psyc pts in ED


We are being overloaded with psyc pts in our dept lately, not uncomon for a wait of 24 hours to be transported to a facility. last weekend, had 8 psyc pts in beds, out of 17 total beds. we have one "eval room with camera and lockable door" the rest mixed in. we try to group the together, but with no help, the screaming, no matter how much meds, the swearing, the escaping, I really though I had died and gone to hell! most psyc facilities always seem to be full or closing, or not right insurance. What is everyone else doing to cope with this? After a recent assault on one of our nurses, we are supposed to have more security, ( yep they are 18 and more afraid of the pts) one crisis clinician in er at all times, (havent found anyone for that job yet!)

I think we should just tube em, and dont forget, they have the right to got out and smoke! HELP!!!!!!!!! another weekend like that and they will be tying me up!

ernurse728, LPN

130 Posts

Wish I could help you out...we have the same problem in our ED. Except we atleast have a seperate area with 3 psych beds and a psych nurse and a mental health person to evaluate the pt's and try to arrange transfer if needed. It is definitely a tough situation. Many of these pt's wait days...especially on weekends awaiting placement. I think that they need more psych facilities that are flexible in order to fix some of these problems.

Specializes in ER, ICU, L&D, OR.

Howdy yall

From deep in the heart of Texas

Problems with psych patients in most ERs are increaseing dramatically, whether they are truly psych, or chemically challenged, or just plain old fashioned assholes. We have the same problem, compounded by security guards who are strictly hands off, if something happens they call for the nurses to take care of it. We have been very fortunate so far, but the law of averages is catching up to us. Im just waiting for something to really go wrong. Ive been injured a number of times from severe bites to a cracked ribs on a couple of occasions. And I dont heal as fast as I used to. We have no locked rooms, admin feels this would violate their rights, false imprisonment or such. So Im just waiting for something to occur. I just hope it doesnt happen to one of my friends. And I have a lot of friends as Ive been there about 1 1/2 decades now. Even all the paperwork and such we have to do just document using restraints is intimidating also.

Fortunately though for us, unless there is a time consuming medical clearance involved, we have quite a few options available to disposition these patients somewhere. Average LOS for psych patients is only 3 hours here.

Good luck in your problem, but unfortunately the number of psych patients is increaseing dramatically. Which may the reason they keep coming up with new terms all the time to classify these people. Some of the time I think these labels are there just to give people an excuse to act out.

Specializes in Emergency Room.

I sympathize with you. We are a small rural hospital and it is murder to get psych patients out. Gotta call county mental health.. wait for them to get off their behinds, come and eval... no transfers if any chemicals involved and no staff to handle them.. god forbid if we need a suicide watch with one on one care the whole facililty has maybe 25 staff nurses, tops. It's just not possible. We have the compounded problem of having a contract with a long term psych facility, full of swallowers, schizos, criminally insane, as well as mentally challenged with aggressive tendencies. When they come to the ER they always have a staff worker with them which is an immense help, but some of them are pretty scary. They are the hard core, difficult to treat patients. they do not accept acute patients unfortunately. Also if the patients need admission we take them if they don't require intense psychiatric care in addition to medical care, then we transfer them.. that too has been a nightmare. but that's another thread. but anyway.. if they need admission, the admin over there is always trying to get away without leaving staff there. What a nightmare. So, i sympathize ikimiwi. I vote to have the air force spray prozac and ativan daily throughout the nation! Would help don't you think?

Specializes in ER, ICU, L&D, OR.

Howdy yall

From deep in the heart of texas

Just keep chanting haldol 5mg/ ativan 2 mg, dont matter whether IV or IM.....

just keep chanting


95 Posts

We have 2 psych beds in our ER. That's it. We are not supposed to deal with psych patients at all unless they are unstable. They are shipped to "their" area and a psych nurse and physican take over. Do we overload? Yes. Are there enuf beds for these patients? No. The psych team that works with us is amazing. They are there 24/7, they bust a gut trying to find spots for their pts and if one must be put in "our" area, they still care for that one. From reading the other comments, I guess I'm spoiled huh?


Specializes in ER, ICU, L&D, OR.

Howdy Yall

From deep in the heart of texas

Well Tiiki

the most important thing to remember is


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