Question for psych nurses!

colleennurse, ASN, RN · Mar 9, 2012

I would say no if you are refering to patients admitted to an inpatient psychiatric area, they are admitted for a reason. You never know what one is thinking and you should never put yourself in a situation where you cant get away or be totally alone. If you are talking about inpatient psych I am not sure why you would be alone in an isolated area. If you are in a room with someone, never let them be in between you and the door. People can be very unpredictable!

Meriwhen, ASN, BSN, MSN, RN · Mar 9, 2012

Depends on you, the situation, the patient and the setting.

If you are a nursing student, NO. Do not even read further because it is NEVER OK.

There are some acutely psychotic patients that it goes without saying that you should never be alone with them. However, many psych patients are not the stereotypical psych patients that we see in movies and TV, and you would probably be fine if you were alone with them. Like colleennurse said, people can be very unpredictable (even if not a psych patient), so you should take precautions.

First, let another staff member know where you are going to be at all times. If you prefer, have them hover nearby.

Second, NEVER be behind a closed door or totally isolated with them unless you have a bona-fide reason to do so (e.g., giving them a shot). Leave the door open. If they want privacy, tell them that's why you're in the room. If the patient asks that the door be fully closed, tell them no. Or take them to a room where you know there is a video camera and/or windows, so at least someone can keep an eye on you.

Third, don't let the patient get between you and the door. Always have a clear escape route.

Fourth: be mindful of boundaries--yours and the patient's--at all times.

Fifth, if you're visiting a patient of the opposite sex, bring along a staff member of that same sex. That's for your protection, not so much for assault possibilities, but to protect against "he said, she said". Occasionally patients have made false accusations against staff, and no matter how out of it the patient is, any accusations made by them about you are taken seriously. Or again, bring them to the room with the video camera and/or windows.

Last: no matter the situation or the patient, if your Spidey sense starts tingling and you think it's a bad idea, DON'T DO IT.

Been there,done that, ASN, RN · Mar 9, 2012

What is the patient's history and diagnosis? What is the policy of the facility?

I was assaulted by a psych patient that was so unpredictable and violent, the 2 (so-called) mental health workers assigned as a 24 hour watch, still let her get to me.

If the patient is not violent... why not?

Blue4me2 · Mar 9, 2012

This area is the hospitals idea of the emergency psych area although it is not part of the emergency department and is isolated to itself but next door to part of the impatient psych unit. You are the only nurse back there with no cameras, only a phone and a button to push if you need help. My thing is what happens if you cant get to the button or phone...who is gonna come. No one can hear you there and no one checks on you periodically either so you could lay there seriously injured until the next shift comes on duty.

Whispera, MSN, RN · Mar 9, 2012

I don't think that setup is safe, Blue...

Meriwhen, ASN, BSN, MSN, RN · Mar 9, 2012

OP: I second that. In your case, it is NOT a good idea to be alone with the patient because it's not a safe environment.

Been there,done that, ASN, RN · Mar 9, 2012

If the patient has not been diagnosed.. or started treatment.. this is not acceptable!

What are they thinking?

There is no way I would expose myself to that kind of danger.

Whispera, MSN, RN · Mar 9, 2012

Even if the patient hasn't been diagnosed or started treatment, for a staff member to be isolated when caring for a patient is NOT good...and this applies to any sort of treatment. If you can't get help in an emergency, you're really out on a limb in such circumstances. It's not acceptable.

Blue4me2 · Mar 9, 2012

Unfortunately where I work they are telling me that it is mandatory that all psychiatric nurses will have to work there at some point....of course I am job hunting again and the market is tight especially for a nurse with less than a year of experience but I am not putting my safety in jeopardy. I have only been working there for two months.

Whispera, MSN, RN · Mar 9, 2012

are you alone with just one patient, or are there times there's more than one?

skydog · Mar 10, 2012

no because you never can predict the outcome.Many times you are alone like giving injections, searching ,or evaluations and you need to be alert to the situation. Doctors set up their offices with escape routes its just a smart move to protect yourself from harm.