Yikes! Violence?

Mandychelle79, ASN, RN · May 7, 2014

Can it happen? Sure. How often does it happen? Depends on the facility and the type of patients accepted. For the most part the patients we accept are not violent and the ones that are, lets just say for the most part fit two categories. Elderly dementia patients or people with drug addictions who know that acting out will get them a shot of what they are craving. In the three years I have worked as a nurse on an acute psych unit, I can count the number of times that I have felt threatened ( not that anything came of it) but actually threatened on my hands and still have fingers left. The latest was a plastic chair getting thrown at me, by a patient who normally seeks out to help calm down.

MidLifeRN2012 · May 7, 2014

I just started work in psych. First nursing job so a bit intimidating all around.

On our unit we wear panic alarms and if someone should get out of control, everyone comes running when it is pressed and a code grey is called. Security also makes a beeline to us. Before going on the floor you are required to take a CPI training course usually at the workplace. They teach you ways to protect yourself while defusing the situation. Almost like a self defense class but without injuring the patient

I think you develop a thick skin over time as a majority of our staff are petite women. Many of them are wives and mothers. It isn't as scary as you may think and I'm a big chicken myself.

Of course I work in a psych unit in a hospital. If may be different in other types of psych areas.

I say go for it if you know it's your passion. For me it is a first job as a nurse and a way to get experienced. If I like it after a year I'll stay or go to another unit.

Rnrpnwannabe · May 7, 2014

Thank you for the responses. I have searched the forum and I know these types of questions have been asked before. I was researching the forensic hospital in the article above, because it is close to where I live and would be convenient. It sounds interesting but scarey, and I am not a big chicken. It still intimidates me. I am 5'10" and hit the gym daily, so I'm not a wimp for sure, but when you've got a 300 lb guy raging and coming at you....yikes! There is also a regular hospital near me and likely other options, I'm sure. I was actually interested in working with rehab or addiction patients (and it sounds like those are the ones that tend to get violent), or youth.

Sometime I think maybe I should just become a registered nurse, but I really want to care for people not only physically, but mentally too.

Again, thanks for helping a newbie. I've been reading the forum posts constantly and finally decided to join in.

MidLifeRN2012 · May 7, 2014

Sometime I think maybe I should just become a registered nurse, but I really want to care for people not only physically, but mentally too.
We are registered nurses on my psych floor. We do what you mention above. We pass meds to our psych patients everyday.
The 'big chicken' comment was meant for myself as I am clearly not in my comfort zone. Up until a month ago I was an accountant sitting in safety in a cubicle waiting to start my first nursing job. I'm sorry if the comment offended you.

Rnrpnwannabe · May 7, 2014

Oh, I wasn't offended at all! I completely understood what you were saying and it did reassure me :)

Michael_Espelin, MSN, APRN · May 8, 2014

The only way to know for sure is to try it. I know that's very fundamental advice, but oh so true.

You seem confident in succeeding in psych, which is a huge part of trying a particular area in nursing. Also, you seem to have a genuine interest in psych, a necessary prerequisite for any psych nurse.

I know many people (including myself at one point) have thought or have told others that being a med-surg nurse is what you have to do at first to "sharpen your skills". But I now believe that if your interest is psych, you should go right into it as early as possible. Contrary to what a lot of people think, you still use your skills, and gain plenty of new skills unique to psych.

A better example than myself (I am a new grad) would be my Mother...a Psychiatric Nurse Practitioner with many years of experience. I always ask her about the violence aspect of her experience in psych and it is very similar to what I have seen so far on this forum. It really depends on where you are working. Her experiences span from prison systems, psych hospitals, nursing homes, to the community, and she can stands by the fact that violence, albeit a concern, is not an issue as long as you are smart about how you go about your day. Always watch your six, always have a partner when you feel uncomfortable, never put yourself in a dangerous situation, and similar to watching your back, never turn your back on a patient casually. The mental health workers are there for you, never be afraid to ask for their help. Yes, violence does happen, but violence happens everywhere...at least in the psych setting there are people there to help you and the staff is equipped to handle a dangerous situation.

Rnrpnwannabe · May 8, 2014

Thank you so much, great info. I appreciate it.

JustKeepDriving · May 9, 2014

I started off working forensic psych in the behavioral stabilization unit (basically my specialty was stabilizing the violent criminally insane) as a new graduate. Psych nursing is an amazing career, every facility and unit is different. I worked lock down super max security. Now, that doesn't mean that every Psych unit is like mine. In forensics there are generally "levels" of stability. If you're working stabilization you aren't going to do therapy. You are going to manage behaviors and medicate.

Super violent and behaviorally unstable patients and patients that attacked staff regularly went to my unit, the generally unstable/unpredictable patient generally went to my building (max), and those that were more stable, less likely to try to hurt staff or one another went to less secure units. Nurses on the less secure units had way more time to do therapy type things, do art with their patients, have movie groups, run treatment mall classes and do on unit groups. My day was not like that, it was constant crisis-intervention, deescalation, milieu management, emergency medications, safe containment, behavioral codes, managing multiple S/R orders and rooms and so on. No time to run groups - I had recreation therapists come in to do that because my staff and I did not have time to do that stuff.

My psych experience is very unique because I worked on a very special unit devoted completely to violent patients. There are people cut out for this line of work and there are people that are not cut out for it. My type of psych nursing was really a hybridization of corrections and nursing. There are few things out there that are quite like it. It's a lot of adrenaline and self control. No matter what - a patient can spit on you, hit you, attempt to stab you with their false teeth, tell you that they are going to come to your house when they are released and rape and kill you - and you can't ever lose your cool. All of your decision making processes must be geared towards safety and they must be therapeutic (regardless of if the patient is a pedophile, rapist, child murderer, mass murderer, serial killer ect).

Personally I loved it and found it intensely interesting and was sad to leave - however I just couldn't handle the hour and a half drive with long work weeks (we were constantly understaffed so I'd often work 16 hour days in order to help my unit out and keep it running safely). I just started not having a life outside of work lol.

Rnrpnwannabe · May 9, 2014

Wow. Hats off to you! This is my concern....I think I could handle that, but not handle it for a long period of time. It must get mentally draining over the years. Or maybe not? I guess as the above poster said, you don't know until you try. Lots of respect to you though!

Rnrpnwannabe · May 9, 2014

Justkeepdriving, I do have to ask....did you ever get seriously injured? What type of injuries did you have working in forensic psych?

Meriwhen, ASN, BSN, MSN, RN · May 9, 2014

This is not directed at you, OP. But I have to admit I find it amusing when people talk about how they're worried about violence in psych, yet are eager and willing to work in an emergency department where there is as great of a risk--if not greater--of violence (see http://www.medscape.com/viewarticle/770718).

Yes, there is a risk of violence in psych. But violence occurs in other areas of nursing as well. Also, with some exceptions such as the poster who worked forensic psych, the risk of violence in psych is not as great as rumor--and bad horror movies--makes it out to be. The psych unit is a controlled environment. Patients are searched when they arrive for anything that can be uses as a weapon or to harm themselves. Access to the unit is strictly regulated. Staff are trained in de-escalation and crisis intervention so they can act to prevent trouble before it happens. They are also trained in how to provide a safe milieu as well as how to keep themselves safe.

Whereas in an ED, it's an open environment where anyone can walk in, they can be carrying whatever sort of weapon, tempers of patients are often short and frazzled...and the staff may not always have the training to handle escalating patient behavior before it explodes.