Safety Precautions in a Psychiatric Unit — Keeping Psychiatric Nurses / NPs Safe
| TLDR Healthcare workers in psychiatric units are at particularly high risk, and patients often need extra care. However, through understanding, de-escalation, and education, your staff can minimize dangerous situations to ensure that, in the words of the Joint Commission, everyone can "expect the safest and highest quality care." |
Since the beginning of the ROAR journey back in 2014, improving workplace safety for millions of lone and vulnerable hospitality workers has been my focus.
Psychiatric hospitals and health units, in particular, are high-risk environments for patients, nurses and nurse practitioners (NPs) alike.
It is my aim to ensure that facilitating safe environments that keep all stakeholders protected is a top priority for psychiatric services and mental health facilities nationwide.
With this in mind, here we will explore 5 safety precautions that nurses, NPs, and other healthcare workers should keep in mind while on the ward. Read on to learn more.
Tips for Recognizing Patient Behavior and Knowing How to Respond
Every mental health facility and provider has their own unique safety culture. Avoiding secluded areas, having clear and easy access to exits, promptly reporting past (and potential) incidents and behaviors, and staying diligent and aware of your surroundings are common guidelines across the board.
However, our clients within the healthcare sector also point to the following general tips on how to stay safe in psychiatric nursing facilities:
1. Read and Understand the Standards for Worker and Patient Behavior
Maintaining eye contact, knowing the patient's personal details (such as their preferred name), being conscious of body language, using active listening techniques (open-ended questions, for example), using courtesy, respect, and proper phone etiquette.
These are just some of the essentials when dealing with psychiatric patients in any area. Make sure you complete and comply with all the necessary safety training at your place of employment.
2. Consider Wireless Panic Buttons as Personal Protective Equipment
No matter your level of training and professionalism, certain psychiatric patients can pose a danger to themselves and those around them. Being able to call for help quickly can not only help deescalate a situation but also prove to be life-saving.
Wireless panic buttons for psych unit staff can be invaluable when dealing with unpredictable situations.
3. De-escalation Model to Prevent Violence
Generally speaking, de-escalation is a communication strategy that uses calm, patience, empathy, and restraint to understand the patient's concerns, manage and resolve any issues, and prevent aggression and violence.
There are various de-escalation models in psychiatry today, such as the 2014 Len Bowers model, or the 2009 De-Escalating Aggressive Behavior Scale (DABS). Talk to colleagues and familiarize yourself with your employer's particular de-escalation methods.
4. Avoid Harmful Clothing and Accessories
If a situation does escalate, you want to make sure that there is as little as possible on your person that a patient can use to harm you. Items like scarves, necklaces, earrings, as well as any sharp objects (like pens, pencils, needles, etc.) should be avoided whenever possible.
5. Educate Yourself and Stay Informed
There are countless resources online to help you stay up to date on the latest safety measures for patient care and guidelines used in psychiatric nursing today.
The Joint Commission's Workplace Violence Prevention Resource Center provides comprehensive guidance for healthcare facilities, including behavioral health settings. Additionally, the Joint Commission issued updated workplace violence prevention requirements for behavioral health care organizations effective July 1, 2024, establishing new standards for leadership oversight, reporting systems, and staff training. Talk to colleagues, do your homework, be diligent, and stay informed.
Prioritizing your own well-being will help guarantee that you stay safe, can handle any situation, and, thereby, deliver the necessary and appropriate care to those in need.
These precautions are practical starting points — but applying them effectively requires understanding the specific risks that psychiatric care environments present. Below, we look at why safety in psychiatric nursing demands particular attention and the types of challenges staff face day to day.
Why is Safety Important in Psychiatric Nursing?
Within psychiatric care, staff regularly deal with behavioral health issues that lead to erratic and unpredictable behaviors. This often manifests as an increased risk of workplace violence in psychiatric wards, general hospitals (with both outpatient and inpatient psychiatric units), and other mental health care facilities.
Today, addressing these issues within psychiatric nursing is a huge challenge that I am proud to be a part of. From doctors' offices and private clinics to assisted living facilities and long-term care centers, through rehabilitation centers and correctional facilities to schools and colleges, even in military clinics and private homes.
Ultimately, we see that patient safety and the safety of staff members are crucial to delivering the best care possible — ensuring the well-being of everyone involved.
What Type of Patients and Diagnoses do Psychiatric Nurses and NPs Handle? Psychiatric nurses and NPs provide both acute care (i.e., active but short-term treatment) and primary care (day-to-day treatment given by healthcare providers).
