Scary Incident Happened to Me Yesterday

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I'm a new psych nurse, and so far I love it. But it seems that lately, I don't know if it is the holiday or what, the negative energy on the unit has been surging.

I'm on the adolescent unit, and we give out meds in the patients' rooms...privately. If we give them during lunch and dinner, all the kids make a big stink about who is getting what, and some even try to steal the others' meds.

I went into a patient's room yesterday to administer meds to the patient with the bed near the window. His room-mate was closer to the door, and has always been cordial and polite, if a little hyperactive. I walked past him to give the meds, and when I turned around to leave, he shut the door and said 'You can't leave.' A surge of panic rose in me. I had his roomate behind me (a big guy) and this one in front of me. The boy was smiling, but refused to move, he continued to block the doorway. I had to side-step him and squeeze past to get out.

This happened just one day after another staff member was beaten by an adult patient, resulting in head injuries.

The boy who blocked the door, as I said, has never been threatening, but reviewing his chart, I saw letters that he wrote about feeling the need to kill people, and indeed, he already had poisoned a relative (although she did not die). His letters are extremely violent, incongruent with his affect...discussing chopping people up and getting very detailed about the things he would do to a particular person. But again, on the unit, he smiles, jokes, and is cooperative.

Another staff member talked to him, and he did apologize to me, saying he was only joking around.

My questions: Am I over reacting? Is this just kid stuff? What should I have done differently?

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Specializes in Hemodialysis, Home Health.

Wow, Meerkat. That IS scary.

Is there any way you could have your patients come to the door entry of their room from now on, to prevent such a thing in the future?

Just have them come to YOU instead of you going IN to them? Stand right outside or AT the door, but visible from the hall.

I would not risk going inside a patient's room like that. They are in psyche for a reason, and you just never know when things could go bad... very bad. :o

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Wow, Meerkat. That IS scary.

Is there any way you could have your patients come to the door entry of their room from now on, to prevent such a thing in the future?

Just have them come to YOU instead of you going IN to them? Stand right outside or AT the door, but visible from the hall.

I would not risk going inside a patient's room like that. They are in psyche for a reason, and you just never know when things could go bad... very bad. :o

That's a good idea. Thanks.

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Specializes in Hemodialysis, Home Health.
That's a good idea. Thanks.

Do be careful. Keep personal safety in mind at all times. Regardless of how they "appear" on the "outside"... the smiles can turn to visciousness in a heartbeat.

Don't ever let your guard down.

Manipulation is the name of the game with a lot of these patients, which I'm sure you already know.

(((HUGS)))

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Specializes in Med-Surg, Psych.

Wow! Sounds scary...

I'm only a few weeks into my Psych rotation and the rule is, staff does not go into a patient's room for any reason.

I'm glad everything turned out okay for you.

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One of the old, traditional "unwritten rules" of psych nursing that I was taught (many years ago) in school is, "Never let the client get between you and the door" (not that you make a big deal of it, or act scared of the client, just that you take care to make sure, in a subtle, unobtrusive way, that you maintain a clear path out of the room).

Esp. with adolescents (and child/adolescent is my specialty), if I started into a room and one of the large, older adolescents (whether male or female) was standing next to the door, I would stop right there and not go farther into the room (i.e., not let him between me and the door), casually, without being obvious about it.

I've been a psych nurse for >20 years now, and I think that one of the things that is often tricky for people starting out in psych is how important it is to be continuously aware of what is going on all around you in the environment (e.g., where the roommate is standing when you go into a client's room to give a med, what's going on in the far corner of the dayroom, etc.) Sort of like driving a car -- you need to be aware of what's going on around you on all sides at all times! You never know when your safety (or even your life) may suddenly depend on how aware you are of subtle changes taking place around you ... (I know that sounds terribly melodramatic, but it's also true. :) )

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One of the old, traditional "unwritten rules" of psych nursing that I was taught (many years ago) in school is, "Never let the client get between you and the door" (not that you make a big deal of it, or act scared of the client, just that you take care to make sure, in a subtle, unobtrusive way, that you maintain a clear path out of the room).

