Difficult Situations in Staffing
Karen was employed at a psychiatric hospital in the community, on the overnight shift. Karen had worked every shift at the hospital depending on family needs. Karen was well liked and respected as a hard worker, who did not complain. Psychiatric hospitals have to admit anyone who are harm to themselves or others no matter how full or find a bed for them else where. There were many times the day lounge area had patients sleeping on the coach, chairs and floor. The hospital never staffed for anticipated admission and there were always admissions, this resulted in increase pateint to staff ratios and safety becomes major issues (Bronn 2010).
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The paper work at night was massive. Calls to management went unanswered, there was a promise that the director of nurses (DON) would be called this nurse doubted that she would do anything about the situation. The DON was once a floor nurse also and she knew how things worked and often would not return the calls until hours later, there was no management to help with the issue. Data support that Psychiatric Nurse burn out rate is related to poor management not just the patients care issues (Hanrahan, Aiken, McClaine, Hanlon 2010).
The role of the staff nurse in an unsafe working environment
On a psychiatric unit the goal is to prvent violance and to provide safety for all patients, which often results in a sacafice to over all patint care (Seed, Torkelson, 2010). This nurse had to take into consideration that there were well over 2/3 of the patients on suicide precautions. Karen was charge nurse but she would have to work as a MHT, the one MHT, that was there refused to leave the side she usually work’s on to come to Karen’s side, the MHT threaten to walk out, there was no choice the patients had to be monitored for safety and this was Karen unit. Karen had a better working knowledge of the patients on the south side of the unit then anyone else.
At about 1am there was an admit a male in his 30’s middle build 140 lbs, 67 inches tall, at home he had become psychotic, with threats to the family, but fairly cooperative at this time, slighlty agitated, about the wait in admissions, and the fact that there were a lot of unit procedures ahead. This nurse wanted to keep the agiation to a minimum knowing that acute psychotic breaks can run the range from just inappriate to the very bizzare and dangerius (Bowers 2010). The goal is to get the patient in bed within an hour, depending on what the status of the unit was. Every patient has a skin/body search done, the ideal situaton would be that the patient be searched by same sex staff, there were no males, the policy allowed for 2 RN’s of any sex to do the search but this made nurses and patients unfocmfotable. Karen had an odd feeling because the patient made note that there were no male staff on the floor.
The patient had been abusing gamma-hydroxybutyrate (GHB), data reflected that patients using this drug have been known to wake up suddenly with agiation (Munir, Hutton, Harney, Buykx, Weiland, Dent 2008 ). The patient went to bed but approximately one hour later came back out, it did not seem to be sthe same person, there was growling and patient proceeded to run around the unit, throwing the furniture which included, TV, chairs, couches. There was fear that this patient would hurt other patients if anyone came out of their room and staff. The patient seemed to be transformed into an animal he was growling showing his teeth, the 2nd RN, heard the commotion and came running out. The MHT was told to remain in the locked nurse station this was the only way to get help. The MHT was a very small...