safety concerns/ need advice

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hi all, hope everyones doing well. have a meeting with safety committee coming up, and we have been brainstorming ideas to propose that would make our workplace safer. Work at a state pysch hospital, about 25% of patients are forensic for murders, rapes, etc. Lots of assaults here, lots of injured staff. Severe injuries are common. When patients viciously assault staff, they are rarely even secluded or restrained ( management wants our seclusion/ restraint numbers to look good for auditors, surveyors,etc. There are police, but they do not go on patient wards, police never even see the patients, and nursing staff is responsible for handling all violent episodes. I've had several broken bones in 24 years on the job, and I'm 6ft , 255lbs. So we will have a chance as we do annually to pitch safety concerns and ideas to the brass. They often turn our ideas down and say they aren't feasible, but im looking for ideas from you guys and gals, our peers in the profession. So far we are asking for use of spit hoods to place on patients spitting blood etc , to have only our first name on id badges ( state law here allows for that, but our hospital does not) , to do away with the sharp pointed scissors on the wards and replace with safety/bandage scissors , . We have had many safety ideas adopted over the years, but usually someone has to get really hurt first. Our administrative team is not proactive, since they are safe in offices away from violent patients. Any ideas would be welcome. Thanks all, and be safe.

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You couldn’t pay me enough to work in that environment. It’s unfortunate that all anyone cares about in psych is money. Staff have no protection nowadays. I’ve been in the field for 7 years and I’m disgusted by most hospitals. Doing away with seclusion, restraint, and even holds is recipe for serious injury. I sure hope the staff that are injured sue these places. I know I would.

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thanks for your input. yes its more dangerous since hospital discourages holds, restraints etc. patients feel emboldened to sucker punch staff, and then stop fighting when help arrives, so they cant be put in hold and have no consequences for assaults. I have had broken orbital socket, chipped vertebra, busted lip , busted chipped tooth, glasses broken, broken tib fib, etc etc, and many coworkers have had worse. im trying to work one more year and retire, but I want to try to make it better for patients and coworkers .

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I wish I would tell you how. Aside from removing contraband. I mean, aside from holds and S&R, your options are limited. The patients knowing you can’t do anything just exacerbates the problem. My hospital has decided that any hold that isn’t CPI is against their rules, so I’m getting out ASAP. I refuse to work in a place that harms staff.

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On 8/10/2019 at 9:16 AM, workingot said:

thanks for your input. yes its more dangerous since hospital discourages holds, restraints etc. patients feel emboldened to sucker punch staff, and then stop fighting when help arrives, so they cant be put in hold and have no consequences for assaults. I have had broken orbital socket, chipped vertebra, busted lip , busted chipped tooth, glasses broken, broken tib fib, etc etc, and many coworkers have had worse. im trying to work one more year and retire, but I want to try to make it better for patients and coworkers .

Oh my God. Are all psych units like this, or only state hospitals. workingot, I'm really interested in what has kept you going all these years and prompted you to stay in an environment that seems so dangerous. Some of your injuries sustained on the job are very serious. Thanks for sharing.

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Specializes in mental health / psychiatic nursing.
21 hours ago, DCubed said:

Oh my God. Are all psych units like this, or only state hospitals. workingot, I'm really interested in what has kept you going all these years and prompted you to stay in an environment that seems so dangerous. Some of your injuries sustained on the job are very serious. Thanks for sharing.

Not all psych units are like this - I float between 3 sub-acute units and there has been exactly 1 s/r incident on one unit in the 2 years I've worked this job. That incident did result in minor staff injury, in general though, while we've had some emergency sends out for decompensations and/or medical issues, staff injuries are minimal and we almost never go hands on.

A lot of this comes down to solid teams and preventative strategies - we really try to anticipate problems before they occur and come with prevention strategies in advance. We like to include clients in this process (if they are able) with them calling out potential triggers, letting us know reactions and how they best like to be deescalated. It sounds weird but it usually works really well - we had one young man with LONG history of violence when decomped, spoke to him while he was calm and he said the best things to do for him when he was punching walls and yelling was to offer to let him onto our locked patio area for fresh and and once a bit calmer, offer him chamomile tea. He went from frequent PRNs and breaking things daily to building constructive coping skills and being able to use words to communicate to staff how he was feeling and get his needs met with out the anger and destructive behaviors he'd lived with for years. It felt miraculous to be a part of the process for him, and he was a changed person when he left our facility - apparently we'd been the first people in his life to actually give him some agency over his life and decisions impacting him.

I highly recommend looking into collaborative problem solving model - it was developed for use with children with challenging behaviors but there have been some pilot trials of it in the adult population, including a state hospital, where it has reduced seclusion and restraints and greatly reduced violence towards staff.

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On 9/13/2019 at 2:22 PM, verene said:

A lot of this comes down to solid teams and preventative strategies - we really try to anticipate problems before they occur and come with prevention strategies in advance. We like to include clients in this process (if they are able) with them calling out potential triggers, letting us know reactions and how they best like to be deescalated. It sounds weird but it usually works really well - we had one young man with LONG history of violence when decomped, spoke to him while he was calm and he said the best things to do for him when he was punching walls and yelling was to offer to let him onto our locked patio area for fresh and and once a bit calmer, offer him chamomile tea. He went from frequent PRNs and breaking things daily to building constructive coping skills and being able to use words to communicate to staff how he was feeling and get his needs met with out the anger and destructive behaviors he'd lived with for years. It felt miraculous to be a part of the process for him, and he was a changed person when he left our facility - apparently we'd been the first people in his life to actually give him some agency over his life....

A lot of good advice and wisdom here. I work on an acute hospital psych floor with a typical patient stay of 3-5 days. Had my share of hands on experiences, and it is the worst part of the job imo. Being proactive and building a rapport is key. If I’m able to do that with the “higher acuity” patients, then we really don’t have many problems.

My main concern is when we take patients that have a long history of violent and sexual predatory behavior back. Patients that have a history of attacking staff/patients and have no desire to actually treat their illness; they just come to avoid jail or get off the streets. They play the game and know exactly what to say to be admitted. These patients totally disrupt the other patients care and worsen their symptoms. Building a rapport with these patients is an exercise in futility. Patients like these know the system and know there is nothing that will be done when they decide to physically or sexually assault others. This is an issue that I’ve been trying to find answers for and coming up short. Very frustrating.

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