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..."
There are a lot of ways to stay safe- never put your back to a patient/group, never go into a room alone, walk with your back to walls, etc. Doing these things takes a lot of the danger away, since you can see everything going on and aren't alone. Speak up when staffing isn't adequate. I have still been hit/kicked/punched/bit/spit on/etc. Never be out of ear shot of other staff to yell for help. Most of the time the patients aren't looking to kill you, just **** you off. If a patient is and they get you- do what you have to do to stay alive/uninjured. Being jobless beats being dead IMO. I am all for self defense.
Thank yall again for all the replies. I have applied to the facility I was talking about, and my professor has informed me that someone called for a reference. I will be working the night shift (11p to 7a) if I get the job.
This facility is an acute in-patient facility. Normal length of stay is approximately five days, but you have the oddities that are only around for one day, or stay as long as two or three months.
I feel a bit more comfortable working nights as the pace is slower, and I will be a new nurse, so I think this is beneficial for me. The facility has PCI training for all employees that is mandatory.
I suppose my last question would be: Has anyone worked the night shift in an inpatient facility, and what are the pros/cons what should I expect on a 'busy' night?
Thanks again!
ETA: I thought I would add that the Pt. Dx generally consist of Psychosis, Schizophrenia/Schizoaffective, Bipolar, and Major Depression
I work at a state mental facility, pretty much the worst of the worst there. The thing about psych nursing is that you never know what a violent situation is going to stem from. You always have to be hypervigilant. I've had full out fights stem over a can of pop. I think the key is your staff. It is vital that you have good staff around you and that you trust them. When I first started, the staff really took me in and taught me everything I needed to know. Where I work you aren't allowed to use restraints, only "seated holds." Let me tell you, it is ridiculous. When someone is spitting at you, punching, and kicking at you, it's pretty hard to put them in a seated hold. You asked about doing whatever necessary in order to save yourself.. That's tricky.. I would say if you trust your staff then do whatever necessary to get out of the situation, and then document your ass off. Meaning, documenting that you used all of the proper holds and procedures. If your are working with good staff members they will back you and also do whatever needs to be done to make sure athat all staff are safe. But, you can still be charged with patient abuse at the same time. Its a tricky situation..
I just saw the question about nights.. I work either 3-11 or 11-7. I would say on the 3-11 shift there is more acting out and behaviors because the patients where I work usually do not have groups at night, so there are limited things to keep them occupied. Night shift where I work is usually very quiet. You have a few things to do that usually only take up an hour or so of your night. The rest of your shift is yours to either read a book, or work on any annual reviews or documentation you have. Sometimes the patients sleep all night and you have nothing going on, but if you have patients that are very manic and not well medicated, then they will be up all night. They could be yelling, or banging things around, or just pacing the halls. It depends on the patient. I would say that for a new nurse I wouldn't want to work all night shift because you really hardly ever get to do any nursing. I would want to be in an environment where I was learning everything I could if I were new, and then eventually go to nights!
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?
My own experience with adolescents is that they are more dangerous than adults. I've worked with both and never had any aggression come my way from the adults, but it did a couple of times from the kids.
My experience is my own. It's not necessarily going to be true for anyone else. I'm just responding here, that's all.
I work at a state mental facility, pretty much the worst of the worst there. The thing about psych nursing is that you never know what a violent situation is going to stem from. You always have to be hypervigilant. I've had full out fights stem over a can of pop.
I think the key is your staff. It is vital that you have good staff around you and that you trust them. When I first started, the staff really took me in and taught me everything I needed to know. Where I work, you aren't allowed to use restraints, only "seated holds." Let me tell you, it is ridiculous. When someone is spitting at you, punching, and kicking at you, it's pretty hard to put them in a seated hold. You asked about doing whatever is necessary in order to save yourself.. That's tricky. I would say if you trust your staff then do whatever is necessary to get out of the situation, and then document your ass off. Meaning, documenting that you used all of the proper holds and procedures. If your are working with good staff members, they will back you and also do whatever needs to be done to make sure that all staff are safe. But, you can still be charged with patient abuse at the same time. Its a tricky situation..
It's an insane situation. You are not allowed to fully protect yourself, you are required to be kind and patient and "superhuman" at all times. The "suits" are rarely exposed to the patients, the lawmakers and policymakers are similarly removed from the front lines, yet you must do what they tell you to do, which could get you seriously hurt or even killed. You should not have to be injured at all as part of your employment conditions.
Psych was too much for me. At least in the ER, I can use whatever level of force is necessary to defend myself.
I think you (OP) need to consult a few attorneys in your state and find out just exactly what the law is about a nurse in Psych defending herself from patients.
If you expect staff to "back you" and lie for you, forget it. No one is going to do that, nor should you. You'll be in even worse trouble.
Thank yall again for all the replies. I have applied to the facility I was talking about, and my professor has informed me that someone called for a reference. I will be working the night shift (11p to 7a) if I get the job.
