Would like some advice on assaultive client

[2batty2care]

Hi!

I just joined this discussion and would like some help from some of you that have had some similiar experiences. I am a psych nurse of 18 years and had a pretty serious assault a couple of years ago. I filed charges and the client went to jail, forensics, and then back to my team. I dealt with this for awhile and then he began making thinly veiled threats to me again. He was sent to another team for awhile but then began acting out and now is back on my team again. I have to meet with my administrators in a couple of days to discuss how I want to deal with him. I don't have long until retirement; maybe about 3 years or less. I can't retire now as I wouldn't make enough money. I don't want to transfer to another team as I feel this would make me even more stressed out as I don't know the patients or the staff as far as which ones are assaultive; patients; or which staff would back me up in an assaultive situation. I've lived with this problem for about the last year as far as how to deal with this client and whether they would send him back to my team. I had some serious problems as far as memory and working out solutions to problems for quite awhile and feel I am just recently back to where I was before the assault. I could tell them that I don't want him around me and don't want to deal with him but our unit is small and this wouldn't last long as I have to give medications, take the clients off unit to eat, and hand out meals on unit. They tell me he is acting more agitated now than when he left my unit and is likely preassaultive. I'm just not sure what to do or what to ask them to do for me and would like some ideas from those of you who may have experienced situations like this. I also don't want him to run me off of my unit. I know the other patients here and I can trust the staff to back me up in assaultive situations. I'm so stressed out now I feel like telling the client to just hit me and get it over with and I'll go back out on workmen's comp instead of looking over my shoulder all of the time waiting for it. If anyone has any suggestions they would be truely appreciated as I'm out of ideas. Thanks for listening. 2batty2care

[2batty2care]

I like the way you think especially the cigarette idea! Don't think I haven't had things like this cross my mind frequently and you had a lot of other good suggestions for my meeting Monday. Thank You So Much! I'll let you know how things turn out and I'll certainly implement some of your suggestions. Let's hear it for the line staff!

[Mr Ian]

Let's hear it for the line staff!

mweh... I'm a manager.

But only by 4 months. Told my team they probably had about 6 months grace before I turned into a complete *******.

If you brought any those ideas to me - I'd tell ya to get lost .. :lol_hitti

Stand firm and let the war cry be heard: Illegitimi non carborundum!

Good luck

[Scrubby]

I'm really sorry to hear that you were assaulted by a patient. Sometimes I think nurses should be allowed to carry tasers...

Is it possible to get a restraining order on this patient? You say he's assaulted you before so there's a history there. You also stated that he's making thinly veiled threats to you etc. Perhaps by having a restraining order in place on this patient, then it becomes administration/management's problem as they would have no choice but to send him elsewhere, or make sure he's not placed under your care and putting your personal safety at risk.

I was very angry when I read your comments about wishing the guy would just hit you and be done with it. No one deserves to feel this way ANYWHERE. I would tell management exactly this so they have an idea on how it is making you feel emotionally to have to care for this person.

Hope it all works out for you

[lpnflorida]

Batty,

A behavior modification plan needs to be made. Get all team members including psychiatrist, social worker etc involved. Consistent approach is the only thing which can possible be helpful. One weak link will escalate things.

I am sorry you are in this situation. I also understand not wanting to leave psych. I felt that way 10 years ago after being there for 20 years. Yet truth be known , it was time for me to leave. I had reached a point of being hyper vigilant and felt I was on the verge of if not already having problems with PTSD due to occurrence at work . I am glad I made the change. I no longer dread going to work, I am no longer fearful for my personal safety.

I still get to use my skills I learned in psych, however I am not any longer faced with the day to day full blown acting out aggressive behavior of clients on a locked psych unit.

I wish you well.

[Mr Ian]

Batty,

A behavior modification plan needs to be made. Get all team members including psychiatrist, social worker etc involved. Consistent approach is the only thing which can possible be helpful. One weak link will escalate things

With respect lpnflorida - Batty's problem is not to manage this individual. His need is to preserve himself and reach retirement intact.

Tho I completely agree with what you said about BMPs - & if I were "treating" this "patient" (too many quotation marks? :icon_roll) I'd have a BMP drawn up - just for consistency for staff guidance more than anything.

But I really don't think it falls to Batty to "get all team members" together to derive one. He just wants to reach retirement.

Sorry to jump on ya.

[lpnflorida]

Mr Ian, I hear what you are saying.

Has it now changed in psych where no longer any member of the team can request a meeting of the minds to come up with a plan? We used to meet weekly on our clients all disciplines involved.

We could also request a meeting be set up with all the powers that be if felt a patient was potential threat to act out severely.

To me setting up a plan is a means of his surving safely in his job until retirement.The indication was it was this one specific patient who was the issue not the entire population.

This person had already indicated moving to a different team, was not something they wanted to do. It seemed having this client go elsewhere was also not an option. So what else could be done unless all team members come up with an effective plan.

This patient wants to single out this one staff person it will be almost impossible to totally avoid them. That is why I felt strongly a BMP is imperative. Our plans use to include not only expectations and consequence of unacceptable behavior, it also focus on type of privilege /reward if patient was successful > it also was set out clearly how staff members were to handle certain situations with the same client so that it would not escalate into violence or that if it did target person was protected by all other staff members.

Perhaps psych has changed much in this regards .

[Mr Ian]

Mr Ian, I hear what you are saying.

Has it now changed in psych where no longer any member of the team can request a meeting of the minds to come up with a plan? We used to meet weekly on our clients all disciplines involved.

No I think it's pretty much the same.

But there's a difference when you've been personally involved in something as Batty has and I believe the meeting tomorrow is about HR rather than clinical.

I'm sure after the HR review - the next step will be, just as you say, to get the clinical team together.