Psychiatric nurses and psychiatric nurse practitioners have a very specialized career. They often care for mentally ill and unstable patients. While any area of nursing has its risks, psychiatric nursing has specific risks that need to be considered.

First, it's essential to describe what type of patients and diagnoses psychiatric nurses and NPs handle. For some, the image of psychiatric nursing is that of a locked, sterile facility with confused patients wandering the halls. While some psychiatric nurses and NPs work in inpatient mental health facilities and address severe illnesses like schizophrenia and bipolar disorder, they also care for and manage patients with diagnoses such as:

  • Dementia
  • Depression
  • Anxiety
  • Eating disorders
  • Autism

Depending on the severity of the illness, extra safety precautions should be observed. For example, a nurse counseling a teenager who suffers from an eating disorder might not be as on "high alert" as he / she would if meeting with a patient who has paranoid schizophrenia. Nurses and nurse practitioners are highly skilled in assessment, and can often judge a situation right off the bat.

Mentally ill patients can become violent with absolutely no trigger. They can suffer from distorted thinking and believe the nurse is there to harm them, and as a result act out to protect themselves. Due to the high potential for volatile behavior, psychiatric nurses and NPs should observe the following safety measures:

  • Communicate - let other staff know where and when you will be interacting with patients.
  • Give and receive thorough report
  • Avoid closed / secluded environments
  • Avoid wearing clothing /accessories that may be used to cause harm. Earrings, necklaces, stethoscopes, lanyards, clothing with loops (i.e., belt loops or cargo pants) or strings can be used to injure someone.
  • Keep security on standby
  • Utilize de-escalation techniques, if appropriate
  • Survey the environment and always have an escape plan
  • Avoid sitting against a wall or across from a door-stay near an exit

Another safety measure should be discussed, which is the use of seclusion and restraint for patients suffering from a behavioral crisis. The American Psychiatric Nurses Association describes their position on the use of seclusion and restraints (mechanical and chemical). Seclusion and restraints should be used judiciously. Patients have the right to be treated safely, and with dignity, therefore the use of restraints and seclusion should result in patients being carefully and continuously monitored, and not used for convenience or punishment. Additionally, if seclusion or restraints are used, they should be used for the minimal amount of time necessary- only to ensure the safety of the individual or staff.

Psychiatric nurses and NPs can have a challenging career. However, while different fields of nursing focus on various patient populations, it all boils down to one of the basics nursing: advocate for patients while maintaining the safety of the individual, other patients, and staff.

Amanda Bucceri Androus, RN, BSN

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