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..."
Specializes in Med./Surg., Diabetes, Med. ICU, home hea.
At some point, SOME day, we/someone will HAVE to address the issue of violence in nursing, but especially psychiatric nursing. It is disturbing to me that we as health care providers have come to accept violence against us as nearly "normal," as "expected." How many of you/us, in nursing school, were told to expect voilence against us if we went into certain specialties and, if we didn't like it, should choose a different career?
Some day this will HAVE to end. HOW it will end is the issue, but it MUST. That society accepts violence against its health care providers in ANY setting is INSANE.
While I have not been personally assualted, I have/had many coworkers that have been. We have a detox unit, adult acute unit, adolecent unit and a step-down (from the acute unit and/or SI and depresion).The only limitations to admission are level 2 and 3 sex offenders, and medical acuity. I think my job is just as dangerous as the working in ER since they all typically have to be cleared through one prior to coming in. In all honesty, i think my job is just as dangerous as a cop, but the only weapon i get is "verbal deescaltion training". I can't tell you the number of dirty needles, drugs, alcohol and most frighteningly knives(no guns yet) i have found in peoples stuff AFTER coming from the ER. Just last the other night we were searching and involuntary pt backpack and found and 8" knive(that's just the blade, not counting the handle) and a 6x6" pouch full of large glass shards.
While it seems benign, since one of the obvious purposes of the search is to find such things, but everyday I am shocked at the new ways pt smuggle things in or staff incompetance during the search(enabling the smuggling). It's not the things I do find, but the things I don't that truely frightens me. Everytime i go in it is at the front of my mind that today could be the day that i get beat up. This whole idea of a controlled environment is a myth.
The milieu is stable, because we work our butts off to promote as much cooperation as possible and most importantly, BECAUSE THE PATIENTS CHOOSE TO BE cooperative. Mental illness is not a risk factor for being violent nor is working in a psych facility a risk factor for being a victim. Yeah we get deescalation, fake self defense(you'll see, it doesn't really help), and all kinds of seemingly reassuring trainings, but at the end of the day if you don't recognize that they cooperate because they choose to be(and the tricky part of our job is finding out what helps them be cooperative with us) that is when you're at the greatest risk for violence. I say this because the patient will pick up on it before you're consciously aware of it and will feel like they have no choice anyway so they might as well get their kicks in while they can.
Nurses categorically are at risk of being victims of violent crimes specifically because we work with the public and there is very little if any consequence for such behavior, and professional/administrative pressure not persue what avenues that are available to us. What makes us as psych nurses feel so vulnerable is that we are acutely aware that a lot of patients are out of touch with reality and we have no way of knowing whether they(or the internal voices) are entertaining homicidal/assualtive thoughts about us or anyone else.
Until we as psych nurses stop making excuses for criminal behavior the media and public at large will continue promoting the myth that the mentally ill are violent and/or aggressive and that psych hospitals are dangerous places. If you read anything about mass shootings in the past few years, as soon as it is discovered that the shooter had mental health issues that becomes the chief topic when talking about the shooter. Rather than just saying he was a murderer and it's scary since he "looks just like the rest of us" it becomes, "he went to the university clinic/supervisor/ranted on youtube revealing...[mental illness symptoms]"
Specializes in med-surg, post-partum, ER, psychiatric.
