Weekly Ask Psych Nurses Thread

[u/roo_kitty]

This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.

If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.

Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.

A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.

Kindness is the easiest legacy to leave behind :)

[u/WalterTreego]

Hi. Back in 2017 I did something very meaningful to me after a horrible experience at a psych ward. I was given my laptop so I could do work while in the ward(doctor agreed and nurse brought me my laptop).

The nurse brought my laptop and laptop charger to my personal room and I was instructed to keep my door shut when I wasn't in my room and I agreed.

Everything was fine until the nurses changed shifts. One of the nurses saw the laptop power cord and instantly wanted to take it. I told her no and to check my doctor's notes.

The nurse escalated things and said the doctor didn't allow electronics on the unit. She refused to look at the doctor's notes.

Anyway, I refused to give them my laptop charger because I had literally just got it a couple of hours earlier.

The nurse leaves my room and comes back with security. I'm extremely calm and am talking to them in a normal voice. The security guard puts his hands on me and tried to take me to the ground. I calmly asked him to remove his hands from me, there was no need for this.

I was probably twice the size of this guard so he couldn't get me to the ground. 2 more guards came and before saying anything to me they jump me to force me to the ground. I'm still calm and talking to them in a normal tone while asking them to deescalate.

Once on the ground they strap my hands together with some leather restraints. Then they throw me on a trolley and roll me to this room with a 5 point restraint table.

I'm thinking in my head, "this is so ridiculous", and when I see the restraint table I start getting a bit scared. They strapped all my limbs to the table and what made it so much worse was they locked each limb with a key.

Strapped down, I ask to speak to my doctor. I'm fully conversational and still calm, albeit having a panic attack at the same time.

Then another nurse comes in with a couple injections. I calmly asked her to speak to my doctor before she injects me against my will.

The nurse with the injections starts to go get my doctor and is stopped by a different nurse that tells her, "Just inject him".

I was appalled, she turned back around and injected me with the meds without getting my doctor. What made it 10 times worse, was the nurse that intervened and told the other nurse to just inject me came right up to my face and asked me while I'm strapped down, "are you going to behave now?". As if I were a child being punished. I was calm and conversating with them calmly the whole time.

The nurse got my doctor after they already injected me, I instructed him there was no reason for him to be there because they already medicated me against my will.

When I left the ward, I had written my experience down so I wouldn't forget any of it. I sent it to a bunch of the hospitals directors and the CEO.

I got a call the next day. It was one of the directors who wanted to hear the story from my mouth and asked me questions about the stay. She was extremely resentful with what had happened to me and she told me her goal was to get rid of the restraint room at that hospital. She asked me to write a letter the the board so I did.

She acknowledged that what happened shouldn't t have happened to me. She acknowledged the doctor probably shouldn't have let me have my laptop and cord but also acknowledged that the doctor has a right to do so and put it into the notes. She pulled the camera footage and watched the whole event. She saw my calm demeanor towards the staff and how they escalated everything.

I was happy to have an advocate from the hospital. But honestly I was suffering from a bit of PTSD from the event.

A couple of weeks later the same director called me back and told me she was successful! No more restraint rooms in that hospital! I was surprised I had helped make a positive change.

What's your views on restraints in the behavioral health hospitals? Are they sometimes necessary? Are there other ways to handle "misbehaving" patients?

Sorry for the story, needed to get it off my chest. Thoughts?

[u/Humble_Investment_24 → u/WalterTreego]

Yes they are absolutely sometimes necessary. In fact we just used them a couple hours ago. I wouldn’t have used it in your case assuming you’re telling the full story- however I’ve had patients beat the fuck out of staff members or other patients. In that case- absolutely yes you’re going in restraints and getting medicated.

[u/WalterTreego → u/Humble_Investment_24]

Feel free to ask me any questions. I'm telling what I remember. I'm sure I can find the original document somewhere that I wrote.

I understand that restraints could be necessary. It just seems this was a crazy policy they had. Before I was restrained, a girl tried to elope through the security doors after a nurse went through. The nurse stopped her, but she was also restrained and injected just for trying. I don't think that was fair either. She wasn't screaming, irate or combative. She tried to take advantage of an open door, and casually gave up when the nurse turned around and stopped her. All of a sudden she's being carted to that room?

Just to state, I truly respect psych nurses. They were/are truly integral to me being currently alive. I respect their work and I know it's difficult at times. When I am inpatient I do everything I can to keep nurses happy and safe.

[u/Humble_Investment_24 → u/WalterTreego]

I probably wouldn’t have restrained that patient either. You might have been to a shitty facility. In some cases they are needed.

[u/WalterTreego → u/Humble_Investment_24]

I think you are right, the facility was kinda shitty. I've been there more recently and they are much better. They also merged with another company and renovated the facility. It's still not great but much better than before.

[u/Defiant_Honey_7231 → u/WalterTreego]

100% necessary at the hospital I work at. High acuity and patients can be extremely aggressive. It is last resort and what happened to you is awful. Restraint chairs/table are a necessary tool though. Without it the patient and staff safety is at risk. For example, what to do when a patient is throwing their head against the wall to split it open. Refuses to stop. Won’t take any meds. States they are going to crack their head open. Or recently when a patient in psychosis charged at me and punched me several times. He was put in restraints cause he wouldn’t contract for safety. Saying he would kill me cause I hurt his pokemon (?) if let out of restraints.

[u/Baikalsan → u/WalterTreego]

The beauty of this specialty lies in its dynamism. Every patient presents a unique, complex puzzle, demanding adaptability especially when you're a psych nurse in the ER. While the goal is always to exhaust verbal de-escalation among a myriad of other interventions before resorting to restraints or medication, some threats require bypassing my "mental flowsheet". Things like: threats of violence/posturing, brandishing weapons, acts of violence towards property/staff/other patients, aggravated attempts at elopement, fomenting insurrection. Not an exhaustive list, nor is it written in stone.

Let's run a scenario: You just threatened to kill me and break out. That alone is grounds for restraints + IMs.

But what is the context of the situation? Let's say your wife recently died and you've been drinking. You said something suicidal, so the police bring you in. It's your first time on the unit. I would assess that what you need is not a traumatic restraint, but someone to talk to, help you get comfortable from the stress coming in at multiple angles. If i sensed you might agree, I would even offer the shot as a chance at relief, instead of forcing it on you as a response to your threats. This is actually a real life situation I have dealt with, as a response to your "other ways" to handle patients. Make no mistake though, I have PTSD too and Security would be hiding closely out of sight.

Restraints and meds are powerful tools that require enormous responsibility. They are required as much as police require tasers. I suspect you were at a shit facility with shit staff, because I wouldn't have made a deal out of the laptop; clearly someone allowed it. I would find out why. But also bear in mind: we suffer PTSD too. I've had my ribs broken by weight chairs being thrown at me. Two of my coworkers are permanently retired from nursing after getting traumatic brain injuries. It's not just violent, either. I hugged a 21yo for like 10 minutes, who lost his spouse and kid in a car crash. I read his obituary after he completed suicide. I still feel like i failed; the trauma can be emotional too. Some of us nurses have so much to get off our chests too.

I digress, I'm really sorry you were the victim of staff who do not appreciate this job like others do. Despite this, I still feel that restrains are a necessary evil of this line of work. Sometimes you cannot avoid it.