Psychiatric Nurses and Safety

NightNerd, MSN, RN · Apr 28, 2016

While psych certainly has the reputation of having the most unpredictable or violent patients, no area of nursing is immune. I had a hospice patient try to strangle me with a stethoscope and attempt to stab a CNA with a pen, and she was less than a week from death at this point. Just as not all psych patients are violent, not all other patients are non violent.

In addition to the thoughts and advice above, I would do a good share day or two on any unit you are interviewing at. I briefly worked in psych, and I felt like one of the biggest factors in the safety (or lack thereof) on our unit was poor communication between members of the IDT. Everyone tried to make everyone else the bad guy as far as setting limits with patients, etc., and this created a lot of needlessly unsafe situations. So I would try to get a sense of how well the team you are joining works together, because that makes a big difference. Also, always pay attention to those dynamics, intervene early when you sense something going on, and give your patients opportunities to use their developing coping skills and deescalate. And you will learn and lattice the common sense stuff (always have yourself near an exit, have another coworker nearby, have that annoying little body alarm on you if required by your facility).

There is a lot you can do to keep yourself safe, but as pointed out above, things happen sometimes that are fast and uncontrollable. I found that kind of uncertainty too difficult to work with day to day, so mad props for having the compassion and interest to explore this field.

Kayla_Martin · Apr 28, 2016

Thank you guys so much for the input. Those last two comments make it seem even more interesting to me. I will definitely be doing some more research into it! Definitely the feedback I was looking for.

Been there,done that, ASN, RN · Apr 28, 2016

Psych patients are't always violent. i did a placement in school on a PTSD unit. They weren't out of control or aggressive just troubled. There are many different types of psych nursing.
If you are a grown up you should be making your own decisions not your husband.

" i did a placement in school on a PTSD unit." That is not psych nursing experience. We all had a psych rotation during nursing school.

Op is wise to listen to listen to her husband.

allnurses Guide · Apr 29, 2016

I have worked Psych in one form or another for the past 10 years and I truly love this population of severely underserved patients. Yes there are safety issues as some patients can be unpredictable and even violent but you will receive training in how to deal with these situations. I have only witnessed one severe injury where a case manager got her nose broken by a patient but she triggered it by being dismissive and rude to the patient. I was also injured in 2009 when I too said something to a patient that triggered a violent response. I will not go into details as it was a well covered incident.

Psych can be a very rewarding area of nursing but you do have to have nerves of steel, and the ability to bob and weave like a boex. They teach you everything you need to know to protect yourself. It's just about keeping a cool head and reacting appropriately.

Hppy

James W. · Apr 29, 2016

I started a 3 year RPN ( psych RN ) training program at a major

( 600 bed)hospital when I was a teenager.

We got a thorough practical/experiential & academic grounding.

The hospital was affiliated with the city health board,

so we got secondments to

major general hospitals for med/surg/maternity training, too.

& we were paid to do the training,

& given commensurate responsibilities as we progressed.

On the other hand, those who demonstrated a consistent lack of ability

to develop the necessary skills, were rightly dropped.

Back in those days psych nursing classes were about 50-50 male/female..

..& "security" - as in guards - was unheard of.. we did it, as nurses..

On my application interview I was asked if I had passed the state

University Entrance Exams, & if I played football (full-contact, not soccer)

- since I answered affirmatively to both, I was in..

I did ask about the football query, & was told..

"It means you are a team player, & can handle physicality,

plus we'd like you to try out for the hospital team."

I'd found Japanese Aikido training very useful for hard body contact

football skills, & it stood me in good stead when having to deal with

difficult patients effectively, with the minimum risk of harm to self,

or others, so I highly recommend it to you.

Obviously, mental patients require a genuine helping approach,

which needs to be openly & honestly communicated, with no false promises..

We studied the work of Hildegard Peplau, who as a pioneering nurse

therapist/theorist - was the antithesis of the dreaded 'Nurse Ratchet'.

H. Peplau had shown how nurses ought to positively interact,

on a professionally caring basis with all manner of deranged/distressed

patients, & did so routinely, prior to the advent of anti-psychotic Rx..

I commend her seminal works to you, as useful classics of the psych Tx genre.

All the best with your future, psych Tx needs you..

