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). 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...
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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.[/quote
Ouch.
Okay, I hear you..... but....my post was not personal to you or anyone. I am very glad you have been never injured by one of your patients. My experience, however, is a different story as Emergency Room nurses are injured every day by patients with and without a psychiatric diagnosis and I most cetrtainly do consider that any patient or visitor can put myself, my staff, the patients, and other visitors in danger. My "What were you thinking" was directed towards the administrator who was, in my opinion, being a little blase about the whole thing and the potential headline that accompany these type of sensational stories.......All very tongue in cheek.
Your experiences are not my experiences. If you search news articles there are patients hurting emergency workers all the time. I will tell you that I have been injured and threatened by situations judged by others as not big deal. I have been in Trauma Room with a multiple gun shot wound victim when another staff member felt it would be helpful to a loudly grieving, "My brother, My brother, My brother", family member access to the patient and let them in the room.........:eek:fter the police tackled the young man and I got up off the floor that I threw myself upon to avoid being shot, and cleaned the crap out of my pants, I realized I couldn't hear properly due to being in close proximity of the discharge of a firearm in a closed room....my ears rang for weeks.
I never looked at innocent by standers the same way again.
Or the nurses I had a discussion with that a patient who admits to HI and SI who says he has a hand grenade in his backpack in the waiting room cannot refuse to be searched for weapons.....who by the way was escorted to his room and left fully clothed with his wallet and 12 in chain attached intact wearing his steel toe'd boots with his switch blade inside his boot.:smackingf Another time when a upset family member went out to their car and returned with a gun........and opened fire. Or the guy who came into the ED in the middle of a heat wave in a long trech coat that gave me a funny feeling he had a shotgun under there and robbed the departmet of narcotics.......
I can go on and on........An ounce of protection is worth a pound of cure.
I have to say if I came around the corner and I unexpectedly saw a stool covered stranger in a patient gown cowering on the floor......My first question would be...."What is going on here" and I probably mouth the words to whomever caught my eye (staff) that was standing there and my next response would be......"Why are we leaving him here in the middle of the hallway where we can't control the situation leaving everybody vulnerable, including the person on the floor, and get the guy off the floor and into a room away for staring eyes of staff and visitors......in some attempt at safety and dignity for the guy on the floor." I feel the OP's animosity was toward the sarcastic administrator, who she's had issues with before, who was being a pain to her and not helping the patient leaning with his back towards the person on the floor obviously in distress.....ignoring the guy all together on the ground like he doesn't exist...... I mean really....get the guy off the floor and attempt to give him so dignity and privacy, he's obviously in distress:icon_roll........At least that was my thought.
I agree. I ,too, kind of get sick of all the attitudes, and I mean this in the best and general way I can (so here it goes) and intolerance of others nurses who cannot see nor accept another persons experiences or point of view as being valid or their own and are so quick to judge one another which is becomming unfortunately comon in our profession amongst our peers. We need to be kinder and gentler to each other and nurture each other along as we share our points of view.:redpinkhe
Just my :twocents: :)
by coincidence an article..http://www.abc.net.au/news/2011-07-13/butter-knife-nurse-attack-130711/2792552
I, too, kind of get sick of all the attitudes and intolerance of other nurses who cannot see nor accept another persons experiences or point of view as being valid or their own and are so quick to judge one another which is becoming unfortunately comon in our profession amongst our peers. We need to be kinder and gentler to each other and nurture each other along as we share our points of view.
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.
Wrong I always assume my life is in danger when caring for any pt with the exception of a NICU pt & with them I wouldn't put it past an upset,overwrought parent to take someone's life. Reality is I don't know what anyone has going on in their heads but I do know that cancer, renal failure, losing a job can all make people snap. I appreciate what you do and your understanding of mental illness but I have seen far too many people injured because they thought a person was "safe." Cruel of me to say but everyone who met Ted Bundy felt he was a charming and charismatic man, his # 1 tactic was to feign injuries or to pose as an authority figure. He approached every single person he murdered in a public area.
Odd, but both times I've had a patient take a swing at me, they were "normal" patients. They were just cranky and over- entitled. My patient that had paranoid schizophrenia? Not one issue.
Nothing wrong with being safe but I have seen nurses and other healthcare workers express a prejudice towards the mentally ill. I'm not saying the OP is one of them. But the stigma is out there.