Great posts I have been reading.......As I stated in an earlier post, I work on one of THE most violent units in the hospital, and since that posting, it has become worse..........unbelievable. :uhoh3:The thing that comes to hurt us as staff is that because of the population of patients we have, THEY have more rights (because they are under age 18) and are more protected.......and they know it! My staff, currently, are very leery, worried, concerned,etc., in anything and all they do due to this. We are currently under the microscope AGAIN because the number of our seclusions and restraints have gone sky high........vice it being looked at as to WHAT is REALLY:eek: going on, it seems what is staff doing wrong (well, they are NOT perfect, but at the moment, they are totally doing the best they can overall) ...........I had a discussion the other day with our staff psychiatrist that I am totally convinced that it is the programming that is being used. We have been trying to say this ever since it was instituted; however, the "powers-to-be" totally disagree...............I am totally realistic that it does truly take time for a patient to come around and finally be in compliance, but under the programming we had when I first started, it was FAR more effective (even for the most impaired of the patients in their executive functioning) than what we are using now. Even the patients make comments about it. They know and know how to totally manipulate, especially with this current programming. :mad:The other thing that is so frustrating is that our staff are highly educated (most have their bachelor's degrees); however are treated less than............mostly by the therapists (a couple in particular), because staff do not have a master's degree et al. However, it is OUR staff who are working with the patients day in and day out 7-days a week and holidays/weekends, whereas the therapists see them for their once a week ONE hour group or sometimes for individual therapy depending upon the patient. They do NOT see the day in/day out actions of these patients and only see/know what the patient does when they have that short period of face-to-face. But yet, overall, our staff are not respected to actually be totally listened to. Every once in awihle, they get lucky. Heck, one therapist is totally "terrified" to come onto our unit. The only time this therapist comes onto the unit is for therapy group(s) and if it is at any other time, it is for a VERY short period of time. :uhoh3:Another thing is that our nurses'/tech station is totally exposed and we have complained a multitude of times to have it enclosed (like on the other units), but the powers-to-be won't allow us to have an enclosed place when we have made suggestions/recommendations as to how it could be done:mad:; however, when we tried to have a boundary set around the nurses'/tech station, we were told to remove it in that it was too "restrictive" or something like that.................so here we are supposed to be teaching patients about boundaries, respect and limit setting, safety, et al, but yet nothing for us to be protected. I have been sitting at the computer doing my charting and getting hit, attacked, et al, because patients climb up over the countertop or barge into the station. I feel that there is very little to nothing done for our safety except for what we are taught when dealing with the patients out in the milieu. Also, we get bullied by patient's family members (one, who got upset, because patient ended up in a physical hold with the intent to seclude, actually called the local police on me and they actually showed up at the unit). Long story on that one of which I won't go into here, but we deal with violence (verbally and physically) on all fronts like I have never seen before........even moreso than in the ED, et al..........
That all said, I would not leave psych nursing for anything (except maybe to go to a Trauma/Level 1 ER here)........... :redbeathe
Specializes in Med./Surg., Diabetes, Med. ICU, home hea.
I've been wondering: what other profession (besides nursing, especially psych and ER nursing) has increasing levels of violence against employees, increasing injuries and even deaths, yet is not mandated by OSHA or some such to make effective changes (other than another useless committe, more safety posters, etc.)?
I've been wondering: what other profession (besides nursing, especially psych and ER nursing) has increasing levels of violence against employees, increasing injuries and even deaths, yet is not mandated by OSHA or some such to make effective changes (other than another useless committe, more safety posters, etc.)?
I haven't seen any hard figures, so I'm not saying you're wrong, but my own observation over >25 years of inpatient psych nursing is that there seems to be a lot less physical aggression than there used to be -- at least in the settings in which I've worked.
Specializes in med-surg, post-partum, ER, psychiatric.
