Psychiatric Nurses and Safety

future_RN, CNA · Apr 30, 2016

I'm a CNA, but used to work at a free-standing inpatient psych hospital on the high acuity floor. The facility will most likely train you in CPI (Crisis Prevention Intervention) and there are many rules and procedures in place for staff safety. But if you work at the kind of place I was working at, your coworkers will pick and choose which codes they respond to, leaving you to your own devices sometimes. But most often times you will be okay. I have been bit, scratched, spit on, had blood sprayed on me (from a patient beating their hand on the door of the locked room she was in), and had one patient beat the brakes off me once. But truly they are sick and need help, so it doesn't bother you as much as you think it would. But just know, a lot of state-funded psychiatric facilities in certain states have shut down, and the private psych hospitals staff to bare minimum, which was dangerous at times depending on how acute and/or unpredictable the unit would be. But if it's your passion, go for it! But being perfectly honest, you will also work with psych patients in skilled nursing facilities. In my area (Chicago) due to the closing of many psych facilities, the skilled nursing facilities have accepted many psych patients so you would be able to interact with and learn about the psychiatric side of nursing there, but not in as great of depths as you would in a solely psychiatric setting.

cjcsoon2bnp, MSN, RN, NP · Apr 30, 2016

I have worked in various psychiatric/mental health facilities in different roles over the 5 years I have been a nurse (pediatric, adult, staff nurse, supervisor/management) and I currently teach psychiatric/mental health nursing. True enough, I have sustained some minor injuries over the years but when you work in a well-run facility with a strong team and remain vigilant with your assessment skills and monitoring of environmental safety it can be a very rewarding career. You really need to know your safety management training (such as CPI or whatever your facility uses) and keep in mind how you present yourself to patients and your use of verbal de-escalation. I have witnessed staff members be injured because they (or one of their peers) have become too lax in monitoring their environment or they become emotionally involved in a situation that has agitated the patient and make a situation worse. This is not to issue blame onto those staff members for what has happened to them, being hurt at work is traumatic but thankfully a relatively uncommon occurrence.

I would not discourage the OP from getting into the psychiatric/mental health field but just do a lot of research on where you are working so you know what you are in for (e.g. an inpatient forensic unit is very different from a partial-hospital outpatient day program) and keep your assessment and de-escalation skills sharp.I should also note, the injuries I have sustained during my nursing career were ALL from children/adolescents on a poorly run inpatient unit. The program had some major changes prior to me taking another position and it resulted in significant injuries to over a dozen staff members as the result of children/adolescents who were bored, confined indoors for a prolonged period of time with little meaningful and therapeutic stimulation. Best of luck to the OP, if you are an LPN looking for a psychiatric/mental health position I might consider looking for a geri psych. unit because I have found they are more likely to have nursing positions for LPNs.

!Chris :specs:

poorni74 · Apr 30, 2016

Nice article

lkeasling · Apr 30, 2016

I went into nursing just to be a psych nurse. There are not many of us out there who truly love working psychiatry. If it is something you want to do then I say do it! Keep in mind it is not easy by any means, but I believe the most gratifying. Yes we have our frequent fliers buff as it was mentioned before you get to know those patients and figure out how to work with them. You will learn so much and if you like it you can make a difference, even with the frequent fliers! Good luck and welcome to the world of psych!

Roy Hanson · Apr 30, 2016

I have 14 years in psych...always go to a patient with a backup. I was beaten by a violent psych patient who SHOULD have been in max security, while 3 qualified female psych nurses, cowered in the nurses station. Its a good field, but watch your back. Even in 'normal' wards, watch your back.

ALZ are infamous for striking out..because they could see you as someone else.

ErinDel, ASN, BSN, RN · May 1, 2016

I just started working in a psych facility. I am training on two floors. One is a detox unit and the other is a locked acute care psych unit. We are staffed with only 1 nurse per shift with 1 MHA at the detox unit. The most amount of patients on that unit is 16. On the locked unit we are staffed with 2 nurses and 3 MHAs per shift. We do not have security in our locked unit. Today I oriented on the detox unit with 1 nurse with a total of 13 patients. It was hectic especially with the med pass and the agitation of these patients detoxing from the drugs and alcohol. I am wondering if I am working somewhere that is safe enough. We have safety training next week. I am only going to be per diem at this facility.

To the OP, I think if you want to try a hand at this field then go for it. You will not know whether it is for you or not until you try... Good luck.. I do think it is wise though to take into consideration your husband's thoughts.