..as a confident caring & humane nurse..

elkpark · Apr 29, 2016

Of course there are individuals who have been assaulted and injured on psychiatric units, and I am in no way diminishing or discounting those experiences. But those are not common experiences, and they are not unique to psychiatric nursing. Nurses get assaulted and injured in all sorts of healthcare settings. And many of us have worked in psychiatric nursing for many years (in my case, >30 yrs) without being seriously injured.

TriciaJ, RN · Apr 29, 2016

The likelihood of injury really depends on how a unit is managed, what is the staff culture. On a well-managed unit, staff are not easily manipulated, they don't throw each other under the bus and they step up to help each other. They remain alert to any subtle changes in the milieu and in individual patients' affect and behaviour and intervene before situations escalate.

On poorly-run units, staff slack off, try to win popularity contests, allow situations to escalate until someone gets hurt. Good management will weed out staff members who don't perform to high standards. Poor managers will worry more if their staff like them.

When applying for a job on a psych unit, it might be helpful to request one or two "shadow" shifts. It will allow you to talk to staff and see first hand what kind of a unit it is.

Elladora · Apr 29, 2016

I was a psych nurse for five years. I took a few punches and kicks, but only had to go to the ER once. Any employer should provide safety training (typically either Mandt or CPI). It's a very challenging, very rewarding career choice. I left solely because of administration, not because of the clientele.

Neurotic Student · Apr 29, 2016

I followed general precautions and never felt unsafe. It depends where you work and who you work with. I worked 2 years and only got hit once but it didn't hurt because pt was small, developmentally delayed, and he did it mostly to intimidate. I worked in a private hospital but I heard that county hospitals get the worst psych pts. Pts are put into different units depending on their acuity and level of functioning. You can work on the lower acuity units, which are mostly pts with depression, bipolar, or substance abuse issues but some of them will deal with psychosis also. There's a lower chance of violence but it's still possible because you never know and also the acuity units get full sometimes and we send our "best" high acuity pt to the lower acuity unit.

I had a good experience due to the people I worked with, so I really loved psych, at least at where I worked at!

xokw, BSN, RN · Apr 29, 2016

" i did a placement in school on a PTSD unit." That is not psych nursing experience. We all had a psych rotation during nursing school.
Op is wise to listen to listen to her husband.

A PTSD unit is ABSOLUTELY a psych experience, to say otherwise is pure ignorance. PTSD is classified as a psychiatric disorder (as per the DSM-5), and can be just as debilitating as the more commonly thought of psychiatric disorders.

she_who_cares · Apr 29, 2016

Not a nurse yet, but I am currently working in a psychiatric facility. I love it! As long as the patients are on their meds, you treat them as a person and not a burden, it's not so bad. I haven't been doing this very long, but we have a lot of different types of patients on my unit. And most of them have other health conditions as well which is why they're on my unit. I'm passionate about what I do and always treat them with the same respect that I hope they will show me. They've acted out against other employees (mainly because they are being provoked & I just posted something about this issue not long ago actually), but not once have they acted out against me. I think it has a lot to do with building that trust with them and showing them that you care in your actions. I'm the one who is able to calm down the patients when another coworker stirs them. Most of them come to me and talk about stuff that bothers them because they know that I will listen and that I care. The same patients who are combative during peri care and dressing changes, refuse showers, vital signs and want to act ugly toward others don't do that to me because I actually acknowledge them and they trust me because they have seen that I care about each of them. And I know it'll be different being a nurse and all, but I think it stems down to earning their trust and making sure they take their meds lol. I really do love it though. It's a different population, that's for sure. But a lot of these patients just need someone to encourage them and tell them that they believe in them and want them to succeed. It's a scary place for them, but knowing that they have someone they can trust plays an important role in it as I've learned. And I'm sure that there's gonna be days where it won't be this graceful lol. But I never considered the possibility of working with psychiatric patients when I finish nursing school until I started this job. And I absolutely love it! To work with this population of people, see them progress, and have them thank you for caring about them (even though it's not expected) is such a rewarding feeling. I always encourage them, but they too encourage me. I think you'll either love it or you'll hate it. It's definitely not for everyone, but from my experience, it's a great area to go into.

Elladora · Apr 29, 2016

They've acted out against other employees (mainly because they are being provoked & I just posted something about this issue not long ago actually), but not once have they acted out against me.

It will happen, and most likely from the person you least expect it from. It's the sad reality of psych work. You can have a wonderful rapport with a client and they will still turn on you. I've seen it happen many, many times.

That said, I still absolutely loved psych work and would do it again in a heartbeat.