Suicidal man at nurses' station

Nurses General Nursing

Published

This happened last week at work... About 1500, I walk around the corner into the nurses' station and see all the nurses, the CNO and the asst. admin standing there. I asked what is going on and one of the nurses point to a man sitting in front of the station with a hospital gown and jeans on. She says that a few minutes earlier, he had walked up to the station and told the secretary that he was going to kill himself. He had walked out of the hospital across the street, came in the front doors (pass security:uhoh3:) and up to the third floor where we are. So she calls admin people and they were trying to figure out what to do. The CNO is on the phone with the house doc and the asst. admin is talking to the US with his back to the patient. I immediately went to the asst admin and asked him why this man isn't isolated away from us. He gets a "look" and asks me why. I tell him "Are you serious? This guy just walked in and said he's about to kill himself. He could very possibly have a weapon of some sort, he obviously has psych issues and this makes him a potential danger to us, our patients and visitors". He rolls his eyes and told me (very condescendingly) that the situation is under control, that I don't have anything to worry about. At that very moment, the house doc strolls off the elevator, sees the guy and says that the patient needed to be isolated before anything else was done. So he's taken to a vacant room and that's that. But before the asst admin gets on the elevator, he comes back up to the station and tells us all that we never had anything to worry about, blah blah blah. When he walked off, he made eye contact with me and gave me one of those "you stupid idiot looks" (which I returned):smokin:. I haven't seen this POS since it happened, but I have a feeling he has it in for me now. He's only been here about 6 months, he's kind of youngish and still seems kind of insecure in his roll. I'm not the type to look for trouble, but I speak up for myself and my co-workers when nobody else will. Any advice? Thanks, guys...

Here in the rural areas of western Indiana, "don't have anything to worry about" is a very popular set of last words before something bad happen (usually some form of boat/atv accident). I would have at least not treated him like a total outsider (especially since he was sitting there right in front of the station). He is need of help and he is asking for it. Hopefully he gets it. I believe there is always going to be that part of us that get nervous/scared about handling someone like that. However, you guys could have provided you know a quiet setting for him and offer to help things to clean up with. Again, I just wouldn't have treated him like a complete outsider. I agree you should completely get away and I agree with the idiots hire idiots post lol.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

HEADLINE.........

"Assistant Administrator at #$*^*&, was stabbed by SI patient last Tuesday. Sources state the desperate patient had a history of mental illness and had jut had surgery for cancer, by all reports he had lost the will to live. Staff at the facility say that the assistant administrator "Joe" was a really nice guy and state that he will be missed...."

In the words of Dr. Phil.....What were you thinking???

As an ED nurse....Realizing the threat of danger is not stigmatizing mental illness. It is realizing that there is a potential danger to the patient and the bystandards until a proper evaluation can be obtained. It is clear to me that the SI individual is not processing information properly and the judgement is impaired. Bolting out of a hospital, in a patient gown I assume, with a leaking colostomy to take cover in the nursing home across the street, may indicate that the patient has impaired thinking. I have in my ED travels met many SI patients that ,when cornered, became aggresive and developed active HI.

A calm call to 911 and possibly to the hospital across the street to inquire if they were looking for anyone and an attempt to guide the patient to a secure quiet enviorment wouold be the prudent thing to do( as well as a towel to assist the patient in containing fecal material) as well as gentle inquiries to his name, does he have any weapons, does he hear voices while getting them away from the patient population.

I don't think the OP was showing distain towards the patient........but I clearly got the distain for the administrator!!!!:lol2:

HEADLINE.........

"Assistant Administrator at #$*^*&, was stabbed by SI patient last Tuesday. Sources state the desperate patient had a history of mental illness and had jut had surgery for cancer, by all reports he had lost the will to live. Staff at the facility say that the assistant administrator "Joe" was a really nice guy and state that he will be missed...."

In the words of Dr. Phil.....What were you thinking???

As an ED nurse....Realizing the threat of danger is not stigmatizing mental illness. It is realizing that there is a potential danger to the patient and the bystandards until a proper evaluation can be obtained. It is clear to me that the SI individual is not processing information properly and the judgement is impaired. Bolting out of a hospital, in a patient gown I assume, with a leaking colostomy to take cover in the nursing home across the street, may indicate that the patient has impaired thinking. I have in my ED travels met many SI patients that ,when cornered, became aggresive and developed active HI.

A calm call to 911 and possibly to the hospital across the street to inquire if they were looking for anyone and an attempt to guide the patient to a secure quiet enviorment wouold be the prudent thing to do( as well as a towel to assist the patient in containing fecal material) as well as gentle inquiries to his name, does he have any weapons, does he hear voices while getting them away from the patient population.

I don't think the OP was showing distain towards the patient........but I clearly got the distain for the administrator!!!!:lol2:

I have worked psych for 12 years and have never been injured. I am well aware of how to assess danger and how to stay safe. The OP was not actively involved - she had to ask others what was going on and based on the 2nd or 3rd hand info she got she knew immediately that this person was a menace who should be far away from everyone else and that he potentially was going to attack them all...why did she think this - because he was a psych patient. She doesn't speak at all of any concern for the patient or show any understanding of his situation - just another nurse who thinks all patients with mental illness are about to kill you and shouldn't be allowed around others. I get so sick of this attitude in the hospital from other nurses. It is unfortunately common and I think comes mostly from watching too many movies and mainstream media reporting sensational cases.

