safety on free-standing IP psych unit

[malepsychRN]

I've been working for 3.5 years on an adult inpatient crisis stabilization unit and as of last summer the other units in our building moved to another location, so we are a free-standing 16 bed unit. There are outpatient and maintenance staff we can call for codes during weekday business hours, but evenings, weekends, and nights the rest of the building is literally empty except for us.

We apparently have good staffing ratios: 3 RNs and 3 techs (sometimes less if we get a call-off) for our 16 bed unit which is usually full or close to it. We have 1 security person; the full-time security person on evening shift is female. The majority of techs are female and I'm the only male RN. Sometimes evenings and night shift is all female staff and we have lots of staff over 55 years old.

I'm a reasonably fit male RN 5'-7" 155# in my 40's. Sometimes I'm the only male in the entire building and we have to deal with psychotic, agitated, threatening male patients who are 6" taller and 100# heavier than me. At the our last RN meeting, several RN's including myself expressed that we don't feel safe--and we were once again blown off by the manager.

So my questions are:

1. Are there any other psych RN's out there on a free-standing unit, and what do you do to handle large agitated patients who can't be talked down?

2. Does this sound like a reasonably safe work environment?

3. Should I be looking for work elsewhere?...I'm thinking about leaving, but I live 5 minutes from work, my coworkers are really great, the psychiatrists treat the RN's well, and I've worked enough different jobs in various fields to know every job has a downside.

[macfar28]

I am in a free standing IP psych facility as well. We have mostly female staff on night shift and it does make many of us feel somewhat vulnerable. Recently we had a patient get up in the wee hours and begin to threaten to tear the place up, f*** all of us up, etc. He then began kicking in the door to the nurses' station. We called 911 which our managers have said is ok when we feel an extreme level of threat. I would encourage you to do the same. Some might disagree with that decision but at the end of the day, your safety (and that of your patients) is what matters. Otherwise, in less volatile situations we really rely on verbal deescalation. But I know it's hard because sometimes there is just no talking a patient down. Good luck to you. I would say stick it out if you can. The positives you listed above can be hard to come by.

[malepsychRN]

macfar28,

Thanks for your input. Also, I could add we have an "open concept" nursing station--unless we abandon it completely and lock ourselves in the med room we are quite exposed. We have had to call police to the unit 8 times in the last couple of months (which is way more than normal) due dangerous patients we've been having. The police have been great, but we have no real plan for self preservation in the 5-10 minutes they take to arrive.

[metricalpound]

I understand that you may be afraid; however, you work in psych - it's dangerous and it's expected to be dangerous. I'm always a little afraid of going to work but I know most of the patients that I work with are awesome or, at the very least, have the potential to awesome.

I work in an open unit where patients can throw stuff at us, flip our computers over, jump over the barrier of the nurses station and get to us, etc. How often does any of this happen? Not very often. We deal with trouble patients by calling a psychiatric code - we have two type of codes, one in which is a psychiatric emergency and one where a patient is escalating and is not accepting redirection and/or not accepting PO meds. When a code is called a group, mostly composed of men, first try to deescalate the patient along with staff. If that doesn't work, the psychiatrist puts in for an IM. We rarely use restraints - about once every 3 months.

Another question that you have to ask yourself is how often have you gotten assaulted by a patient…

[malepsychRN]

metrical pound,

I understand and accept that it is dangerous in psych--what has changed for us a few months ago is that on weekends and evenings the rest of the building is entirely empty--there is no one to call for a code. My main question is: Is it a reasonably safe work environment to have all female staff or me as the only guy with female staff with no back up except to call the police?

(I've been punched a couple times and scratched once, though coworkers have gotten black eyes, and hair pulls. We are excellent at verbal deescalation and I'm pretty quick when I need to get out of the way!)

[macfar28]

Yes OP, we have a completely open nurses' station - unless you consider half doors and counters closed. lol.

We too have one male staff on weekend nights when I work, however he is slight of frame. We don't tend to rely on him any more so than any of the female staff. We call codes as well unless the situation is so volatile that we know we will most likely need backup ready. In the particular situation I named, the patient had already choked a peer and assaulted 2 of our PAs earlier in the week. (One might ask why he was still on our unit - still awaiting that response). Otherwise I think the police would not have been called.

(As it turned out a police woman arrived but refused to come on the unit without backup. Seemed a tad strange. Anyhow, we were able to manage the situation and medicate him however I believe we were extremely lucky. He was finally discharged 2 days later and is now in jail for assaulting our ED staff when he attempted readmission.)

Our staff took heat from others (mostly those who believe they know everything - as they are in bed asleep and able to work with large males during the dayshift) for calling 911 but I still believe it was the right thing to do and as the target of his violence, I was glad they did. In the scenario you describe, I would think 911 would be and should be an option. Sometimes the size does matter and a patient's perception of what they can get away with, is pertinent.

[sopsyched]

As long as all of your staff is well trained in CPI you should be fine. I work in a free standing psych inpt unit with mostly female staff, a couple of our nurses are males and maybe half of our MHT's are males. When we have a pt who we know is escalating we use prevention methods, try to talk the pt down, offer the quiet room, PRN's. If someone flips we use our restraint training. We have called the police on a couple of occasions, once on a weekend when there were only two nurses and three MHT's (we don't have security) we had a pt attack an MHT on admit in an attempt to escape. He was large and another MHT called for help. We saw on video what was happening and due to our low staffing and his size and aggression we called 911 then went to assist. We were able to get him on the ground safely by the time the police arrived. I think it's all in your training. Make sure you know how to subdue someone who is stronger than you, there are ways you can move their arms that make it harder for them to fight. Make sure you can pull up IM's quickly, and most importantly, make sure you work with people whom you trust. One thing you guys might want to do is request more crisis, escalation, and restraint training.