safety in the outpatient setting

[peachnurse22]

started working as an RN at an outpatient psych clinic in December 2014. I'm the only RN at this center, and work with LCSW/LPC and 1-2 psychiatrists (depends on the day and what month, lots of turn over unfortunately). It's a state-contracted agency and we are in the south - so the budget is of course $0.00 for anything deemed 'extra' or 'unnecessary'.

To my point...we've seen a huge increase in aggressive patients over the past 3 weeks. Wednesday for example, we had a psychotic client screaming and running around the office (it's a super small office with about 12 offices, 1 break room and the front office area). We have a very vague, poorly worded, and basically unused policy for dealing with aggressive clients. It's caused a lot of fear and anger with leadership among our team because of the lack of communication. We're told to verbally de-escalate the patient and if possible reach for our phones - call the office manager - and ask for "Dr. Sharps" - this triggers the office manager to either call 911 or go across the hall to a public health department we share the building with to see if their officer on duty can help us. Lately that particular officer is either off at taco bell, on break, or needs back-up that takes 30 minutes to get there. Meanwhile, said patient is running the halls - many of our staff are doing therapy with their clients - and the rest of us are unaware of the danger unless we hear a client screaming. There has also been issues with clients bringing pocket knives and switch blades back to the treatment area.

Anyway, I was just wanting some feedback on what other work environments are like. What does your safety policy look like at work? Do you have lockdown procedures, panic buttons, or a way to communicate with your staff if you're in danger? My director promised us some answers and solutions by the end of the month. I've considered anonymously going to OSHA if things don't change. Is this overreacting?

Sorry for the wall of text. I'm a fairly new nurse but did my 1 year in med-surg. Overall, this new job has been cake. These past few weeks have been frightening. Thanks for reading and for your feedback! Sorry in advance for the numerous grammar and possible spelling mistakes. I might be 1-2 margaritas in to my Friday night...

TL;DR - RN at outpatient psych clinic feels unsafe at work w/ intake and triage clients that come in aggressive. Policy sucks and leadership is weak. What are your safety policies at work? Am I overreacting? Tell me!

[Davey Do]

What does your safety policy look like at work? Do you have lockdown procedures, panic buttons, or a way to communicate with your staff if you're in danger? My director promised us some answers and solutions by the end of the month. I've considered anonymously going to OSHA if things don't change. Is this overreacting? Am I overreacting? Tell me!

No, you're not overreacting, peachnurse. Safety is a priority.

It's been over 12 years since I've worked in a Mental Health Clinic, but here goes:

Clients had to be "buzzed in" through a locked door before entering the office area. Service may be refused and behavior guidelines signs were posted. Panic buttons were in every office and all Staff were trained in CPI. Since the Clinic also housed a Crisis Stabilization Unit, a Security Guard was available 24/7.

Accreditation, Benefitting, and Surveying Agencies require a documented policy and procedure in the such events. If this is inadequate, there is a chain of command (which you've already done) and a hotline to confidentially notify of concerns. Attempt internal rectification within a reasonable amount of time before utilizing outside resources. Submit objective documentation to all involved parties.

Again, safety is a priority and you have reasonable concerns.

Do what you need to do in order to feel safe.

The very best to you, peachnurse!

[peachnurse22]

Thanks so much for your input Davey Do. If you don't mind me asking - what kind of facility did you work for? State-funded or private?

Yesterday we had a staff meeting about the policy which is severely lacking. Coming up with a system such as panic buttons in each office, or some kind of intercom system to notify everyone of the situation will apparently to costly for us. All we have to rely on is e-mails if there is an aggressive client, and that's it. Our front office staff (non-licensed administrative staff) are given the entire burden of calling 911 or running down the hall to get the police officer. That officer isn't an employee of my clinic - he's a state employee who works at the public health department.

Is this just and extra cost-saving measure then utilizing this officer instead of calling 911? I feel like our safety isn't a priority at this place. I've only been here 7 months and I'm starting to wonder if it's OK to think about finding something else

[Davey Do]

what kind of facility did you work for? State-funded or private?

Hmmm... I guess it was private, hadn't really thought about it because the clinic has to adhere to government (OMH) and accreditation (JAHCO) standards. Not to mention benefitting (medicaid, medicare, private insurance), Public Health, etc. etc.

It sounds like your Administrators are at least working on resolving the safety issue concerns....