If you search news articles you will see dialysis patients have killed nurses, cancer patients have killed nurses, head trauma patients have killed nurses. Yet we don't immediately assume our lives are in danger when caring for these patients. Seeing as the admin had already been talking to this man and assessing his risk, perhaps he was able to clinically judge that this man wasn't at any more immediate risk of attacking him than any other patient.

Specializes in ICU + Infection Prevention.

Just went through hospital orientation. The head of the Psych unit TAUGHT the whole new employee class that the boundary between suicidal and homicidal can be tenuous so keep your guard up, isolate, remove weapons, until someone experienced can deal with it.

Specializes in NICU, Peds.

You came across a situation that others had under control and were dealing with adequately and you stuck your oar in. I'd be a little miffed and give you a "look" too.

I have worked psych for 12 years and have never been injured. I am well aware of how to assess danger and how to stay safe. The OP was not actively involved - she had to ask others what was going on and based on the 2nd or 3rd hand info she got she knew immediately that this person was a menace who should be far away from everyone else and that he potentially was going to attack them all...why did she think this - because he was a psych patient. She doesn't speak at all of any concern for the patient or show any understanding of his situation - just another nurse who thinks all patients with mental illness are about to kill you and shouldn't be allowed around others. I get so sick of this attitude in the hospital from other nurses. It is unfortunately common and I think comes mostly from watching too many movies and mainstream media reporting sensational cases.

If you search news articles you will see dialysis patients have killed nurses, cancer patients have killed nurses, head trauma patients have killed nurses. Yet we don't immediately assume our lives are in danger when caring for these patients. Seeing as the admin had already been talking to this man and assessing his risk, perhaps he was able to clinically judge that this man wasn't at any more immediate risk of attacking him than any other patient.

I am curious, a person who is suicidal does not warrant more cautious measures?? :confused:

Specializes in Med/Surg, Trauma and Psychiatry.

You were absolutely right about what should have been done. The patient declared he was suicidal and was obviously looking for help why he came to the Unit. The patient could have had a weapon on him and he could have escalated to the point where he fatally hurt others and then himself. As nurses we were taught, "SAFETY FIRST," and that is exactly what you apparently were thinking. I am a Psychiatric Nurse and I would be thinking along the same line you were thinking. While someone tries to de-escalate him, someone should have been calling the Hospital Security Personnel because they have training in this area. While the Medical Doctor might be needed at the scene what can he do? If I were you I would make an appointment to speak to the Administrator and explain to him what your line of thinking was, and that you were thinking of the safety of everyone involved. Also, let him know that the hospital Safety Officer was one of the first person or second person you would call to the scene because that is a part of what they were trained to do. What happened in the end with the person, was he screened and admitted to Psyche? Yiggs

Specializes in Family Nurse Practitioner.
Admin types can't think without a computer in front of them.

Psych patients have potential, but for the most part they are looking for someone to help, like we all are. You can say "I'm so sorry you're feeling so bad, come with me and we'll find someone that can help." Escort him down to the ER, or to an empty room (and call EHS) if there's no ER. Give him a towel or Chux for his leaks if they can't be fixed immediately. Offer water, Kleenex and a sympathetic ear. Simple.

Maybe it is because I do this for a living but Canoehead's great suggestion seems like a no-brainer and makes me sad that no one reached out to him like this as soon as he showed up. It is always easy to judge in hindsight but I would think any competent nurse should be able to recognize and assist a distraught patient in a therapeutic manner. Even a psychotic patient will often respond to kind but firm direction and are able to be peacefully escorted to another area where they and your other patients will be safe. Please remember to be compassionate.

Specializes in Family Nurse Practitioner.
While someone tries to de-escalate him, someone should have been calling the Hospital Security Personnel because they have training in this area.

I must have missed this part because it didn't sound like anyone was assisting him but rather all huddled around the nurses station whispering about how to get rid of him. :confused:

Specializes in Medical.

seizetheday - I didn't get from the OP that she saw the guy as a menace in need of quarantining so much as an unknown with the potential for harm to self or others. And supporting her position? The very first thing out of the doctor's mouth. Unless you think he was uninformed and stigmatising too.

seizetheday - I didn't get from the OP that she saw the guy as a menace in need of quarantining so much as an unknown with the potential for harm to self or others. And supporting her position? The very first thing out of the doctor's mouth. Unless you think he was uninformed and stigmatising too.

he obviously has psych issues and this makes him a potential danger to us, our patients and visitors".

I guess this statement says to me pretty strongly what her attitude is towards psych patients. The reality is though that people with psych issues are on every ward because they also have heart attacks and cancer and they have babies and they get in car accidents. Do you isolate all those people and approach them assuming they are going to harm you because they have psychiatric problems. The fact that people believe that having a psych issue makes you an immediate threat to staff, patients and visitors is sad. Compassion for human beings...oh except those with psych issues is really not what nursing is about. Psych patients recount countless stories of the disrespect and disdain they experience from health care providers and how it keeps them from seeking help for both physical and mental health needs because who likes to be treated like they are a criminal or a wild animal when they go to a health care professional looking for help. There is no reason why caution can't be combined with compassion and respect.

Specializes in Medical.

I agree that the OP may not have phrased this optimally, and maybe should have said that this patient obviously had a significant, active psych issue. He came seeking help because he was at risk of self harm. Although most suicidal people are only dangerous to themselves, if this man - who had not yet been assessed - was delusional or otherwise altered he could also pose a risk to others.

I don't disagree that there is still significant stigma toward people with psych issues. I don't think that this post indicates that the OP shares this attitude - I think it's more likely that the focus of her post was the attitude of the administrator.

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