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.
If you haven't "gotten" it yet, healthcare is, first and foremost, a business. Nurses, especially registered nurses, are "overpaid technicians" that are a necessity yet get in the way of profits. Hospital administrators are making headway against this, at least in part. Many are now turning as many positions into "part-time" and/or per diem. This leaves them with a pool of employees who are hungry/desperate for work. Of course, never forget the often used mantra of the "nursing shortage" used to create a wave of new grads desperate for work and often unemployable.
My experience reveals that most physicians are not aware of this situation. While most specialists will have no worry, nurse practicioners are and will be more attractive to administrators looking to cut costs where they can. While I don't wish ill on anyone, there is a perverse satisfaction knowing that some time in the future, some physicians may find difficulty competing with nurse practicioners who undercut them due to salary differences.
interesting to read this thread - whilst mental illness is not a predictor of violence, psychiatric nurses have the highest exposure to violence. I am sure there are many reasons as to why. The bottom line is (coming back to the origin of this thread) if your life is threatened, the criminal code supports you in doing 'anything' that is necessary to prevent death or serious injury - nothing to do with healthcare just the law of the land.
... psychiatric nurses have the highest exposure to violence.
Do you have a source to support that statement? I'm not saying I'm sure it's wrong, but I know that what I hear from ED nurses sounds a lot worse than what I've seen over the years in psych settings. I know that there is a general assumption "out there" that psych is the most dangerous/violent nursing specialty, but I haven't seen any hard numbers that support that.
Specializes in Med./Surg., Diabetes, Med. ICU, home hea.
I, too, would REALLY like to see some hard statistics, but my guess is that they will NEVER come forth. In both E.R. and psych settings, I hear from both nurses and "lay" persons the general attitude of "considering the setting, what do you expect?" I've certaintly never heard of anyone condoning the situation, but in psych I've repeatedly run into the notion that violence against staff is "just part of their illness" and "part of the job." I've heard various administrators, when staff brings up lack of security and protection on the psychiatric units, tell them/us (something to the effect) of "Maybe this line of work isn't for you" or "No one's making you work here, there's the door and don't let it hit you on the way out." I've had other R.N.'s tell myelf and others that if we can't accept the assaults, maybe it's because we're just on compassionate enough; of course, this is usally from an R.N. who doesn't get directly involved in the seclusion and restraints, who "stands back" and directs the staff that are getting hurt.
Violence against nurses, against ALL medical staff, is just plain WRONG. For the most part, the public is blissfully unaware of it, probably wouldn't be too upset over it if they were due to their own stressors in today's world. Administrators, I'm sure, find it cheaper to just rely on (and contest, of course) workman's compensation and disability insurance as well as the bluster of yet another "safety commitee" meeting and more workspace safety posters than providing the number of staff and type of safety measures truly needed. Special interests are more concerned with "patient rights" than the rights of staff to not be subjected to assaults. On the rare occasion when a staff member is killed, the media treats it like a one-time "special interest" piece and the whole matter quietly goes away as the lawsuits and bargaining goes on behind the scenes and the whole matter forgotten as a whole.
ALL clients, their family and friends need to know that, from the moment they enter the "system," be it through presentation in the E.R. or through law enforcement, that any assault against any person will be not tolerated but they will be subject to both criminal and civil legal action and this needs to be backed up every time. Of course, administrators, law enforcement, and the courts (and sometimes nurses themselves!) will likely never agree to do so because staff, after all, is considered expendable and easily replaceable.
I spent many years in a trauma setting and now work in psych. There is no 'acceptance' or normalisation of violence despite violence being part of their illness. Safety is of paramount importance and our data comes from not only local collection but provincial too. We also pursue legal action when staff are assaulted.
I understand that there can be a general air of acceptance in many health care settings - I would urge you not to accept that kind of behaviour and respond with hard data, objective reporting and transparency and clarity around policy and procedure.
Specializes in Peds, med/surge, nursing home, wounds.
I am fairly new to the Psych nursing, though I have my BA in Psych and have had my RN since 2006... I started at my facility about 2 months ago. So far, I have had very little exposure to anything violent- I did have one patient who started to push me a little, I had one patient who tried to elope, and I have been threatened a few times. I would say the biggest part of why I feel safe working there is the staff... In my facility I know every other staff has my back as I have theirs. We all have an idea of what is going on with every patient, so you know who to look out for. If you are going to be anywhere where you have a concern, someone will always come with or be withing shouting distance. I can't say that I have felt yet or foresee any time when I would be in a situation with a patient that I would have to worry about how far to go to defend myself. Also, make sure you have a good poker face. I have heard and can see sometimes that if a patient who is not all there can sense there is something fearful, they are much more likely to focus on you. I have heard stories of past staff in my facility that would be less than helpful to you in the begining as to "weed out" the weaker staff, so really know who you are working with. And speak up if you feel off about anything. Don't be afraid to run away or not looking "professional" if you feel unsafe. In the end, if you can't take care of yourself, and you get hurt or too scared to work, you won't be able to help anyone. Just my 2 cents, hope it helps. Oh, and from my understanding, it is likely that no matter what you do, you will be sued or something. From the way my facility put it, it's mostly because the patients are not quite seeing reality, and they do everything they can to make it as little inconvience as possible (I work adolescent inpt, so we are often pulled into legal stuff from what I have been told). In conclusion, make sure you REALLY know who you are working for and with!
Specializes in Med./Surg., Diabetes, Med. ICU, home hea.
Tertpsych: wow! (Almost) unbelieveable! I guess I'm just jaded by my 2 stints in psychiatric settings. I hope the company you work for never stoops low to the greed and maliciousness that I've experienced. I almost can't imagine what it would be like to work in a facility that was (generally) safe and ACTUALLY backed up its staff. Even MORE amazing is the fact that the district attorney actually tries to prosecute such an assault or that the judge doesn't just throw it out, as has been my experience... yes, I've had deputies take my statment, only to be told that the ADA would not prosecute as the would be defendent had "mental health issues" and didn't want to waste her/his time when the judge would only throw it out. And a civil suit? The assaultive clients have little to nothing to loose, so it would cost more than I could ever hope to recoup from them.
I'm glad there is a facility, somewhere, like yours!
Specializes in telemetry, med-surg, home health, psych.
my friend was in corrections for 10 yrs, then was in the ER for 10 years before going in to psych with me...............she says the ER was far more dangerous..middle of the night, nobody there, wild ones coming in to steal drugs, etc. etc..........many close calls.........
she loves psych and say there is far less danger here..........
We have trained MHT watching our higher risk pts. closely, we can usually foresee a problem and either medicate or de-escalate......if we do have a code we have a code team and there has been no injuries in the 15 yrs. I have been working .............
We are private..........maybe state hospitals are different, can't say........
Yosemite, RN, ASN, EMT-I
194 Posts
If you haven't "gotten" it yet, healthcare is, first and foremost, a business. Nurses, especially registered nurses, are "overpaid technicians" that are a necessity yet get in the way of profits. Hospital administrators are making headway against this, at least in part. Many are now turning as many positions into "part-time" and/or per diem. This leaves them with a pool of employees who are hungry/desperate for work. Of course, never forget the often used mantra of the "nursing shortage" used to create a wave of new grads desperate for work and often unemployable.
My experience reveals that most physicians are not aware of this situation. While most specialists will have no worry, nurse practicioners are and will be more attractive to administrators looking to cut costs where they can. While I don't wish ill on anyone, there is a perverse satisfaction knowing that some time in the future, some physicians may find difficulty competing with nurse practicioners who undercut them due to salary differences.