Violence and injuries on inpatient psychiatric units towards staff and patients are well documented as significant problems. As psychiatric nurses when we come into the building to work with aggressive patients we have 5-6 locked doors to get to our work area. When we step into the door we rarely know in advance what is on the other side.
On an acute psychiatric unit, the clients range from rapist murders, schizophrenia, Bi-polar, depression, impulse control issues, addictions, personality disorders, Psychotic disorders.
In a 13 hour shift – nurses on a psychiatric unit can go from calm, quiet and everyone having the good conversation. To an explosive situation in a matter of minutes.
A few years a go when the administration asked why was our hospital not classified as a hazard duty pay. He claims because we are an “acute” hospital. The week before he was asked this question one of the “acute” nurses was removed from the hospital on a stretcher and placed in ICU with head injuries because a violent patient beat her until she was unconscious. This is not counting the broken arms we have had, the multi scratches, black eyes and ruined clothes that staff has experienced.
Psychiatric nursing is not always dangerous but it is always unpredictable.
It takes a special breed to be a nurse in psychiatric nursing.
In psych nursing, things are not black and white. You have to be able to tolerate ambiguity, be calm in the midst of chaos and, at times, be in situations that can become violent.
Psych nurses treat patients who are delusional, angry, manic, depressed, have attempted suicide, are out of control due to substance abuse, or are suffering from eating disorders and everyone from children to elders.
They work everywhere from dedicated psychiatric hospitals to inpatient/outpatient units at,clinics and in private general hospitals practice if they are certified to prescribe medications.I think a lot of people don’t really understand what psychiatric nurses do.They work with patients who are often at their worst and most vulnerable when their mental illnesses are acute. They have to treat patients with dignity and rationality even though patients may be out of control.
Those who choose psych nursing have deep personal feelings for why they choose this field.I personally enjoy hearing the stories of their lives. How did they get in the situation they are now in and what they were like when they were younger.
Psych nursing requires a wide range of skills from the practical to the creative. Nurses in the field say that those who do well in it are caring and compassionate but are also assertive. They have a strong sense of themselves but enjoying reaching out to others.
To be a good psychiatric nurse, you need three things,1)You must be able to listen.
2) You must be nonjudgmental.
3) You must be decisive.
Psych nursing calls for expert assessing skills.Nurses must observe patients closely, and document even the slightest changes in behavior, facial expressions, hand movements, tones of voice to determine patients’ condition and progress.
To reach patients, psych nurses will sit with them over a meal, over a game or an art project even sit up with them all night if they’re under a suicide watch or suffer acute anxiety. If one nurse makes progress establishing a good rapport with a particular patient, that nurse will often be assigned to the patient daily on their shift.
Psych nurses also administer medications and talk with patients about dealing with often unpleasant side effects. They must persuade patients that the discomfort is something they must tolerate in order to get better.
Psych nurses also have to be tough-skinned, as patients will blame them for medication side effects and, worse,hurl insults at them, make racial or ethnic slurs and ask highly personal questions that violate nurse/patient boundaries.
You can’t take cruel remarks or anger directed at you as personal attacks. That can be hard to do sometimes. But you have to accept that it’s the patients’ illnesses that trigger this kind of behavior.
If patients are too intrusive or otherwise causing problems with others on a unit, psych nurses have to restrict them to their rooms or even put them in “quiet” rooms to keep them from harming themselves or others.The potential for violence is the most difficult part of the job,for psych nurses. Patients who are acting up have to
be physically restrained.
It can get very scary, And that’s where having a team of nurses, attendants, and patient assistance can be critical for your own safety. The work can be emotionally and physically draining.
You need to be able to find a place of peace within yourself, After working with psych nurses for over 20 years who you work with helps you deal with some of the difficult experiences. It creates a strong bond between us. As a team and as protection for each other. Working as a team in this environment has to be a strong link.More people understand that mental illness stems from biological malfunctions in the brain, nurses working with people with psychiatric problems fight perceptions that there must be something wrong with them to want to do this kind of work. There’s still a stigma attached to doing this kind of nursing in the medical profession, although it is getting better.Very special nurses work under these conditions.
I have the honor of being elbow to elbow with some of the finest staff under some of the most dangerous conditions. It takes a team like the one we have to give the best care – and the best family working unit.
