I started working nights on a 21 bed psychiatric unit about 7 months back and have recently been “promoted” to charge. We have 7 private rooms and 7 double rooms with 2 beds. The private rooms are ideally saved for the extremely sick or those who absolutely cannot have a roommate for whatever reason (Transgender, some sort of contagious infections,etc). Now normally, we can shuffle patients around say if we have a male in the ER downstairs that needs placement but only have a female bed available. (Obviously males and females cannot room together). But The other night I was in charge and we had a situation where we only had an empty female bed available, there was a male patient in the ER needing placement, and all of our private rooms except for 1 absolutely could not be moved due to their level of acuity. The 1 Patient who could be moved absolutely refused. I tried to talk to her for an hour and she was adamant she was not moving and the only way she was going out of the room was By going down kicking and screaming. I called my nursing supervisor (who had told us all how much she despises psychiatric patients, psychiatric nurses are lazy and basically just those who couldn’t make it in “real” nursing, etc) and she completely lost her cool on me and told me the patient did not have a choice on moving and I needed to force her. I told her that I agreed with her that the patient did not technically have the “right” to not move as this was a hospital not a hotel, but there was no way I could “force” her unless I literally put my hands on her which would 1. Be assault/battery and 2. Would be considered a restraint which would require all the proper paperwork, the doctor coming in at 3am for a (unnecessary in my opinion) restraint and in general would just be wrong for it to escalate to that point . She hung up on me. Fortunately, the patient in the ER labs came back abnormal and it had to be corrected so he ended up not coming up on my shift, but I honestly don’t know what I would have done Had they not and they expected a bed for that patient. My question is, while I know patients do not have the “right” to refuse to move rooms, but what should I do in situations like this When it comes up next time?
Specializes in Psych (25 years), Medical (15 years).
4 hours ago, Tenebrae said:
Your supervisor sounds like an ***.
As many are.
4 hours ago, TheMoonisMyLantern said:
They used to call that a "show of force" but apparently that wasn't friendly enough so now they call it a "show of support"
Back in the 90's at Anomaly State Hospital, we called them The Goon Squad.
Actually, summons for assistance was called A Mass Alert, which meant security and any available staff.
I worked in an admission cottage with the rowdies, and one weekend, there was a skeleton crew of three staff for 30 recipients. Three of the recipients plotted to take over the cottage. The psychiatrist RX 75 mg Serentil IM all around. I called a Mass Alert and the Goon Squad showed up.
I explained to the leader of the rebels that he needed to allow me to administer the shot. The recipient slapped the alcohol wipe out of my hand, and the Goon Squad converged like the loving hand of a god and took the rebel to the seclusion room where the IM could be given.
The other two rebels took the injection without incident.
Back in the 90's at Anomaly State Hospital, we called them The Goon Squad.
Actually, summons for assistance was called A Mass Alert, which meant security and any available staff.
I worked in an admission cottage with the rowdies, and one weekend, there was a skeleton crew of three staff for 30 recipients. Three of the recipients plotted to take over the cottage. The psychiatrist RX 75 mg Serentil IM all around. I called a Mass Alert and the Goon Squad showed up.
I explained to the leader of the rebels that he needed to allow me to administer the shot. The recipient slapped the alcohol wipe out of my hand, and the Goon Squad converged like the loving hand of a god and took the rebel to the seclusion room where the IM could be given.
The other two rebels took the injection without incident.
Wow Davey, I wish I could have been there to help hold or give the IM's, the milieu mutinies were always fun to deal with LOL
Specializes in Psych, Addictions, SOL (Student of Life).
15 hours ago, TheMoonisMyLantern said:
That's probably the best policy, transphobia is just too alive and well and the last person a trans person needs during a psych patient is for a roommate to be ignorant. The problem we ran into on our adolescent unit is that there are more people out as trans at a younger age so you can run out of private rooms. It's definitely a complicated issue, balancing equality with safety with preference with legalities, I really think all hospitals need to go to private rooms for everyone, that would solve so much drama.
It would solve a lot of drama for sure - but think of the loss in profits.
We actually had a situation where a patient's parent sued the facility due to his precious child being seperated and made to be in a private room which he saw as discriminatory. It was ultimately settled out of court but said child's college fund got a nice infusion.
Specializes in Psych, Addictions, SOL (Student of Life).
22 hours ago, Sour Lemon said:
I didn't take it that way, at all. Every hospital I've worked at has put transgender individuals in private rooms. No one thinks it's contagious. At least I've never heard that from anyone.
