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?
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.
Could you start another thread and List some of those Do's and Donts for us? I am in school now, and Psych is where my career will be.
I work in a psych hospital with all populations (children, adolescents, adult, and geri) and there is no way we would be giving meds to pt's in their rooms. The way we do things to keep confidentiality a priority is to keep most pt's in the dayroom during med time, then a mental health worker calls them up to the med room door one by one. This works quite efficiently and eliminates the "I want what she's having" syndrome. We are also rarely in pt's rooms unless we need to do a search for one reason or another, or if the pt happens to be in crisis in their room (rarely happens-usually happens when they come out of family session, in the dayroom, or after a tumultuous phone call). Hopefully you reported this incident to the DON. I would say this is a policy which needs to be reconsidered. Good luck and please be careful.
Lots of great advice from those in the know. Here's another do/don't (not sure which): If a pt states or indicates any thought or intent of harm to self or others, take it seriously. You don't have to call security unless the threat is imminent, but increase your monitoring and closely monitor body language, i.e.-pacing, fist-clenching, increase in rate or volume of speech. Stay calm, centered and quiet yourself. It sounds like you handled this situation v. well. You were aware of your surroundings and the possibility of a threat and extricated yourself quite handily. Pat yourself on the back, you have very good instincts. I don't remember you mentioning it in your post, but the very next thing you should have done was to notify your co-workers of the situation. If you did, good for you, if not, another lesson learned. This is an area of nursing where teamwork can save YOUR bacon, as well as the pt's. Don't ever forget that.
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.
It SHOULD be that way. However, there are a few obstacles. One, we MUST go into our patients rooms because their bathrooms and closets are locked and we have to unlock them if they need to use them. Second, We do not have a med room or a med window. The nurses station is tiny and everything is kept in there. If we have patients lining up outside the nurses station people cannot get in and out of there.
Could you start another thread and List some of those Do's and Donts for us? I am in school now, and Psych is where my career will be.
Hey this is a great idea! I know Psych nursing is where I want to be also. I consider myself lucky as I was taught by a retired psych nurse w/a lot of experience. He taught us like you said, to be aware of what is going on at all times, never to go into a pt.'s room alone,to pay attention to how things "feel" & trust your gut.I would love to learn from your experiences. Thanks! :)
Hey this is a great idea! I know Psych nursing is where I want to be also. I consider myself lucky as I was taught by a retired psych nurse w/a lot of experience. He taught us like you said, to be aware of what is going on at all times, never to go into a pt.'s room alone,to pay attention to how things "feel" & trust your gut.I would love to learn from your experiences. Thanks! :)
It's funny, I have worked in psych>10 yrs and I had NEVER been taught not to go into a pt's room alone. Granted, if the pt is especially threatening, we take the precaution of taking a buddy, but if the threat is imminent, we take action by moving them to security room and getting some calming medication in them stat. We all wear panic buttons on our clothing, though, and try to practice a general "awareness" that includes knowing where ALL STAFF are at all times. :uhoh21:
Hi, I also work in a Psych unit. We can stand outside the doorway instead of going into the room, but no formal rule. Here's what I feel uncomfortable with. The units have several smoke breaks to an outside area during the day and the rule is 7pts to smoke=1staff. Talk about a pt room and a closed door...how about the closed elevator door on the ride up&down for smoke break crowded elbow to elbow with patients having active command hallucinations. Smoking is a big deal on the units...the pts become very agitated about their smoke "privileges".
Many times when stuck in the elvevator with pts, I think, "well, I hope none of them decide to get violent in here, or worse yet, God forbid the elevator gets stuck between floors. This is not an option for staff, it is expected if you get assigned smoke breaks.
Hi, I also work in a Psych unit. We can stand outside the doorway instead of going into the room, but no formal rule. Here's what I feel uncomfortable with. The units have several smoke breaks to an outside area during the day and the rule is 7pts to smoke=1staff. Talk about a pt room and a closed door...how about the closed elevator door on the ride up&down for smoke break crowded elbow to elbow with patients having active command hallucinations. Smoking is a big deal on the units...the pts become very agitated about their smoke "privileges".
Many times when stuck in the elvevator with pts, I think, "well, I hope none of them decide to get violent in here, or worse yet, God forbid the elevator gets stuck between floors. This is not an option for staff, it is expected if you get assigned smoke breaks.
How do others deal with this issue?
When our hospital at large went non-smoking, a room w/additional ventilation was set up for smokers on our psych unit. It still continued to be a problem, though, as pts wanted xtra smoke breaks and would persuade others who didn't have the ability to say no to "lend" them cigarettes. Eventually, smoking was banned even on the psych unit. Many psych units and state hospitals in our area were doing the same thing. There have been surprisingly few problems w/this. We offer pt's nicotine patches, nicotine gum and clonidine prn for those that don't have contraindications. Many problems were solved by this decision.
I'm in complete agreement with Elkpark. Going into rooms by yourself to pass meds on a psych unit is just plain asking for trouble(bad policy for the institution, does not have safety in mind). If not possible to have a central location for passing meds then I would most definately take another staff member with me & stand in the doorway rather than enter the room. It is extreemly unwise to get into a location you can not escape from. Constant awareness is a given, after all as psych nurses our assessment & observation skills are some of our strongest points. Myself I try VERY hard not to let anyone get behind me. Do I think the situation you stated was serious, most definately I do, luckily you were not seriously harmed simply scared this time. If you gut tells you that you are in danger by all means LISTEN TO IT. Individual panic alarms are great however a lot of damage can be inflicted in a brief time depending on the individual...I have been assaulted way back when I was a new nurse. It is unsetteling at best, fortunately I only suffered a black eye & some bruises. Thankfully you were not harmed.
Thunderwolf, MSN, RN
3 Articles; 6,621 Posts
Great member feedback. Glad it was helpful to you. Thanks for sharing.