Great and interesting/informative posts from all. Elkpark, I wish I could same was true where I work reference the decrease in violence. We are quite the opposite. In fact, it is a constant topic as to how our numbers have increased in seclusions and restraints as a result of the violence on our unit. A lot of "theories" have gone around from: number of patients, number of back-to-back admissions, types of patients, etc. We have had this number of patients on the unit before so that can be essentially ruled out. The current staff we have of which the majority did not work on our unit when we had that many patients as we have now, and were hired on when there were half that number, so it was a "shock" to them. THAT could be a factor of the "new" staff not having worked with the number of patients we have now compared to when they first were hired. There could be the possibility of the numerous of back-to-back admissions have contributed to the increase of negative behaviors in that it could have contributed to disrupting the milieu of the other patients already adjusted to the unit. But I personally feel it is much more than that in that we have had back-to-back admissions, and yes, the milieu was disrupted, but for a SHORT while. This has been ENDLESS. So that leads to the possibility of the types of patients we are getting now vice before. But then again, we had violent patients back then, too. But even with that, those patients could be worked with and despite their violence, staff still enjoyed them. NOW, it is a different story. I personally think (as do some of our more seasoned core staff) that it is a mix of the type of patients we have been getting coupled with the current treatment program that was "redeveloped" since I was hired on the unit. All of us who worked on the unit under the other programming have all agreed that when the "new" programming was instituted we saw a dramatic increase of the negative behaviors and that was with giving the new program time. Heck, the patients even verbalized various things about the new program of how they could have certain behaviors and nothing could be done about it (compared to the "old" programming). The treatment team feels that programming was too "punitive"............the old program developed REAL WORLD life skills and in the real world they are NOT going to get all of these options and chances. What we all feel we are teaching our patients is "enabling" overall. At any rate, I could write a book on all of this. LOL At any rate, I personally feel the KEY in reducing violence on the units is the ENTIRE treatment team is actively involved, working side-by-side with our psych techs and us RNs. A few years ago, when JAHCO was at our facility, another team (not affiliated with JAHCO) also was visiting. I believe they were out of MA. At any rate, they told us that they essentially reduced their number of seclusions and restraints to ZERO. HOW? the ENTIRE treatment team was involved actively ON the units. The rationale was that the psych techs and the RNs are involved with the patients 24/365, so why not the treatment team (at least during the patients' waking hours. I have brought that up from time-to-time, every time something is mentioned about how our seclusion/restraint numbers have gone up (which is quite often.......we were averaging over 10/day and then some....it has dropped down somewhat, but the violence still remains even though not to the point where intervention is warranted). It falls on deaf ears. Heck, one of our social workers/therapists, when asked to be on the unit, always has some excuse or another. She is scared to death to be on our unit. A few years ago, when it was directed that they be on our unit by their supervisor, as a result of having so many of our core staff off duty due to injuries, she refused to be on the unit and when she was had one of our OTs with her. But yet SHE is the first to complain abuot what staff is doing wrong and criticizing. She is a HORRIBLE therapist (as you can see by the outcomes of so many of her patients overall). She is doing NOTHING for and with her one patient we have at the moment and this patient has been with us for nearly a year. But that is another story. So, what make sense totally it is not being done at our facility. WHY? More-than-likely, as with everything else, it comes down to $$$$$ ...............and the fact the therapists/treatment team would actually have to work a weekend or evening............Hmmmmmmmmmmmmm.............and not have their Mon-Fri schedule of coming in after 0900 hrs and leaving by 1600 hrs (seriously)......Add to all of that, we are also in a staffing shortage not only on our unit (just lost two more staff...........they "quit".....translation: they would have been administratively removed from the unit/hospital), and the entire hospital being short staffed (amazingly always on weekends and holidays and holiday/weekends............FMLAs abound, etc.)...........and no consequences as a result, even with the requirement of having to have a doctor's note, especially on holidays, holiday/weekends. I have worked weekends that we were so critically short-staffed throughout the entire hospital that the DON came in to work and mandated that the Administrative Dir/Unit Nursing Directors come in (all of the units) to work as psych techs that weekend (all shifts).........vice something being done about this, this has gone on for as long as I have been at the hospital. Our DON is way too laid back overall is the general opinion. When that happens, we see an increase in the violence on the units. We are lucky if we have TWO security officers on duty, most of the time it is ONE for the entire hospital. And the patients pick up on that, and act out as a result. I guess, unfortunately, before somebody wakes up and truly listens to all of us about our concerns (and how we also have a right to be safe and protected) it will take something extremely bad to happen. Vice being proactive all-too-often it is reactive in approaches. We have a very close-knit unit with our staff. Many are waiting to get into masters-producing schools for their social work, and truly have a love for what they are doing. The come in day in and day out and put up with getting punched, spit on, kicked, scratched, bitten, peed on, etc.........and feel like there is always a dark cloud luming over their heads out of fear they could lose their jobs if something goes amiss in that so many things are in the gray area or how