Understaffed and feeling unsafe

[jnks]

I work for a big for profit company that contracts with county mental health services. So of course they skimp on worker/patient safety in the name of the almighty dollar. 
 

my job is in a crisis center that also serves as a hub for finding beds for patients on holds. Management says we don’t take aggressive patients because we don’t do restraints and are not equipped but then says we can’t turn anyone away. 
 

We had a call that a prior patient was coming back our way. He had done a long time in prison for a violent crime and staff had to call 911 last time because he was a threat to the staff’s life. We only have 2-3 staff at night and if there are peds patients, it can be just one staff member alone with 1-4 patients. I can’t get over this fear now about my job.

we don’t have a panic button, I think the police would have a hard time getting inside right away. I am thinking about threatening to walk if they won’t hire more support staff. It’s my day off and I’m gripped by overwhelming anxiety and I’m the least anxiety-prone person in the world. 
 

I love psych but I don’t want to be scared at work. Any advice on how to handle this? I already see my own psychiatrist and therapist so I’m good on that end but want to handle this in a way that will get our staff some support. 

[TheMoonisMyLantern, ADN, LPN, RN]

I can commiserate with you. I loved psych but the lack of staffing and total disregard for staff safety in the name of "trauma informed care" just became too big a price to pay. Some facilities do take safety seriously and staff well, so I hear, but there really aren't that many options where I live. Things have been cut to the bone for so long leadership doesn't even realize that having staff injuries on a daily basis is NOT normal. 

I can tell you that ultimatums rarely work no matter the situation, the best thing you can do is look out for YOU and find a facility that has better policies in place to keep people in place. 

I don't see how your boss can say "we don't take violent patients" but also states "we have to take everyone", both those statements can't be true at the same time.

Good luck to you.

[PsychNurse24, BSN, RN]

I also work at a facility, only PRN now, where we get differing opinions on which patients we take. We’ve had some directors who back up the staff when we say we think a referral patient is too aggressive or violent. Other times we’ve had directors say we take everybody.  You can give an ultimatum but it probably won’t turn out well for you. Panic buttons are pretty inexpensive, so maybe you can do some research on the cost and talk to a facilities person and put in a proposal. Maybe being proactive will help. I know I suggested having loud air horns Before we got panic alarms.  And the nursing office was on the unit and when I first started I left that door open. As I gained experience I always kept it closed and locked. That’s Helped me feel safer. But as the other person said, you might just want to start looking for a new job in psych somewhere else.  Good Luck.

[lilRN16, ASN, BSN, RN]

Try psych in California. Not perfect, but we have mandated ratios.

Hope things get better for you. 

[jnks]

I am in California

[lilRN16, ASN, BSN, RN]

On 8/13/2021 at 5:22 AM, jnks said:

I am in California

You need to tattle... Call OSHA, State Public Health or your local county's Health facility evaluator office.

And if you can financially afford it, run far away... If you're in California, you should be properly staffed.

[hppygr8ful, ASN, RN, EMT-I]

3 hours ago, lilRN16 said:

If you're in California, you should be properly staffed.

California RN here.......Just so you know there are no mandated staffing rations for free standing in-patient psych facilities.

Hppy

[Orca, ADN, ASN, RN]

On 1/23/2021 at 6:55 PM, TheMoonisMyLantern said:

I can tell you that ultimatums rarely work no matter the situation, the best thing you can do is look out for YOU and find a facility that has better policies in place to keep people in place. 

Very much this. If your employer is that entrenched in understaffing, you threatening to leave won't suddenly scare them out of it. 

 

On 1/23/2021 at 6:55 PM, TheMoonisMyLantern said:

I don't see how your boss can say "we don't take violent patients" but also states "we have to take everyone", both those statements can't be true at the same time.

I worked on a hospital inpatient geropsych unit. Supposedly we were there only for mental health issues that could be improved with counseling and drug therapy. In practice, if they had Medicare, in they came, Alzheimer's, end stage Huntington's chorea, you name it. An elderly female patient was injured when an Alzheimer's patient pushed a table into her when we were gathering patients for a group exercise. It wouldn't do wonders for my depression if someone who was convinced that I was their parent repeatedly wandered into my room and took my property. I saw stuff like this happen all the time.

I was once offered the nurse manager job on that unit, and I told them that before I would consider it, they would have to decide whether they were a psychiatric unit or an Alzheimer's crisis stabilization unit. Needless to say, they didn't give me the job. They hired a lap dog who lasted for about three weeks and quit. Another downside was that they wanted me to essentially be available 24/7 and help to market the program in the community, but pay would have been about half what the other nurse managers in the hospital were making (contract company who believed that they could pay out west what they were paying in the south).

[lilRN16, ASN, BSN, RN]

On 8/17/2021 at 6:44 AM, hppygr8ful said:

California RN here.......Just so you know there are no mandated staffing rations for free standing in-patient psych facilities.

Hppy

So you're saying only psych facilities on a hospital license have mandated ratios? That seems really odd... 

Welp, glad I only pick hospital based inpatients... The lack of ratio sounds like a SNF... yikes!

[Nimrodel, BSN, RN]

Re CA staffing, yes, only psych hospitals which are attached to a “medical” hospital have ratios. Otherwise the magic 1:7 does not exist in freestanding psych hospitals. 

[lilRN16, ASN, BSN, RN]

On 9/12/2021 at 6:27 PM, Nimrodel said:

Re CA staffing, yes, only psych hospitals which are attached to a “medical” hospital have ratios. Otherwise the magic 1:7 does not exist in freestanding psych hospitals. 

Where is it 1:7? That sounds like some *insert hick state* foolishness.

California is 1:6