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How do you get used to working with violent people?

47 replies

forobviousreasonsanon · 26/11/2024 20:11

I work in inpatient psychiatry; very small case load but very specialised and intense. We take step downs from intensive care, prison etc, although not classed as forensic or secure.

How do you get used to credible threats of violence? I know the worst response is to look scared but I can’t always help it!

This is my first job, I’m newly qualified. Even the verbal is draining at times, it’s just continuously being called a c**t or being told to fuck off.

I’m fully trained in break away and interventions, we have medications, alarms, locked doors etc so very very safe - but it’s still a bit scary.

The background stuff is exhausting too, lots of background reports trying to work out why this happens and it’s never pleasant. People never come to us with a simple background. It’s fascinating but it’s just exhausting sometimes. Dealing with people who’ve committed sexual offences etc.

Today has been a v, v long day, we don’t formally debrief and I’m just so bloody tired.. Does it get easier?

OP posts:
Pinkruler · 26/11/2024 20:15

Sorry to hear this - sounds very stressful. Do you have enough training in dealing with This? Sounds like you've been thrown in the deep end.

Helico · 26/11/2024 20:18

Honestly? I wouldn’t/couldn’t do it.

Two close friends were psych nurses working with psychotic and often dangerous inpatients. Both have ptsd now.
Both told how fling in the deep end they were and how unsupported they were.

PassingStranger · 26/11/2024 20:22

Can you change your job?

Robertplantgoddess · 26/11/2024 20:23

It does get easier once you realise it's (mostly) not personal.
However after 20years of doing it the thought of going back to it fills me with dread (I changed jobs 3 years ago).
What becomes normal for you also shifts in your mind and you dont realise how 'unnormal' the behaviour you put up with is until you chat to people who don't work in that area.

KnopkaPixie · 26/11/2024 20:43

Never worked in the mental health field but have worked in security, night clubs etc. It's a combination of agreeing with them in the moment, making yourself look physically bigger, (easy for me to say because I'm over six foot but really skinny) making your face go absolutely blank and limiting eye contact.

But it's really hard. Just sending support really x

wizzywig · 26/11/2024 20:44

View it as their form of communication

Apsndbd · 26/11/2024 20:47

Trying to control your own nervous system response - I’m very aware of mine now and how to calm it.
But team support is needed and ways to “fill your cup” out of work when work depletes it

Octavia64 · 26/11/2024 20:47

Once you've done it for a while it becomes normal.

I appreciate that is not helpful right now.

MrsTerryPratchett · 26/11/2024 20:48

Some people can and some can't. I have ADHD and we process risk differently. I swear 90% of the people in my department have it because the NT people find it harder.

I just do remain calm in emergencies. It isn't trained or learned, it's innate. Sorry, I know that's not what is useful.

forobviousreasonsanon · 26/11/2024 20:49

We don’t get a huge amount of training no, I’ve been fortunate that the unit I work on has been reasonably settled until the last few weeks but it’s just been one alarm after another. It’s difficult accepting that I have to walk towards that situation too.

That’s generally what I try to do, see it as communication - I spend most of my day saying that to other (non qualified) staff but it’s so hard sometimes.

I think it’s because it’s either violence towards others or self, neither is pleasant to
isten to and its not something I can discuss at all outside of work.

I do have supervision tomorrow, so might mention then and ask my supervisor, she’s done this for 30 odd years.

OP posts:
Octavia64 · 26/11/2024 20:51

I found martial arts training helpful.

Certainly desensitised me to violence. Also meant I had a fair idea what to do if protocols failed.

I never used it. Ever. Words and body language are a lot better.

forobviousreasonsanon · 26/11/2024 20:52

MrsTerryPratchett · 26/11/2024 20:48

Some people can and some can't. I have ADHD and we process risk differently. I swear 90% of the people in my department have it because the NT people find it harder.

I just do remain calm in emergencies. It isn't trained or learned, it's innate. Sorry, I know that's not what is useful.

There might be a thing in that, there’s a lot of neurodiversity in my workplace too.

