National Nurses United

substance abuse issues, or a screaming patient in the ICU, the list goes on. "Every floor in the hospital is going to have a behavioral health issue," observes Weiss. "People on other floors may be attacked because of how they interact with the patient. L&D can be dangerous because you don't know what's going to happen with the birth." But psych nurses are probably the best educated and equipped to handle potentially violent people. "I believe behavioral health is one of the safest places in the hospital," stated Beekman. "Behavioral health nurses know how to interact with the agitated. We validate the person, we have a ther- apeutic relationship, and we never get into a power struggle with a patient." To be sure, it can be very challenging when patients are intensely demanding and act out by screaming, hitting, or spitting. But Rucker, who has worked at Jackson Park for 40 years, including 14 years as an LPN, also says that it's a misconception that her job as a behavioral health RN in the emergency department is always dan- gerous and that there is constant fighting. "I have never been hit, not one time" said Rucker, who has only had one injury in the ED. "I was putting a patient in restraints and the side rail went down and broke my finger. The patient didn't break it." Rucker says her hospital has sitters for all of their psychiatric patients in the ED and they let her know if someone is pacing, agi- tated, or talking to themselves. This level of staffing is key to workplace violence prevention in her hospital. She will talk to the patients and if they are hearing voices that others cannot, she will ask them which arm they would like the shot to help them calm down. "Don't wait until they are screaming," advised Rucker, who notes that if you wait too long, the patient may no longer have con- trol over themselves. California has a workplace violence prevention law, fought for by California Nurses Association (CNA), mandating that health care employers have employee input on unit-specific plans to prevent workplace violence, report incidents of violence and threats of vio- lence, and provide training, among other requirements. The federal workplace violence prevention bill, which passed in the U.S. House of 22 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G J U LY | A U G U S T | S E P T E M B E R 2 0 2 2 Advice for RNs considering behavioral health If you are considering working in behavioral health, here is some advice from the nurses interviewed for this article. "Behavioral health is all around us," observed Ron Weiss, RN in the behavioral health unit at Glendale Memorial Hospital in Glendale, Calif. "Being in this specialty, you learn how to be more [mature] and more caring. You learn how to put flexible boundaries in place, how to create safe places that will affect the trust with the patient." "Be an expert listener," said Laura Dixon, RN at Sutter Center for Psychiatry in Sacramento, Calif. "Sometimes people just want to tell you what's going on and share their perspective and why it happened. They don't always need feedback or analysis. They just want to be heard and validated for what they've gone through." Weiss and the other nurses wholeheartedly agree. "You need to really want to listen and be there," said Weiss. "Be that consistent, safe person." "Ask yourself, am I willing to listen without judging?" advised Linda Rucker, behavioral health RN in the emergency department at Jackson Park Hospital in Chicago. "Am I going to be an advocate for a patient who has an illness that is the least understood? Listen to their words. It takes a lot of patience." "Have compassion for people or it will wear you out," said Clayton Dezan, RN in the behavioral health unit at San Bernardino Community Hospital in San Bernardino, Calif. "Be very aware of your surroundings and understand that these patients are going through issues. Always talk in a calm voice. Have a set of boundaries that everyone has to fol- low." "Meet people where they are instead of expecting people to just come to your light," noted Dixon, whose patients are in the latency and adolescent age groups. "You try to help them towards something so they can find their own path to health and well-being." "Make sure that you do want to work in mental health," said Susan Beekman, RN in the adult behavioral health unit at Mission Hospital in Asheville, N.C. "You have to make sure that you're mentally sound yourself so you can care for these patients. — C.S. Clayton Dezan, RN, behavioral health unit, San Bernardino Community Hospital, San Bernardino, Calif.

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