This facility is an acute in-patient facility. Normal length of stay is approximately five days, but you have the oddities that are only around for one day, or stay as long as two or three months.
I feel a bit more comfortable working nights as the pace is slower, and I will be a new nurse, so I think this is beneficial for me. The facility has PCI training for all employees that is mandatory.
I suppose my last question would be: Has anyone worked the night shift in an inpatient facility, and what are the pros/cons what should I expect on a 'busy' night?
Thanks again!
ETA: I thought I would add that the Pt. Dx generally consist of Psychosis, Schizophrenia/Schizoaffective, Bipolar, and Major Depression
Expect acute patients to be out of control. They have likely been off of their meds and it is going to take some time to get good blood levels of their meds.
Pros of a busy night - well, I guess it's going to go quicker, maybe you will like the "excitement".
Cons - danger, too much work, no breaks.
Nights - should be quieter than days or evenings. time to learn, time to read histories, time to study the diagnoses in DSM-IV and other reference books, just quieter over all as you learn policies and procedures and learn bedside psychiatric nursing.
Seated holds sounds like you require a great deal of strength for this method to work. I have no idea how this works I'm guessing you have a nurse either side and sit the patient down and prevent them standing up.
If we tried to use such techniques in our forensic facility I foresee at great deal of staff injuries. People being put in hospital by patients, massive amounts of sick leave.
We use restraint called C & R. It basically bends the patients wrist back and inflicts a great deal of acute pain. Very effective and had been in place for 18 years now. Not one broken wrist in our work place.
Our work place is very unionised and when we are confronted with people attempting to change the way restaints are done we can always make it a union issue or health and safety issue.
Oh a note about night shift. Kick back watch TV bring in a laptop play some games. Reading polices and patient histories at 3.00am is useless, your brain is all mush. Do the basics but just relax. This is my opinion. When you look back on your career will you say I read polices at 3.00am or watched Dexter on my laptop and got paid for it. :)
Specializes in Med./Surg., Diabetes, Med. ICU, home hea.
Yes, there is "training" in de-escalation, physical restraint. When an involuntary client is angry, psychotic (or both), intent on leaving, hurting another client, you, etc., this can be of little help. I have been in numerous situations where there is just not enough room for enough bodies to easily restrain a client. Adrenaline is amazing, I'm a sizeable man and have had difficulty managing one limb. Elderly, adolescent females, persons of smaller stature can and do become formidable opponents when fear and anger take over. This year alone, I've been to urgent care 3 times and am still undergoing blood draws.
Don't get me wrong, training, education and experience are critical, but I can't imagine a psychiatric unit that is so well staffed that they can assuredly handle all situations.
Yes, you can defend yourself, but at the LEAST, you WILL be terminated no matter WHAT occurred. If you are terminated, your nursing career will likely be over (and not just in psych).
If you feel you MUST work in psych, I would steer WELL clear of state facilities, county facilities, any facility where the majority of clients are involuntary if at all possible. The toughest situation is where the court orders medication for an involuntary client and you MUST give it come hell or high water, KNOWING FULL WELL the client is going to resist violently.
Psych can be so rewarding, helping a tortured client steer back to hope or consentual reality. But where else in nursing is it taken as a given that if you expect to NOT be assaulted, spit on, bitten, cursed, threatened, stalked, YOU are the one not facing up to reality and need to find a new job?
Yes, you can defend yourself, but at the LEAST, you WILL be terminated no matter WHAT occurred. If you are terminated, your nursing career will likely be over (and not just in psych).
Thank goodness we have acts of law that prevent this type of issue. If someone is trying kill you and you are sleeper hold and you punch them in the groin you get fired?
So basically you need to be a punching bag? And not defend yourself because of fear you may lose your job? Is that the same for police,corrections officers or anyone else that deals with violence?
In NZ we are allowed to use resonable force to protect ourselves or others.
Don't get me wrong, training, education and experience are critical, but I can't imagine a psychiatric unit that is so well staffed that they can assuredly handle all situations.
My work place. 8 staff to 15 Pt ratio; if acuity increases then the staff to pt ratio increases. I think we can handle 99% of violent situations and have only had to call the police once in 18 years.
Guest717236
1,062 Posts
You must have a cohesive team, the team needs to work together
to ensure safety. I never worked inpatient at a hospital. I did work
years in a psychiatric crisis center which in addition had 10 patient
beds. The day shift had 3 RNs and 2 MHAs. In the evening it was
one RN and one MHA. Although we were in a city environment,
the police responded very quickly for transport.
If it were not for an outstanding team who worked well together
I would not have stayed as long as I did (7 years).
There are inservices to help you learn how to protect yourself if
faced with an situation where the patients acts out.
Keep your awareness at all times, sometimes it is the patient
we least expect whose behavior can change suddenly.