National Nurses United

Representatives last year (H.R. 1195) and was introduced in the U.S. Senate this year (S. 4182), is modeled on California's landmark bill. Weiss is not only the charge nurse in his unit, he is also part of the code gray response team called to de-escalate situations in other parts of the hospital. In some cases, he has been able to get the situ- ation quickly resolved by having a conversation with the patient and discovering that they were acting out because they were bored or because they heard voices in their head that others cannot hear. Once the bored patient was given something to do, they were fine. And the patient who heard voices wanted it to stop, so Weiss got them the proper dose of medication. Among the unhoused patients, Weiss notes that some take meth, not because they want to get high but because they want to stay awake and are afraid to sleep on the streets and get their belongings stolen or beaten up by others. "But unfortunately, the side effect of meth is psychosis," said Weiss, who acknowledges that some of the repeat patients make the rounds of hospitals because they have nowhere else to go and they know they will have a place to sleep and regular meals in the BHU. Weiss observes that knowing crisis de-escalation tactics, having transparent communication, providing consistency of care, and having a willingness to build rapport with a patient are all important to reducing workplace violence. Of course, Weiss conceded that unpredictable, violent outbursts do occur in behavioral health units when patients are hallucinating or have impulse control disorder. Of course, what's key to preventing workplace violence in BHUs and all units is appropriate and even robust staffing of RNs and ancillary health workers, like sitters. Ever since Weiss began working at Glendale Memorial Hospital in 2016, he has been consistently demanding that management take action to make his unit safer. After Weiss' numerous emails and bringing up safety issues at countless professional practice commit- tee (PPC) meetings over many months, the BHU got convex safety mirrors installed to eliminate blind spots, a much-needed second restraint bed, and the implementation of duress alarms. When Dixon's Sutter facility faced a big upsurge in workplace vio- lence and inadequate staffing for the acuity of patients, they decided to organize to have a say in their working conditions, patient care, and RN retention. In December 2020, they voted to join CNA. Retaining staff and safe staffing are paramount in their bargaining for a first contract. "We rely on each other very heavily for de-escalat- ing patients," noted Dixon, who has been kicked, bitten, and hit by patients. "Having high turnover can be dangerous for us." "Not having proper staffing is always a struggle," added Dixon, who says that Sutter's acuity system is based on a medical model and does not necessarily correlate to the patient's psychiatric condition. "Nurses would be canceled and as the census goes up, the potential for workplace violence goes up as well." Staffing is a huge concern for all the nurses interviewed. Susan Beekman reports that her adult BHU does primary nursing and their RN-to-patient ratio is usually 7 to 1. Whenever they go out of ratio, Beekman said, "I get out the ADO and turn it in." The other two adult units at Copestone use "team" nursing, with just two RNs and three or four techs for 17 to 18 patients. One nurse provides all the medication and the other staff provide care. "They need another nurse on each of those units," observed Beekman, especially if there is a behavioral health emergency. "I've always spoken out against team nursing because it's trying to do more with less." Nurses at Mission have been holding protests and rallies for more than a year to bring attention to dangerous short staffing and the critical need to retain experienced nurses. In September, the National Nurses Organizing Committee RN members won signifi- cant raises, a big victory, which will help with retaining and recruiting nurses. Beekman said the raises are a good start, but she would also like to see a commitment to safe staffing. Dorothea Dix would undoubtedly be proud and gratified that the nurses interviewed for this article care deeply about their patients. Beekman was drawn to behavioral health after her experience help- ing unhoused people at Good News Rescue Mission in Redding, California. "A lot of them had mental illness, substance abuse issues," observed Beekman, who has also worked in labor and delivery, the ICU, and PACU. "I liked working with those people and saw how they really needed a hand up." Chuleenan Svetvilas is a communications specialist at National Nurses United. J U LY | A U G U S T | S E P T E M B E R 2 0 2 2 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 N A T I O N A L N U R S E 23 "I have worked in these units for 16 years and the need for psychiatric services has never been this high." Susan Beekman, RN, behavioral health unit, Mission Hospital, Asheville, N.C.

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