When I first read the OP, I pretty much agreed that having your back to the pt. and not escorting him to a room (by means of theraputic comm. and deescalating of course) were huge mistakes.
Then I read on and was a little surprised by stating this is an over reaction. But the arguement about why it is makes sense too.
For me, I think the "I want to kill myself" hence suicidal ideation is the red flag. Upon reading that, my thoughts became very defensive and "safety first". Safety for the patient and myself/other people both of course.
I guess you can do the right thing but do it in the wrong way. I can picture myself going through the proper mechanics of handling the situation..........but doing it in a "How do I get this guy away from me" way too (as someone described the OP post as sounding). Thats not good either. I'll have to pay attention to that.
I have no disdain toward psych patients. I did not say anything within earshot of this patient. I said he was a potential danger because he's suicidal and could have a weapon. I understand that there are nurses that have a certain attitude toward psych patients - there are also nurses that have a very defensive attitude who fail to clarify the tone of a post before being insulting to the OP. I'm not trained in handling psych patients; I'm also a petite 5'2, I have kids and I recently found out I'm pregnant. My husband was upset because I even said anything. The reason I posted this was to seek opinions on what I should do (if anything) as follow-up with my manager. Thanks to all who have responded appropriately and for everyone's support.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
quote]
this was actually years ago no less.......south side chicago and gary indiana (which by the way is nothing like the song in music man....)michigan cit, in......... oh and the and grenade.....massachusetts outside of the city proper......
i have always been what you call #@%* maganet....
thanks!*wine! and you know what.....i actually really loved my job and the people i worked with.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I have no disdain toward psych patients. I did not say anything within earshot of this patient. I said he was a potential danger because he's suicidal and could have a weapon. I understand that there are nurses that have a certain attitude toward psych patients - there are also nurses that have a very defensive attitude who fail to clarify the tone of a post before being insulting to the OP. I'm not trained in handling psych patients; I'm also a petite 5'2, I have kids and I recently found out I'm pregnant. My husband was upset because I even said anything. The reason I posted this was to seek opinions on what I should do (if anything) as follow-up with my manager. Thanks to all who have responded appropriately and for everyone's support.
I think your administrator was the inappropriate one and anyone with any backgroud knows not to turn your back on an unstable patient and my bigger qiestion is Why wasn't he comforting and talking with the patient trying to gain trust and start a rapport with the patient to help de-esclate the situation.
Stigma against mental illness alive and well in the nursing field. Having a psychiatric illness does not automatically make one a danger and having a mental heath issue does not mean you should be isolated form the population. I understand your concern about the unknown but the disdain you show here for mental health is what keeps people form seeking help - and why many kill themselves without seeking help. people are told go to a health professional - here a guy asks for help and he gets a visceral reaction from you about how dangerous he is and get him away from me and everybody else. I am glad other people on the unit were able to treat him like a human being.
"Having a psychiatric illness does not automatically make one a danger."
No, but declaring that you want to kill yourself and presenting in a obviously distressed and disorganized fashion indicates the possibility of a weapon and a level of instability that has to be taken seriously. Caution in such a situation isn't stigmatizing mental illness; it's recognizing the very real possibility of danger to everyone involved.
"Having a mental health issue does not mean you should be isolated from the population."
He needed to be taken to a quiet area because his words and his behavior showed him to be a potential threat. This is not the same as isolating someone because they have mental illness.
"The disdain you show here for mental health is what keeps people form seeking help."
I saw no disdain from the OP toward the patient. Toward the administrator, yes, but the patient, no.
"here a guy asks for help and he gets a visceral reaction from you about how dangerous he is and get him away from me and everybody else."
The man didn't actually ask for help. He showed up all disheveled and said he was going to kill himself. His actions may have been a plea for help, but the way he did it shows an air of desperation, and desperate people are capable of all kinds of things.
The OP's idea of getting him away from the nurses' station into a room and away from all the hoopla and staring spectators was a good one with the potential of de-escalating both the situation and the patient.
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.
This was also a good approach, although I would have asked the man if he had any weapons or sharp items on him. I would also have asked how he planned to kill himself to assess how serious he was and how imminent the danger might be.
It's a mistake to look at psych patients like they have three eyes and they'll jump you the second you say something wrong.
It's an equally big mistake to ignore serious indicators of escalation and potential harm so as not to make the patient feel bad.
. 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...
:eek:
Esme12, ASN, BSN, RN
20,908 Posts