I've been a psych nurse for over 20 years. I used to work in a provincial psychiatric hospital and assaults on nurses and other patients there were quite common. It was clear that patients could attack and injure nurses repeatedly and it was unlikely anything (other than meds & restraints) would be done about it. It was a very different story if they just threatened (let alone attacked) a doctor or administrator - they would be very quickly moved to a secure facility. I now work in a general hospital inpatient psychiatric unit with a similar population except fewer schizophrenics, more mood disorders and more personality disorders. It is the safest unit I have ever worked on. I'm convinced the difference is that we have excellent psychiatrists who make it very clear to the aggressive types that such behaviour will not be tolerated, that they are in control of their actions, and that we will not hesitate to call police and press charges against those who assault staff or other patients. This is followed up with action and I have seen patients discharged and taken into secure custody by the police right from the ward. We see far less acting out on the ward as a result. It is a far safer environment for everyone - staff and patient alike. The key things are not being willing to accept antisocial behaviour on the unit, the message to the troublesome PD's that they are in control and responsible for their actions, combined with solid support from our psychiatrists.