Safety Concern

Pedal · Jul 14, 2012

Sounds like a dangerous place. Things can turn very fast in psych as you probably know. You always need a safety plan to protect yourself and others on the unit. Maybe you are recognizing the potential for injury is there and you are looking to head this off early. Can you bring up your concerns with the DON and effect some change?

hanasea · Jul 15, 2012

Just looking for advice on being torn between loving what it means to be a psych nurse and having serious concerns about safety of entering the unit where I work. Have been there for 2 years now and even though there are short intervals where things seem to be running smoothly, most of the time we are operating in some pretty scary conditions. The acuity is high, beds are filled, short staffed, in a facility separate from the hospital by a few miles with no emergency back up or security other than calling 911. Psych is my passion and currently going to school for a psych NP program. My plan is to work in outpatient eventually, but really would like input for others on inpatient units as to how safety/staffing is managed. If this is how other inpatient units operate, then there really needs to be a complete overhaul of the mental health system. We are also being overtaken by the use of bath salts. Feeling like I am putting my license on the line every day, not to mention physical/emotional well being.

I am currently working at psychiatric ward of teaching hospital. I want to share my experiance with my fellow nurses.

We have close ward and open ward, and a few day ago I worked at close ward. Normally I am in open ward setting, but I was kicked to close ward that day. Someday that kind of thing happening.

One of Schizophrenia patient acted out, and kicked out my chest directly.

His doctor saw it, and ordered security room locking. While moving him to SR, he frantically kicked the doctor, me, a nurse aide, a security guard. Originally the patient was going to discharge the day after tommorow, but the discharge plan cancled after this incident.

He was chronic patient, and his family is poor. Also, he didn't had any sense. I always felt so sorry for him.

Sueing a patient from hospital will be a hot potato, isn't it? Well, here, I am in South Korea, and we're just going to be silent. I didn't got any bruise. My co-workers asked me if I feel ok, and I answered I'm just fine. I was physically fine, and there was a patient to manage, what can I say? Saying I am not ok, I want to X-ray my chest, etc? That would be look no good.

I am just wondering. I heard US nurses are better protected by their law. I wonder, if that kind of incident happened in your ward, what would you do?

I love my patient, and I want to help and care for them. But after that experiance, I felt differently. I tried to care him, he cried so hard and pleaded to open the door of SR... but I just don't want to open the door anymore, I felt so afraid of him.

How do you deal with that kind of emotion? I am open to other nurses' suggestion. You will be more experiance than me, and have a lot of experiance.

Thank you for reading.

Psychcns · Jul 15, 2012

At one facility I worked at we had collapsible stretchers to transport patients to a seclusion room. Pt would first be restrained to the stretcher wherever the incident occurred and then the stretcher was carried by at least four people.

When pts are agitated it is best to give a chemical restraint to prevent them from harming themselves or others.

I hate seeing pt in seclusion or restraint.. Best to prevent these occurrences whenever possible.. Prn medication, 1:1 contact, structure in milieu, etc

Best to you, this is difficult work, safety has to come first....

Topaz7 · Jul 18, 2012

We would call a code. Everyone in our hospital is trained in cpi -dics, nurses, case workers, activity therapy etc. We try not to go hands on unless we need to and after we have more staff. A lot of times just seeing all of the staff makes the pt cooperate but if not and the pt is still acting out hurting self/others we do cpi approved team control, chemical restraints, seclusion and restraints depending on what they require sometimes all are used and pt is placed on 1:1. we don't really have any issues getting them to seclusion for restraints because they will either walk or we have so much staff present we just carry them. carrying then rarely happens. I find that usually show if staff, verbal /deescalation works.

Elladora · Jul 25, 2012

Our entire staff is trained in CPI. Every staff member carries a walkie with them at all times. When a resident "acts up" we make an all call for staff. We also have a security staff (one person) on duty in the evening as that's when we seem to have the most behaviors. Our facility does not have any restraints or a quiet/seclusion room. If staff ever feels they are in danger, we are authorized to call 911. Clients move under their own free will, we do not carry clients. (Although we might stand on either side of them and guide them where they need to go). Clients that refuse to move usually go one of two ways for us - we sit with them and they eventually calm and go where they need to or they are so out of control that they are transported to the hospital, either by our staff or by ambulance/police car. All that said, nine times out of ten we can deescalate a situation by talking to a client.

sleepdeprived1 · Nov 15, 2012

I KNOW I am not safe at work. No security and MINIMAL staffing on my shift so all hell breaks loose I am screwed until 911 police show up! Let's just fill EVERY available bed we can though! Doctors arent on my shift either to deal with these severely agitated patients..but they will be happy to give me a telephone order for something PO that will take effect hours after this psychotic patient has beaten the crap out of me!-Still love my job though..DEFINATELY SOMETHING needs to be done about these unsafe environments..mgmt/admin. doesnt seem too concerned..(at all) maybe all us nurses can sign a petition or something??

adnrnstudent, ASN, RN · Nov 16, 2012

I am just wondering. I heard US nurses are better protected by their law.

Laws cannot protect nurses. Only good security can. Now laws requiring good security might do some good.

This next comment isn't for hanasea specifically, but for everyone reading that thinks passing a criminal law is useful. In general regarding laws: US criminal laws do not protect Americans because criminals do not follow the law. Laws generally hurt the people they are intended to protect. A perfect example is Illinois Gun Laws. Chicago gangs could care less about gun permits, but I cannot legally protect my family with a conceal carry in Illinois.

Cougar1113 · Nov 16, 2012

I work on an inpatient locked psych unit that is actually in a seperate building down the street from the hospital and if anything happens we have to have someone run to the phone and call for security, then it takes a few minutes for security to show up. Management has recently cut staffing for "funding" reasons. We now have to have a minimum of 21 psych patients before night shift is allowed to have a 3rd nurse or 3rd nursing assistant (normal on 3rd shift is 1 nurse and one aide for each floor), day shift has full staff. We have more admissions on night shift than any other shift. It has also become a known fact that there are more elopement attempts on the night shift. I love my job but worry about my safety and the safety of my other staff members. It should be mandatory that management work at least one shift on each of the 3 shifts once a month. Yeah, I don't see that happening either but it would be nice, then they may have their eyes opened as to what its like to be on the floor and in the line of fire.