Violence in Psychiatric Nursing

[Mashira]

Hello!

I am a final semester nursing student. I intend on going into psychiatric nursing as soon as I graduate. I have done clinical rotations at one particular facility for about two years now. That is the facility in which I intend to work.

Today I was able to attend a portion of orientation. It was based on how to protect yourself, the patient, and deescalate a violent or potentially violent situation.

I am starting this thread primarily for my fiance, who is very concerned about my safety in a psychiatric facility. I intend to work on the adult acute unit. We have rarely had violent outbursts on my unit. I understand that psychiatric patients are not 'out to get' the nurses/staff/mental health workers. However, in the case of violence, when 'approved moves' are not adequate, your take down team is taking too long, and you have no help, what is expected of the nurse? (I understand that you should ALWAYS be vigilent, never put yourself in that situation, and have team members on your unit in sight at all times.) The question was posed by my fiance ("If you were in a life or death situation, would you defend yourself however necessary"), and I told him that I would do whatever was least harmful, approved, and that would get me out of the situation. He believes that if my life were at risk, I should be able to do what I need to do to survive. Part of me agrees with this, and another part realizes that it is not appropriate, or legal in all instances.

I would really like your thoughts on this situation. Also, I would like any situations that you have been in as psych nurses that may be similar. It would be very helpful, as this topic has caused a lot of hurt feelings and strife for me.

Ending note: I realize that this situation is highly unlikely, especially where I would be working, but the question is "What if..."

[Blackcat99]

I use to work in psych many many years ago. If I was in a life or death situation with a psych patient I would do whatever I had to do to save myself even if it meant hurting the patient. The way I see it, I can always find another job. If I'm dead, I'm dead for good period. Don't get yourself killed by worrying about doing things the "approved way". Do what you have to do to save yourself in a life or death situation.

[bekindtokittens]

I went into psych as a new grad. I recently felt the urge for a change and spent two weeks at a job in sub-acute. I felt threatened there just as much as I have working on my acute psych unit. I've since returned to psych full time and realize where my passion lays.

However, if I was ever in a position in which a situation got out of control and I didn't have enough staff in order to do a "proper" take down, I'd do what needed to be done to keep myself alive. If an employer wants procedures followed, they'd better staff the unit appropriately.

[Meriwhen, ASN, BSN, MSN, RN]

My better half and parents were worried about me working in a psych hospital. I told them that it's far safer than working in an ED: it's a more controlled enviroment and we get special training courses in the art of deescalation, self-defense, crisis management, and how to give an injection under any possible circumstances.

I'll admit, there's some things about my work day that I don't mention to the family--being threatened sometimes, propositioned at other times, having the occasional thing thrown at me (and I'm definitely not mentioning to them the one time the object hit its mark!). And you can't ever be lax at a psych facility--you need to be on your guard at all times. But I feel far safer there than I would working in an ED or even in a regular hospital.

As far as if there not being enough staff during a crisis...I haven't yet encountered that during a code--our facility's staff (not just clinical staff--including them all from maintenance to management) is pretty good about responding to codes. But should such a thing ever happen, I agree with bekindtokittens: I'm calling 911 and focusing on keeping myself alive.

[geode19947]

I am in a similar situation. I was previously a nurse in a prison and will now be working at an adolescent unit (residential treatment center). I, too, am concerned about the violence...i look forward to hearing what anyone has to say on the topic of "what if...". In prison, I always had the protection of the Officers. My perception is that inmates have more behavioral issues than those in psych unit. Is my perception correct or slightly deviated?

[brownbook]

Yes of course, if you are in a life and death situation as a Psych RN (or any RN) and you have to defend yourself. Kick, hit, scream, yell, bite, all of that is legitimate self defense.

Reassure your fiancee your psych unit is safe, has mandated training for all staff, has emergency response teams, etc. You have more chance of getting killed driving your car on the way to work than being beaten up in a psych unit!

Sounds like something my husband would pull on me to get me to NOT do what I want to do, not work where I want to work, etc. Since I am experienced in this type of controlling relationship, sounds like your fiancee has some control issues?

[drmorton2b]

To keep it brief. It all depends on the patients and many other variables.

[Mashira]

Thanks everyone! I really appreciate all the responses.

I agree that if it comes down to it, instincts will kick in. I honestly don't see it happening, and I just wanted to reassure myself and my fiance of that. I'm not sure if this is standard, but you aren't allowed in or out of my Psych Facility without a visitor ID#, employee badge, or police badge. So, my fiance will never be able to see how nice/calm/controlled the facility really is. (Which he understands as he works as a military contractor, and I could never see his workplace).

He's not at all controlling, just very concerned about my safety. He has never tried to convince me to give up Psych (except for initially, when he thought it was like the 'movies'). However, that was quickly handeled with letting him in on what it's really like, pulling up research articles, meta-anaylsis ect..

As we are now engaged we've been talking on 'What about work when you're pregnant?', 'What if you get badly hurt?', just a lot of those 'What if...' situations that it's good to make clear in the beginning so that there are no surprises down the line.

Thank you again for all your help!

[texasbsn]

Hi Just wanted to put in my .I have been a psych nurse for 1.5 years.I have been hit but, but it is rare.Desclation is often the key. I agree that the ED is more dangerous.On a psych floor their are procdures in place to keep the enviroment safe for pt and staff.Good luck:)

[texasbsn]

I currently work in psych(1.5 years). there are many procdures in place to help protect pt and staff.Good luck in your choice.I find psych nursing to rewarding.:)

[tishmarie]

Safety is your number one priority. Never go into a situation alone. Make sure you have people there to back you up. And never be afraid or show that your afraid. The hospitals specialize in medical emergencies and are not prepared to deal with psy issues and most of the time problems arise when a patient arrives at the hospital with a medical condition due to psy issues or psy issues manifest through the ordeal. The other day a situation occured with a patient and I felt more scared than I ever have in my life. It made me think that I might just go back to school for the psy tech program because I felt safer at the prison I used to work in. I mean at the prison I was never scared because I knew the CO's would help me. At the hospital security isnt even alloweed to carry mace.

[RevolutioN2013]

My husband is afraid for me to work in psych. I am pre-nursing but I am really interested in the field. We have a local VA hospital in my town which in my view is an excellent place to practice. However, about 5 years ago a disturbed vet came in and when he perceived that the doctor and nurse were out to hurt him he shot and killed the doctor and wounded the nurse. This is all my husband focuses on when I say I want to work psych.