In my time on the units I never missed a med pass of always being aware of where I was at any given moment, where the most agitated IM was at that time, the layout of each unit and kept an eye on the door. It's not paranoid to be realistic about who you are dealing with and at least have something of a plan B. It's also smart to maintain the relationship with each IM the same. Consistant, firm and fair. I have seen some nurses taunt and argue with IM's just because they feel superior. I would hate to be in their shoes if there were to be a riot. They should be in another career field, but it does no good to report them. Mgmt ignores it.