope for my sake and the pts that's good enough and no harm comes to him/her..but there's always that possibility, and I don't like being put in that situation.

[ZASHAGALKA, RN]

I have absolutely no understanding of a health care professional who would have the attitude that a psych/suicide patient is taking time away from people who "really need it" or "really ARE sick." And the idea that an attempt suicide pt. has any more "created" his/her situation than the AMI pt. who is overweight and drinks and smokes is ridiculous. Patients do not suffer depression, suicidal ideation or attempt suicide because it is "fun". These are sick people who deserve every bit as much professional care, attention and concern as any other patient who crosses your path.

It is a tragedy of our society and health care system that psychiatric patients are VERY often treated as second-class and/or as a nuisance. Imagine the outrage if a cancer patient were treated as a nuisance/interruption in the ER, a waste of bed space in the ICU, and disposable when it comes to funding of adequate inpatient and outpatient resources.

Isn't there a saying about a society being best judged by how well it treats its most vulnerable?

Follow the rest of the thread before you vent. Nobody's disagreeing with you.

You say imagine if it were a cancer patient. I've had that same conversation about cancer patients that should be in hospice instead of aggressive care. My comments were that nurses vent and have a macabre humor and that, even if something like that is said, it doesn't affect care.

I was very specific that we vent and joke as an outlet. Empathy is a commodity and you can't just give and give without that outlet. Otherwise, you are headed for an early burnout.

You heard comments about psych and got upset. What you failed to realize is that this thread was ABOUT psych. I don't think anybody's specialing psych out; just discussing psych because it was the topic.

In fact, if you read the whole thread, I think you will find that most of the posters, including me, were incredulous at the idea that care would be withheld from psych patients.

~faith,

Timothy.

[MandyInMS]

From a patient care and legal/liability perspective security should be posted at the door, or in the room, of a suicide-watch pt in a med/surg setting if nursing staffing levels do not allow for an appropriate level of monitoring. And your hospital security staff should have training in this specific type of work. It is inappropriate to ask the patients family/friends to monitor the patient. In a short-staffed ICU, you would not ask family/friends to monitor the patient and come and find a nurse if the heart monitor starts going off.

I TOTALLY agreeeee with you ! we have all spoken to our higher ups about this to no avail...dangerous AND inappropriate...they don't seem to be HEARING us...do I have the right to refuse based on safety issues? I'm seriously considering it when placed in that position again :/

[Tweety, BSN, RN]

I was very specific that we vent and joke as an outlet. Empathy is a commodity and you can't just give and give without that outlet. Otherwise, you are headed for an early burnout.

~faith,

Timothy.

Timothy, I totally agree that we need outlets to vent our frustrations and to deal with the stress.

Not everyone handles it the way you do however. Perhaps you should say "this is the way I and many of my coworkers avoid burnout" rather imply that without that specific outlet people are headed for burnout. The sick nursing jokes about patients might be offensive to some nurses who deal with their stress and burnout in other ways.

Just a thought.

[ZASHAGALKA, RN]

I TOTALLY agreeeee with you ! we have all spoken to our higher ups about this to no avail...dangerous AND inappropriate...they don't seem to be HEARING us...do I have the right to refuse based on safety issues? I'm seriously considering it when placed in that position again :/

Not just a right, you have an obligation to refuse to accept an unsafe assignment.

BUT.

You need to check with your Nurse Practice Act which should be available on your BON's website. It should detail your obligations and the correct actions to take.

Mind you, most NPAs forbid retaliation for refusing unsafe assignments - but there is a huge difference between overt retaliation and subtle. Be careful not to initiate any CLMs (Career Limiting Moves).

I would suggest a polite but persistent approach to address your concerns and climb up your chain of command. Start a paper trail - the more it looks like you addressed the problem, the less liable you will be if something tragic happens, but more important, the more likely your hospital will decide that the risk management of potentially having to justify a tragic event in light of such a paper trail outweighs actually addressing the problem.

~faith,

Timothy.

[Tweety, BSN, RN]

I TOTALLY agreeeee with you ! we have all spoken to our higher ups about this to no avail...dangerous AND inappropriate...they don't seem to be HEARING us...do I have the right to refuse based on safety issues? I'm seriously considering it when placed in that position again :/

Mandy, you have a duty to refuse an unsafe assignment. Perhaps, even if he/she isn't your patient, you can do an incident report to let risk management know. Sometimes higher ups don't help until someone seriously explains the legal raminifications of not keeping a suicidal patient safe. Our risk management has a box we can drop incident reports in so they get it first before the managers.

Many years ago our facility learned the hard way when a patient jumped off a roof to his death.

Good luck.

