Psych Nursing Safe?

medbeach · Apr 23, 2010

Staffing is a big issue in the safety on psych units. I have to agree with previous posts about using common sense- some nurses seem to be frequent fliers on the workman's comp injuries. I think certain times of the day are particularly vulnerable to outbursts of violent patients. The stress energy coming from the nurse's station can affect the patients to create a violent situation. Sounds crazy, but its true- negative energy feeds the fire in some of these patients. Sometimes you get one going off and then another joins in- thats when you realize how big of a safety issue being short staffed is.

Overall, I think all units should have some type of safety training, have adequate staffing, have security staff close by and be researching effective ways to reduce violence and improve safety.

brownbook · May 1, 2010

I've only floated to our locked psych unit once in a while, and my husband is a psychiatric social worker. I hate to admit it but "psych" patients do scare me. I repeat over and over to myself "psych patients harm themselves more often than they harm others." I hate to see the "prejudice" continue that psych patients are dangerous. I realize if a psych patient is hospitalized they are obviously not functioning well, they are in crisis. But a well staffed, well run, psychiatric unit should not have numerous assults. No it is not the nurses fault but it is not the norm, it should not just be accepted that "I work in a psych unit I am going to get assulted once a month"! A patient or staff being injured should be a root cause analysis incident report, what went wrong, why did this happen, what will we do to prevent it happening again.

elkpark · May 1, 2010

Keep in mind that nurses get assaulted and injured in plenty of other healthcare settings besides just psych settings. So often, people talk like that's the only place you are at risk of injury, but, in my experience, psych units are not necessarily any more dangerous than other healthcare settings.

Meraki · May 1, 2010

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 agree with you. Good staffing, along with the unit culture go along way however many of the times when I've seen a patient make contact (push, hit, shove etc..) it is poor decision making by the staff. That fact we are a well staffed unit is what I think keeps the staff in those situations from being injured as in a flash others are there to help out, but it doesn't keep kids from lashing out in the first place.

By poor decision making I think it is a combination of lack of common sense, a lack of learned sense, and getting caught up in the moment. You need to be able to read patients, kind of that sixth sense, where before they have said or done anything you have a feel for where they are at. Some staff just aren't good at it -they miss cues, they get caught up in the emotion (irritation, frustration) of the moment, control and power sneak into the interaction, they grow impatient with someone being oppositional, they interact when the patient needed space or they give space when the patient needed interaction, etc... some of this can only come with time and experience and newer staff need to defer to the sixth sense of senior staff to stay safe. Other people even with experience still don't quite get it. I think there are some personality types are just aren't a good match for psych.

Not saying that there is never an incident that isn't preventable, and like elkpark mentioned, those happen everywhere. I don't think those are the majority given we've been able to almost eliminate violent incidents and restraints on our unit. After every incident we debrief and look at what we could have done differently - not about blame but we looking at what we can control - the environment and our actions and reactions to patients.