@Sour Lemon I realize that almost no one (but I'm sure there are few) believes transgenderism is contagious. Still some very real concerns with regard to patient's rights. In Massechutes there are laws in place called public accomodation laws that make it unlawful to isolate a patient for no other reason than the fact that they are transgender. Where single gender units exist the trans person is to be housed with the gender group they identify as. I'm sure California is well on its way to making such laws as well.
I know from my own facility when we had seperate male/female units when ever it was safely possible the trans person was allowed to receive treatment with the group they identified as. It has become much more difficult when we codensed down to one multi-gendered unit.
Specializes in mental health / psychiatic nursing.
It's a challenge to have patients move - particularly from single to double. How we handle in in my facility is a few different ways depending on the patient/urgency of need:
Often, if given a day to think about it and knowing that we will take their choice of roommate into account - some will just come around to the idea of moving. (Often we will give a choice of X room or Y room - so they have some control and choice but staying in current room isn't an option). Sometimes for those who are a bit on the fence - sell them on the new room - it's got a better view, it's bigger, it's further away from that one peer that really annoys them - whatever it is that appeals to them. (We've also been known to award a willingness to help the unit out with a cafe card or other small incentive as a thank you).
If it is a truly urgent transfer situation (or emergency situation of needing to move people away from eachother) - it isn't a discussion it's a "your moving, here's the cart for your belongings were going to X room". If it turns into a code it turns into a code (usually it doesn't though).
We've definitely had patients threaten violence to keep a single room and almost all of them when push came to shove went willingly. DO have a conversation with the nurse manager and psychiatrist/PMHNP if you anticipate that violence is potential so a game plan can be worked in advance if at all possible.
I started working nights on a 21 bed psychiatric unit about 7 months back and have recently been “promoted” to charge. We have 7 private rooms and 7 double rooms with 2 beds. The private rooms are ideally saved for the extremely sick or those who absolutely cannot have a roommate for whatever reason (Transgender, some sort of contagious infections,etc). Now normally, we can shuffle patients around say if we have a male in the ER downstairs that needs placement but only have a female bed available. (Obviously males and females cannot room together). But The other night I was in charge and we had a situation where we only had an empty female bed available, there was a male patient in the ER needing placement, and all of our private rooms except for 1 absolutely could not be moved due to their level of acuity. The 1 Patient who could be moved absolutely refused. I tried to talk to her for an hour and she was adamant she was not moving and the only way she was going out of the room was By going down kicking and screaming. I called my nursing supervisor (who had told us all how much she despises psychiatric patients, psychiatric nurses are lazy and basically just those who couldn’t make it in “real” nursing, etc) and she completely lost her cool on me and told me the patient did not have a choice on moving and I needed to force her. I told her that I agreed with her that the patient did not technically have the “right” to not move as this was a hospital not a hotel, but there was no way I could “force” her unless I literally put my hands on her which would 1. Be assault/battery and 2. Would be considered a restraint which would require all the proper paperwork, the doctor coming in at 3am for a (unnecessary in my opinion) restraint and in general would just be wrong for it to escalate to that point . She hung up on me. Fortunately, the patient in the ER labs came back abnormal and it had to be corrected so he ended up not coming up on my shift, but I honestly don’t know what I would have done Had they not and they expected a bed for that patient. My question is, while I know patients do not have the “right” to refuse to move rooms, but what should I do in situations like this When it comes up next time?
This is a tough one and I think every situation is different. I work in an inpatient unit and we do not have security. In similar situations we talk as a team. There are usually several therapists, a shift supervisor, several behavioral health workers, and one nurse on duty. We have to decide between letting a patient manipulate everyone vs what is best for the entire unit. You stated it was 3 AM. We’ve had belligerent patients get very upset in the night and yell and scream and throw chairs and try to break windows, etc. The whole unit would be awake and upset and some triggered by the chaos. It can take hours to calm the unit down. Sometimes it is better to let a patient manipulate you to keep the unit safe for the rest of the patients. Sometimes we are able to call the emergency department or the sending hospital and ask if we can delay the admission until morning. Sometimes that works and other times they have to place the patient elsewhere. Hopefully you have a team that you can talk to and I am sorry you don’t have a manager that you can talk to.
TheMoonisMyLantern, LPN, RN
924 Posts
They used to call that a "show of force" but apparently that wasn't friendly enough so now they call it a "show of support" ?