[ZASHAGALKA, RN]

tweety,

Thought well taken, but let me add that I don't believe it's 'sick' humor but macabre or, if you prefer, morbid. And it is a common strategy, although I agree that it is but one strategy and not universally used.

~faith,

Timothy.

[mandrews]

our suicide attempts get treatment in the er then they have to go to icu where an employee of the hospital (nurse usually) has to sit there and watch them one on one. I work at a small hospital so that means if there are 3 nurses on the floor taking care of 18 patients one of us has to go to the unit and the other two absorb her patients. if it is the end of the shift it makes it hard because we have to give report on her patients that we have barely seen. they get care right away in the er.

melissa

[lovinghands]

For the record, I want to point out that I did mention that such judgements aren't 'right', even if I can understand them and maybe exhibit them from time to time.

But if you deal with suicidal patients routinely, can you honestly deny that you've never said / thought some variant of 'they ought to teach a course on how to do it right'. It's macabre and wrong, but as I said in another thread: some preverse humor/cynicism is required to keep your sanity. Nursing requires too high an emotional expenditure not to have a 'healthy' balance. And as long as it doesn't affect care, I do believe it's healthy.

It's how we keep our empathy sharp.

~faith,

Timothy.

Degrading my patients does not promote empathy or compassion. I have worked with suicidal patients for eleven years. I have also lost a loved one to suicide. If you made this "humorous" comment in my workplace, you'd be sharply reprimanded. In my opinion, statements like the above are heartless and a reflection of one's true character.

[drriley]

I did follow the thread -- and then went back to the start to add my own comments, so that no one ever thinks that these things go silently unchallenged.

I note that the incredulity, empathy, etc that you refer to are, as evidenced by the posts themselves, a 20/20 matter.

Beyond this, however, is the fact that you mention the thread is about suicide/psych patients, by way of example. Again, I refer you to the cancer patient comparison -- I doubt that you or anyone would have ever used cancer as a "gallows humour" attempt at dealing with the stress of the job in the same manner. Nor would anyone target acute cardiac patients, seriously ill paeds patients, etc. etc. The sad fact of our society is that psych patients ARE viewed, by many, in the very way that I described.

Follow the rest of the thread before you vent. Nobody's disagreeing with you.

You say imagine if it were a cancer patient. I've had that same conversation about cancer patients that should be in hospice instead of aggressive care. My comments were that nurses vent and have a macabre humor and that, even if something like that is said, it doesn't affect care.

I was very specific that we vent and joke as an outlet. Empathy is a commodity and you can't just give and give without that outlet. Otherwise, you are headed for an early burnout.

You heard comments about psych and got upset. What you failed to realize is that this thread was ABOUT psych. I don't think anybody's specialing psych out; just discussing psych because it was the topic.

In fact, if you read the whole thread, I think you will find that most of the posters, including me, were incredulous at the idea that care would be withheld from psych patients.

~faith,

Timothy.

[Frolicking]

*Disclamer I'm not a nurse or nursing student yet. I'm currently working on becoming sane before I pursue my nursing career.*

This week I was denied any care at my local ER when I was actively suicidal.

The backstory is I minorly injured my mother early in the day durring a dissociative episode. I was taken to the ER by a police officer where I was kept for 8 hours. Within the first hour I became luicd and tried to get them to explain what type of hold I was being kept on(I wanted to leave and get outpatient treatment as I wasn't receiving any care and was very cold in the room I was being kept in).

At first I was told it was a three hour hold but after four hours they refused to tell me why I was still being held. I was not suicidal at the time or violent after my dissociative episode ended. I was labeled uncooperative because I refused to take the klonoptin they wanted to give me unless I could discuss it with the doctor(I had taken an overdose of Xanax XR within the last 12 hours and was concerned the doctor wasn't aware of that).I never got to speak with the doctor Eventually they discharged me after I agreed to go to the outpatient appointments I already had scheduled.

After I got home I became extreamly agitated and remorsful about hurting my mother. I began selfharming and my parents recognized I was suicdal. I agreed to go to the ER and admit myself for my safety and was taken there by a local crisis organization.

I never even got to talk to the triage nurse. The check in person said they wouldn't consider admitting me because I had been discharged already that day. The people from the crisis team I was with tried to explain to the woman that I wasn't suicidal then and I was now. The person at check-in told me I could spend the night in the waiting room if I didn't cry too loudly. If my crying was disruptive they'd have security throw me out.

Is this even ethical? They didn't even look at my injuries which were significant though certainly not life threatening. I've had to have family members take off work so someone can be with me 24/7 and plead with outpatient providers to make emergency appointments with me since. I'm now terrified of the ER because of the contempt I experienced there.

[Tweety, BSN, RN]

Frolicking sorry to hear about your experiences. I hope you get the help you need.