it is "interpreted" by the treatment team when they are watching things on the video cameras (of which can be a blessing but have also been a curse) vice the team actually BEING on the unit to see how things are from start to finish with the patients. We sure are NOT doing this for the $$$$, that is for danged sure. At any rate, just because people are mentally ill does not justify them to be violent towards staff nor justification that staff have to "take it" because they are working with the mentally ill. They KNOW full out what they are doing in MOST cases. I know that from the debriefings I do with my patients after a seclusion/restraint. Just as the patients have full rights to be protected and safe, there MUST be measures in place to have the same rights for staff, too. And it should be mandated by law as it is for the patients. I am tired of seeing so many of the professional publications constantly talking about work-place violence but yet I have to see what is truly being done about it. When I (and some of my staff) have presented suggestions as to how to protect us (simple things such as enclosing the nurses' station not only to protect us but also our expensive equipment in the station (camera monitors, cables, comptuers, etc.), they won't do it at all and flat out told us it is not going to happen. Yet our equipment is constantly being broken and damaged. That is really saving money when we are in critical budget crisis and having to constantly cut back on spending all over. Hmmmmmmmmmmmm...........................Well, again, I hope it doesn't take something so serious to happen before something is done to protect staff as equally as the patients are protected. WE ALL have the equal rights to feel safe and be protected. Maybe one of these days......as I keep telling myself. This has been a very interesting discussion forum. Great info! :-)
Specializes in Med./Surg., Diabetes, Med. ICU, home hea.
Thank you, Sarmedic70, for keeping this thread going. Sometimes, we nurses (and other healthcare professionals) can be our own worst enemies. We ALL must be ever vigilant against those, even in our own ranks, being cavalier concerning violence against us. We can expect the pencil pushers who are out of harms way to be this way, but when our own tell us to accept this behavior, even tell us to find another profession if we don't like it, is unacceptable. Administration considers nurses (and other health care professionals) as "dime a dozen," easily replaceable... we must never think this way about ourselves.
Specializes in med-surg, post-partum, ER, psychiatric.
Thank you, YosemiteRN I am quite passionate, hello duh, about this topic of violence in the work place. You are so very correct as to how we ALL must be ever vigilant about those who are cavalier about the violence inflicted upon those of us who work the "front lines." I (and my staff) are so frustrated with how the "attitudes" are amongst most of our treatment team, demeaning our psych tech staff because they do not have masters' degrees (quite a few have their Bachelors in either Social Work/Sociology/Psychology and are awaiting to get into a Masters-producing course, one postponed furthering her education to raise her family and she has life experiences; however, none of that matters. I was sitting in a meeting a couple or so years ago reference how to reduce the numbers of our seclusions and restraints (this was when they were about 1/3 of what we have been having of late........hmmmmmmmmmmmmmmm)....and our PhD Neuropsychologist in particular made demaning comments about our staff and how they are just a bunch of high school-aged kids. Another RN, who was in a similar meeting later on, made the mistake of saying this to our staff of what was said from the treatment team and this neuropsychologist. That didn't help matters at all. Yet these same individuals who made these comments are the FIRST ones who spend very little to nearly no time on the unit. The neuropsychologist has been on the one maybe twice since I have been working there over the past several years; the therapists/social workers only come on unit for either a therapy group (less than 1 hr per week) or to grab a patient for individual therapy OFF of the unit or do points cash outs. The psychiatrist comes on the unit periodically but doesn't spend a lot of time on the unit at all and it goes from there. But yet, THEY are the first ones to say the staff don't know what they are talking about regarding the patients or criticize the staff. VERY little praise occurs. Staff are scared in some aspects of making the wrong decisions in intervening be it seclusion or restraint. I always tell them to always inform the RN on duty and let the RN bear the burden of making the decision (it's the least I can do to assist and support them and ease their fears as much as possible). Staff are NOT provided adequate enough training overall, especially for our type of unit. Yeah, SMT of our unit had provided SOME training, but it was NOT exactly what the staff truly needed (and not the type of training that I had proposed to be conducted and even provided the materials as a guidelines). But of course, I am JUST a RN. If you get my drift. At any rate, we are expected to "deal with" the violence on our unit and constantly get hit, kicked, bitten, scratched, peed/poo'd on, smears on us, punched, you name it......this happens EVERY DAY. Not to mention the vile and vulgar names thrown at us by the patients and swearing at us. But they are "excused" because..............and we are expected to "handle it" because................ We are limited as to what we can do on our unit, as determined by the treatment team/SMT even though federal law mandates otherwise and our staff know that. That makes our job that much more difficult as well..............Well, I need to get off of my soapbox. Nothing will ever change to say the least on many levels. Yes, on other units we hae had staff severely injured, but NOTHING changes......it is always asked "What did staff do/not do?" and rarely about what about what the patient did..........but because the patient has a mental illness.......that justifies it all, as it would appear by the attitudes of administration on down. Well, i can only hope and pray that some day somebody will "get it" and take on the mantra that was posted by missarahRN: "Mental illness is not a risk factor for being violent nor is working in a psych facility a risk factor for being a victim"........Cheers!