Kaptain57 · May 1, 2016

I was a patient in several hospitals. I found it very distressing that although the nurses were extremely composed and professional they had to be concerned about their welfare as I am a large man. No nurse should ever have to be afraid from us and we have great respect and regard for them (and no we know they are just doing their jobs but you should see the way they comfort the traumatized people and hold them together.....what is not to respect and admire?) I therefore carry a card in my wallet that says: protect all nurses.......so they don't have to worry or be concerned. I wish all patients could do the same. I have seen so many people turned around by these nurses and no one cares not even the apna........I just that is the way it has to be. I have seen nurses spend 4 hours with one elderly patient, just gently holding her hand and never interrupting> how does someone do that> or spend days working on someone getting them well enough to come to group. None of the patients believe we are so called good enough for the nurses ....we know the realities and they have families which is wonderful.........but patients all were crying and hugging the nurses when they left. That is not a fantasty or an exaggeration or anyting but a fact......and it wasn't because someone was cooking onions.......pretty amazing pretty amazing......hard to know what to say.

lkeasling · May 1, 2016

Well I have seen the comments on here and if I was going into the field as a new nurse I would run based on these comments. Here is food for thought; I have worked psychiatry for more than 20 years. The times I was hit was by alzhiemers patients who come from a generation who thinks it is ok to hit. I have never been injured to a point of needing medical help. Why? Because I use my words. If you come into the field you will find your assessment skills will be a great asset. You will be able to learn to ' trust your gut' so to speak. You will not only Lear about psychotropic meds but other meds and how they interact with the psychotropics. You will learn about the human condition and how you can contribute to attempt to make it better. There will be days you will be so angry you will want to quit, other days you won't be able to hold your happiness in, and then there are days you will sit in your car and cry. But any nurse from any area will tell you all of this. Psych nursing is a specialized field, just like cardiac nursing, Er nursing and ob-gyn nursing. We have our physical days and we have our emotional days. Yes you get training to learn how to intervene in a crisis, but if you don't treat the patients like they should be treated, then you will get the reputation among patients as a nurse who doesn't care. As a nurse THAT is the worst injury to ever try to recover from.

scthomas93 · May 1, 2016

i worked on a psych unit for 6 months, did not like it!! mostly worked the overnight shift and that's when those patients really get wired up!! i spent most of the night giving out shots to calm people down!! so many nurses at this place ended up with injuries including the nurse that ended up with a broke eye socket!! after that my husband was like "you coming up out of there" Lol.. but even if he hadn't i would have ended up quitting on my own anyway, psych just wasn't for me!! felt like i was constantly on edge!! but there are nurses who love it!! good luck to you!!

Roy Hanson · May 1, 2016

dont definitely, but research can do only so much. Real life experience is the only way. And its not on the Internet. Stop living the world of internet, and deal with it on your own. Acute local psych ward..watch your back. They are there for a reason. Detox is interesting. Ask them how many times they have been to detox, it may surprises you. As Johnny Cash once said, one drink is the same as a thousand.

fawnmarie, ASN · May 2, 2016

Well I have seen the comments on here and if I was going into the field as a new nurse I would run based on these comments. Here is food for thought; I have worked psychiatry for more than 20 years. The times I was hit was by alzhiemers patients who come from a generation who thinks it is ok to hit. I have never been injured to a point of needing medical help. Why? Because I use my words. If you come into the field you will find your assessment skills will be a great asset. You will be able to learn to ' trust your gut' so to speak. You will not only Lear about psychotropic meds but other meds and how they interact with the psychotropics. You will learn about the human condition and how you can contribute to attempt to make it better. There will be days you will be so angry you will want to quit, other days you won't be able to hold your happiness in, and then there are days you will sit in your car and cry. But any nurse from any area will tell you all of this. Psych nursing is a specialized field, just like cardiac nursing, Er nursing and ob-gyn nursing. We have our physical days and we have our emotional days. Yes you get training to learn how to intervene in a crisis, but if you don't treat the patients like they should be treated, then you will get the reputation among patients as a nurse who doesn't care. As a nurse THAT is the worst injury to ever try to recover from.

Well said. I don't want to scare anyone who may be considering a career in psychiatric nursing. The truth is, I loved it for many, many years. It is a fascinating field. I encountered people whom I didn't know actually existed, like the man who believed he was a famous country singer and offered to pay me "25 grand a day" to be his private nurse. I also forged deep friendships with my co-workers, which I believe happens when you work in that kind of environment. Teamwork is crucial. Your colleagues become your family. I wish I could have stayed in my previous position, but for some strange reason, there was a push to not medicate as much, and the environment became too dangerous. How I miss the good old days when we could give the appropriate doses of appropriate meds! There was a time when I really loved everything about that job...patients, staff, even the supervisors. We were family.

Mandychelle79, ASN, RN · May 3, 2016

In 7 yrs in psych I've had two major injuries... Sprained wrist from blocking a punch from a dementia patient and a mild concussion from being kicked in face by a mentally challenged individual who was allowed to have her boots. I've had some bumps and bruises. Usually from the ones who are admitted while still drunk. We seem to go month and months without issues then suddenly we have a lot of back to back incidents. Most of the issues are carry overs from previous shift not picking up on clues and offering prns.