Diagnoses vary greatly, and since mental illness can affect people of any age, socio-economic background, etc., nurses can be faced with a number of different and often difficult issues.
The psychiatric patients they care for present a wide range of conditions, including:
- Mood disorders — depression, anxiety, bipolar disorder
- Neurodevelopmental conditions — autism spectrum disorders
- Neurocognitive disorders — dementia, Alzheimer's disease
- Severe psychiatric illness — schizophrenia, psychotic disorders
- Substance use disorders — alcohol and drug dependence
No two patients are the same, and neither are the care provided nor the safety issues and risk levels involved.
Want to know what other psychiatric facilities are doing to keep their staff safe? We can walk you through it.
Contact UsWhat kind of Safety Issues/Concerns do Psychiatric Nurses / NPs Face?
Our clients suggest that one approach to improving the overall safety of nurses and patients is to consider sentinel and adverse events. The Joint Commission defines a sentinel event as "any unanticipated event that results in death or serious physical or psychological injury to a patient;" a sentinel event is "not related to the natural course of the patient's illness."
An adverse event, on the other hand, is an unexpected medical problem that happens during treatment with a drug or other therapy.
These often have little to do with a nurse's training or level of competency and, therefore, can be tricky to negotiate.
Other key factors include things like the specific health systems and physical environments, staffing (and staff training), inpatient/outpatient care, patient populations, diagnoses, medication, and so on.
For example, patients arriving in the emergency department of a facility might be in greater distress than those receiving daily in-house care (and may, therefore, react violently.)
Nursing homes are generally safer than psychiatric wards or prisons; patients dealing with minor disorders and/or with no history of mental illness tend to be less violent and unpredictable than more high-risk patients struggling with serious ongoing mental health issues.
Suicide and Constant Observations
Suicide is one of the most critical safety concerns in psychiatric care, accounting for approximately 1.1% of all deaths worldwide in 2021, with an estimated 727,000 people dying by suicide annually according to the World Health Organization.
Most suicides are linked to psychiatric issues — with depression, substance abuse, and psychosis being the most relevant risk factors. With timely and proper care, however, suicide is preventable.
Constant observations (COs) with the purpose of interventions and prevention are commonplace when it comes to patients who exhibit self-harm and/or suicidal tendencies or behavior, and can be life-saving.
But they can also pose a real danger to the caregiver involved, which is why proper training and communication are vital.
Inpatient Violence and Self Isolation
Violent incidents in psychiatric settings are driven by diagnosis, medication, emotional state, and environmental factors — and early behavioral cues like withdrawal or sleep disruption often precede escalation.
Incidents of violence depend on a patient's diagnosis and background, the medication they are taking, and the emotional and physical state they are in.
Depression, loss of sleep and/or appetite, inactivity, lack of social interaction, and self-isolation can at times all be signs of possible future aggression.
Research from the California Institute of Technology has shown that a certain neural chemical is overproduced during long-term social isolation, leading to increased aggression and fear — a finding with direct implications for psychiatric care settings where patients may experience extended periods of reduced social contact.
Psychiatric nurses and NPs are carefully trained to recognize warning signs and know how to react in a timely manner in order to prevent potential harm.
Absconding and Door Locking
Even non-violent patients may attempt to flee without warning, creating immediate safety concerns for both the patient and staff depending on the facility's physical layout and security measures.
Depending on the individual facility/home and its physical settings (security levels, staff and population numbers, type of patient rooms, etc.), this can pose a real problem.
It is crucial to make sure that you are familiar with and have access to all areas of a facility and are able to respond quickly (and/or contact fellow staff promptly.)
Blame and Defensive Practice
Fear of liability can drive clinicians to order unnecessary tests or procedures — a pattern that diverts resources from patient care and can mask underlying safety gaps.
Being one of the more controversial areas in the U.S. medical industry, defensive practice is an ongoing topic of debate among medical professionals and scholars alike.
But while there is no consensus on its merits, it is generally agreed that the safety and well-being of psychiatric patients depends, for the most part, on the safety initiatives designed to protect the professionals whose care they're in.
Ultimately, while my personal experience of workplace violence and unsafe conditions lies within the hospitality industry, it is clear that the mental health sector is in great need of safer working environments. Using these safety precautions as part of a comprehensive health and safety plan is a good place to start.
STAFF SAFETY
Keep Your Psychiatric Unit Staff Safe
Psychiatric nursing demands constant vigilance. A staff duress system gives your team a silent, instant way to call for backup — from anywhere on the unit, without escalating the situation.