Specializes in Med./Surg., Diabetes, Med. ICU, home hea.
Hmmm... well, your administration could always do what mine did... put up another safety poster in the "break room" (like there were times for breaks; I'd see the posters only when I had to use the bathroom and couldn't hold it any more), or make up some catch phrase to remind staff to be safe. Damnit, the more I think about it, the angrier I get.
I may need a bed there myself if another health care professional insinuates that violence against staff is "normal" or "what do you expect?" for this type of environment.
I think there's an international conspiracy to screw nurses over......short staffed? Over-worked? Unappreciated by management? Not just in my country??????
.....As I stated in an earlier post, I work on one of THE most violent units in the hospital, and since that posting, it has become worse..........unbelievable. :uhoh3:The thing that comes to hurt us as staff is that because of the population of patients we have, THEY have more rights (because they are under age 18) and are more protected.......and they know it! 
My staff, currently, are very leery, worried, concerned,etc., in anything and all they do due to this. We are currently under the microscope AGAIN because the number of our seclusions and restraints have gone sky high........vice it being looked at as to WHAT is REALLY:eek: going on, it seems what is staff doing wrong (well, they are NOT perfect, but at the moment, they are totally doing the best they can overall) ...........I had a discussion the other day with our staff psychiatrist that I am totally convinced that it is the programming that is being used. We have been trying to say this ever since it was instituted; however, the "powers-to-be" totally disagree......
But yet, overall, our staff are not respected to actually be totally listened to. Every once in awihle, they get lucky. Heck, one therapist is totally "terrified" to come onto our unit. The only time this therapist comes onto the unit is for therapy group(s) and if it is at any other time, it is for a VERY short period of time. :uhoh3:Another thing is that our nurses'/tech station is totally exposed and we have complained a multitude of times to have it enclosed (like on the other units), but the powers-to-be won't allow us to have an enclosed place when we have made suggestions/recommendations as to how it could be done:mad:; however, when we tried to have a boundary set around the nurses'/tech station, we were told to remove it in that it was too "restrictive" or something like that.................so here we are supposed to be teaching patients about boundaries, respect and limit setting, safety, et al, but yet nothing for us to be protected. I have been sitting at the computer doing my charting and getting hit, attacked, et al, because patients climb up over the countertop or barge into the station.
I think there's an international conspiracy to screw nurses over......short staffed? Over-worked? Unappreciated by management? Not just in my country??????
Yosemite, RN, ASN, EMT-I
194 Posts
At some point, SOME day, we/someone will HAVE to address the issue of violence in nursing, but especially psychiatric nursing. It is disturbing to me that we as health care providers have come to accept violence against us as nearly "normal," as "expected." How many of you/us, in nursing school, were told to expect voilence against us if we went into certain specialties and, if we didn't like it, should choose a different career?
Some day this will HAVE to end. HOW it will end is the issue, but it MUST. That society accepts violence against its health care providers in ANY setting is INSANE.