Psych Nursing Safe?

Jules A, MSN · Apr 16, 2010

We do get a fair amount of injuries because kids are so volitile and we always run short staffed. Personally I'm not looking forward to getting hurt but not afraid of it either. Depending on how concerned you are this is something you will need to consider.

NurseJJ09 · Apr 16, 2010

Thanks for your reply. What types of injuries have you seen?

Blackcat99 · Apr 17, 2010

I knew a guy who got his nose bit off by a patient. I also knew a lady who got attacked and will always walk with a very pronounced limp for the rest of her life. I got jumped and pulled around by my hair. Another patient threw a large chair at me but missed me. Another female patient almost jumped me but then she tripped at the last minute and fell down instead. When I worked, staff were always getting hurt. I was one of the lucky ones. I left that job without being permanently disabled. This was a state psych hospital for adults in Calif. However, I have heard that the teenagers are even more violent then the adults. :eek: Is it safe to work in s psych hospital? NO WAY.

Jules A, MSN · Apr 17, 2010

The teenagers are definitely more violent than adults in general. I have known staff with numerous broken noses, a broken leg, a broken tail bone, concussion, hair pulling to the point of injuring someone's neck and lots of soft tissue injuries, black eyes, bruises etc. from being struck. Hmmmm kind of makes me wonder why I love going to work, but I do. I think psych is either in your blood or not.

Meraki · Apr 17, 2010

I've worked in acute psych with adolescents for the last twelve years and I've never been injured nor have I ever seen any staff injured directly injured by patients other than a couple bruises. On the kids unit, you may get your shins kicked and the occasional scratch. Nursing on my unit is very safe despite the fact that we have 18 teens in crisis - some are acutely psychotic, others very angry, others homicidal, others suicidal...many are involuntary - we get the works...

I think it is important to look at the philosophy and practices of the unit to get a feel for how safe it will be. If they use restraints often, are woefully understaffed, have a 'these are bad kids' attitude, have poor teamwork, have little programming or activities so the kids are bored, are very restrictive with rules, do little relationship building, run down physical environment, etc...all those things make a unit unsafe.

Is there a risk - of course. But I disagree with the above, there are safe ways to work in psych. Twelve years with no injuries beyond a handful of bruises is a pretty safe environment.

NurseJJ09 · Apr 17, 2010

Thanks for your feedback. After the last few posts, I was beginning to get discouraged. I'm very interested in this field but also don't want to have my children worrying about me every time I leave for work. I'm aware that there is always some element of danger when you are dealing with a psych patient but would like to think there are plans in place to keep the staff, as well as the patients, safe. Can anyone name some of the "safer" facilities in the NY area (Westchester, Putnam or Dutchess counties)?

aura_of_laura · Apr 19, 2010

In my experience, injuries happen to people who don't know who to use common sense- such as getting in an angry patient's personal space, power struggling with patients, and refusing to use the PPE that is provided (like Kevlar sleeves). I've seen patients injured by staff, too. Psych is a challenging field, but also very rewarding.

We have mandatory Therapeutic Crisis Intervention training semiannually.

As the above poster said, the culture of the unit makes a tremendous difference. 90% of the time, injuries are preventable - learning how to manage the environment is part of being a good nurse!

Blackcat99 · Apr 19, 2010

In my experience, injuries happen to people who don't know who to use common sense- such as getting in an angry patient's personal space, power struggling with patients, and refusing to use the PPE that is provided (like Kevlar sleeves). I've seen patients injured by staff, too. Psych is a challenging field, but also very rewarding.
We have mandatory Therapeutic Crisis Intervention training semiannually.
As the above poster said, the culture of the unit makes a tremendous difference. 90% of the time, injuries are preventable - learning how to manage the environment is part of being a good nurse!

Oh so it's the nurses fault that they got injured? :mad: They didn't use common sense? I think injuries happen when you combine too many angry violent psychotic people with severely understaffed psych units.

aura_of_laura · Apr 20, 2010

Oh so it's the nurses fault that they got injured? They didn't use common sense? I think injuries happen when you combine too many angry violent psychotic people with severely understaffed psych units.

True, that increases the risk of staff injuries. But, as a former inpatient nurse, supervisor, and now the employee health nurse, I've seen first-hand how injuries happen, and how they're preventable.

When a nurse gets within two feet of an IED, bipolar 15 year old, 230 lb teenage girl admitted for HI, who dislocated the shoulder of the officer that brought her in, and coos "What's wrong, honey?" as the girl is pacing and cursing, the nurse lacks common sense, and while she didn't "deserve" to get hurt, it is the nurse's fault. The patient is there to be kept safe and to be treated for a psychiatric crisis. That nurse acted foolishly, and got punched in the face. Bad injury, and it was one hundred percent preventable. On top of that, the girl ended up being restrained, and had charges pressed against her.

Staffing is great, but it doesn't eliminate the risk of poor decision making. I stand by my statement that most psychiatric staff injuries can be prevented with crisis-intervention training and common sense.

Jules A, MSN · Apr 20, 2010

True, that increases the risk of staff injuries. But, as a former inpatient nurse, supervisor, and now the employee health nurse, I've seen first-hand how injuries happen, and how they're preventable.
When a nurse gets within two feet of an IED, bipolar 15 year old, 230 lb teenage girl admitted for HI, who dislocated the shoulder of the officer that brought her in, and coos "What's wrong, honey?" as the girl is pacing and cursing, the nurse lacks common sense, and while she didn't "deserve" to get hurt, it is the nurse's fault. The patient is there to be kept safe and to be treated for a psychiatric crisis. That nurse acted foolishly, and got punched in the face. Bad injury, and it was one hundred percent preventable. On top of that, the girl ended up being restrained, and had charges pressed against her.
Staffing is great, but it doesn't eliminate the risk of poor decision making. I stand by my statement that most psychiatric staff injuries can be prevented with crisis-intervention training and common sense.

I totally agree that common sense is key and mistakes also negatively affect the patient as your story illustrates however without adequate staffing no amount of common sense will prevent inevitable injuries. IMO staffing is more than just "great" it is essential.

7student7 · Apr 21, 2010

I think it would take a particularly dense nurse to "coo" at a pacing, cussing patient. But, even staff members who use common sense get attacked. And, sometimes it's necessary to step in when patients are acting out.

Last week there was a psychotic patient standing in front of the tv. Other patients were getting angry and were starting to argue. The woman in front of the tv was, admittedly, pretty wacky, but she had been nice all day, so I nicely asked her to step back from the tv a little. Her happy personality did a complete 180 and she glared at me and started stalking me around the day room. I would have been attacked if not for a male staff member who spent 30 minutes distracting her from me.

So yeah, it would have been nice if I could have avoided confronting the obviously irrational woman, but what should I have done instead? Let another patient start a fight with her? If I had been hurt would it have been my fault? Please tell me, what is the sensible thing to do in situations like these?

I 100% believe that adequate staffing is essential no matter what level of training and "common sense" that staff has. Having an extra staff member available to spend 30 minutes talking that woman down definitely kept me from being attacked.

Also, I think the "managing the environment" has a lot to do with staff numbers. When there's no staff and shave time and gym time are canceled, the patients get frustrated. When a patient has to wait hours to ask a nurse a simple question, they get angry. When a patients spills food on themselves and there's no tech available to unlock the clothing room because there's only 1 of them on the floor and they're fending off requests left and right trying to get the paperwork and vitals done, patient get freaking ANGRY. Wouldn't you? Inadequate staff can't manage much of anything and it really increases the negativity on the unit. Please don't downplay staffing.