Angela Brooks has worked in a state-funded psychiatric hospital in Kentucky for 21 years as a nurse, assisting sometimes-dangerous patients who come in shackled and cuffed. At AngelaBrook.com, she offers stories of life on the inside of a psychiatric ward, and the site, as well as her company, offers support for nurses in the mental health field and helps them bring passion into their role at work.Join the fun and connect with like-minded business owners and Nurses EVERY single day! Click here and “become friends” with Angela’s NOW!
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Angela Brooks has worked in a state-funded psychiatric hospital in Kentucky for 21 years as a nurse, assisting sometimes-dangerous patients who come in shackled and cuffed. At AngelaBrook.com, she offers stories of life on the inside of a psychiatric ward, and the site, as well as her company, offers support for nurses in the mental health field and helps them bring passion into their role at work.Join the fun and connect with like-minded business owners and Nurses EVERY single day! Click here and “become friends” with Angela’s NOW!
I have a deep amount of respect for any person who works in an inpatient setting. I've worked in community mental health over the past 20 + years and know that currently in most cases when someone is admitted for inpatient services, there must be a very high risk of injury to self or others. It really takes a special team of people to deal with those challenges and risks.
I think it is also important to point out that because someone has a diagnosis of schizophrenia or any other mental illness, it does not mean they will be violent. Unfortunately the media tends to show only those cases. NAMI is a wonderful resource for individuals wishing to learn more.
Thanks Angela for sharing your expertise and experiences. I applaud you and your co-workers for the work that you do.
Thanks
Cheryl
Crystal Biggs Birdwell
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Well you tell it like it is, I admire you for your bravery, keep up the good work.
The only thing I can say "wow"!!! I know this would not be my job, I have a great appreciation for people who are called to be a nurse.
Hi Angela. I love what you are doing for your patients and you must love it as well to have the longevity that you do. I come from a family where all there women have been in the nursing profession. My mother, now retired, was a nurses aid for 25 years. My older sister works in the ER and my younger sister works in hospice care. None of those are as volatile as psychiatric nursing but they all have their moments I suppose. It takes a special person to do what you and your colleagues do on a daily basis.
Golda
Thank you Golda – it is a job not many stay long in. It is never dull and seems to be getting more dangerous with the type of patients that come in for hospital care
As a 30 year RN, ( worked 25 years inpatient calm, one gid ER Psycy only at JMH Miami, then 16 years, in pt psych, by that time we on our own. I did learn something, that many of the pts we tie down was not neccesary. IF we have the staff to Care , talk someone down. In the last 16 years of my inpt, severity, I applied skills, of deescalation, and dang if it didnt work Most or the time maybe 90%. The other 10% look out. I have worked ( before 16 years in acouty of kern, ca, We were not allowed to restrain, admin wouldnt aloow us to bring in 1 to 1 staff for monitor the vilent person, not in restaints. I had an easy going psychotic patient one time, and a much migger man and criminal, walked up to him a decked him, could , have killed him on the floor but in cali I was as charge nurse impotent to restrain the violent man doing the beatings. And I guess I am supposed to accept it, even my self had 30 years worth of injury, Last one was in psycotic break, hit me in face, my glasses went flying. I understood this man.! In fact he had a job all his life but out of his control,l ( wish some one alcoholic could explain to my son what alcoholic means, he wont talk to me. ) People that work in mental health, some understand, some dont, for a few but not most is more easy than being an RN where I was before , paying my dues and as a kid, I am sure I cleaned at least 10000 butts of ka ka, etc etc etc . Older Jewisk menm and women, I watch so many draw their last breath, expert I am in Cpr in fact one private dute nurse, ( by the wqaay their ver rare nowadays,. She told me She notriced I was so good , and cared so much. Wow that reafirmed that I was not just bringing back people , end of the line, Hell. I became a CPR Instrotor for next 20 years, taught my employees in Miami and Bakersfield Ca. Anyone think I should write a book? Well I have many times. Hey if ur bored reding this account, you know where the exit door is, di ba? Some of the greatest times of my life were not off duty but on duty when even I was charge nurse was part of a team.
I am currently a Senior nursing student completing my mental health clinical rotation. So far it has been a different but great experience. Thanks for your insight!
I am a senior completing my mental health clinical rotation. I have to admit mental health scares me just a bit but with your insight I feel a little bit better. I took particular interest when you listed the three things needed to be a good psych nurse. I think being strong should also be added to that list. Like you said patients will blame the nurse for adverse effects and become physical. Not everyone can handle that aspect of working with psych patients.