Esp. with adolescents (and child/adolescent is my specialty), if I started into a room and one of the large, older adolescents (whether male or female) was standing next to the door, I would stop right there and not go farther into the room (i.e., not let him between me and the door), casually, without being obvious about it.

I've been a psych nurse for >20 years now, and I think that one of the things that is often tricky for people starting out in psych is how important it is to be continuously aware of what is going on all around you in the environment (e.g., where the roommate is standing when you go into a client's room to give a med, what's going on in the far corner of the dayroom, etc.) Sort of like driving a car -- you need to be aware of what's going on around you on all sides at all times! You never know when your safety (or even your life) may suddenly depend on how aware you are of subtle changes taking place around you ... (I know that sounds terribly melodramatic, but it's also true. :) )

Elk, I think you are right. I guess it's one of those things that comes with experience. I am having trouble gauging my own reactions to things. Would you have considered that a serious incident or brushed it off? Do you think I was in danger if I had not gotten out? I'm trying learn, that's all. I think I am feeling conflicted because many years ago in college, a student knocked on my door about ten o'clock at night. I stupidly opened it, and he came in. As soon as he did, he locked the door behind him and sexually assaulted me. I almost feel like I had a flashback of that, which is why I'm trying to figure out if my fear was valid or just a knee jerk reaction from the past.

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Would you have considered that a serious incident or brushed it off?
I think that I would have considered it somewhere in between those two choices -- fortunately, nothing bad happened, but, obviously, it could have been a v. serious situation. I would consider it a big red flag that I need to be more careful in the future to avoid putting myself in a situation like that (I'm not saying that as any sort of criticism of you -- just saying that it's a experience to learn from).

As you are experiencing, psych nursing is very different, in some important ways, from nursing in other settings (e.g., how often do nurses in other settings have to think about whether it's a good idea or not to walk into a client's room? They walk in and out of clients' rooms all day without thinking anything of it ...) You have to learn a whole new way of looking at and thinking about clinical situations, which can take some time. I hope that you are working with some seasoned, experienced adolescent psych "pros" who can mentor you and help you develop the skills you need.

I consider myself v. fortunate that I was taught a lot of stuff in my psych rotation in school (back in the Dark Ages) that we apparently don't teach nursing students anymore -- inc. a whole list of basic "Dos & Don'ts" that have served me well all these years. Most of them I don't even think about anymore (they are so ingrained) until a question like yours gets asked.

And, certainly, part of your reaction was related to your past experience of being assaulted -- that doesn't mean, however, that it would be more "correct" to just dismiss the current experience out of hand. It could have turned out v. differently than it did! My advice would be to continue working on developing the skill of being (at least generally) aware of what's happening all around you at all times on the unit. Best wishes!

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Specializes in PeriOp, ICU, PICU, NICU.

Meerkat, I would have been very scared myself. Please keep in mind that although they may be kids, they are there for a reason. It is better to always be cautious. Take care of yourself. ;)

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Is there a somewhat private place where you can have pts come to get their meds (and vitals) rather than going into pt rooms? When I was working inpatient child and adolescent, we ocassionally had problems with the pts being nosy about what meds everyone was getting and with pts trying to give their meds to other pts (we always checked for cheeking), but it wasn't so constant that we routinely passed meds in pt rooms.

Another thing to be cautious of is standing IN a doorway or putting a part of your body through the door when there is a patient on the other side of it. I've had a couple of coworkers injured by getting doors slammed on parts of their bodies. Since we had heavy fire doors on pt rooms, they were lucky not to be more seriously injured than they were.

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Specializes in ICU, CM, Geriatrics, Management.
... Just have them come to YOU instead of you going IN...

This is the way to go if possible.

Can't the milieu be modified to allow for this? And, as another poster suggested, this could also be the method employed to secure VSs.

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thanks for all your suggestions...I think you are all correct. And thanks for your support.

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