OP posts:
KnopkaPixie · 26/11/2024 20:52

KnopkaPixie · 26/11/2024 20:43

Never worked in the mental health field but have worked in security, night clubs etc. It's a combination of agreeing with them in the moment, making yourself look physically bigger, (easy for me to say because I'm over six foot but really skinny) making your face go absolutely blank and limiting eye contact.

But it's really hard. Just sending support really x

Using a montonous tone of voice as well. They will pick up on any emotion.

As for how it impacts you personally, that's a different story.

Bobbybobbins · 26/11/2024 20:52

I wouldn't be able to do it and greatly admire those that can. Definitely be aware of the impact it could have on your mental health.

forobviousreasonsanon · 26/11/2024 20:56

Pinkruler · 26/11/2024 20:15

Sorry to hear this - sounds very stressful. Do you have enough training in dealing with This? Sounds like you've been thrown in the deep end.

It is very sink or swim yes, unfortunately.

OP posts:
KnopkaPixie · 26/11/2024 20:59

Octavia64 · 26/11/2024 20:51

I found martial arts training helpful.

Certainly desensitised me to violence. Also meant I had a fair idea what to do if protocols failed.

I never used it. Ever. Words and body language are a lot better.

Yes. I used to do Krav Maga.

Evenmoretired44 · 26/11/2024 20:59

Definitely bring it to supervision. That’s what supervision is for.
Agree with others re martial arts training not to use but a few of the breakaway skills are based on jujitsu so it would be a way of practising your skills and increasing your confidence.
And then:
regular holidays
not too many bank shifts
keep an eye on what you watch and read out of work
part time if you can

often people spend a couple of years on the wards and then move to the community for this reason.

BodyKeepingScore · 26/11/2024 21:02

KnopkaPixie · 26/11/2024 20:43

Never worked in the mental health field but have worked in security, night clubs etc. It's a combination of agreeing with them in the moment, making yourself look physically bigger, (easy for me to say because I'm over six foot but really skinny) making your face go absolutely blank and limiting eye contact.

But it's really hard. Just sending support really x

These sound like atrocious strategies for dealing with people experiencing extreme mental illness.

Doyouthinktheyknow · 26/11/2024 21:10

I think it’s really hard and I couldn’t work in a mental health intensive care unit, used to respond regularly to incidents and that was bad enough! It just scared me in a way other wards didn’t.

I’ve worked in inpatient mental health for more than 20 years and dealt with and been victim of my fair share of violence, you never really get used to it. As I said, PICU was never for me though. Think you find out what you enjoy and where you flourish and it may just be it isn’t for you.

Having a supportive team around really helps deal with anything. Definitely bring it up in supervision, you should be well supported as a newly qualified nurse.

KnopkaPixie · 26/11/2024 21:14

BodyKeepingScore · 26/11/2024 21:02

These sound like atrocious strategies for dealing with people experiencing extreme mental illness.

You're probably right. I did say that I'd never worked in mental health but tried to apply my experience of night club and security work when people can tend to get a bit violent.

I realise that my remit when doing that job was to get them home or back to wherever they were staying safe without anybody getting hurt and I wasn't too interested in their long term wellbeing.

I was trying to offer strategies for the immediate danger situation. I could have judged things wrong.

MrsTerryPratchett · 26/11/2024 21:21

Octavia64 · 26/11/2024 20:51

I found martial arts training helpful.

Certainly desensitised me to violence. Also meant I had a fair idea what to do if protocols failed.

I never used it. Ever. Words and body language are a lot better.

Kickboxing here!

x2boys · 26/11/2024 21:28

forobviousreasonsanon · 26/11/2024 20:11

I work in inpatient psychiatry; very small case load but very specialised and intense. We take step downs from intensive care, prison etc, although not classed as forensic or secure.

How do you get used to credible threats of violence? I know the worst response is to look scared but I can’t always help it!

This is my first job, I’m newly qualified. Even the verbal is draining at times, it’s just continuously being called a c**t or being told to fuck off.

I’m fully trained in break away and interventions, we have medications, alarms, locked doors etc so very very safe - but it’s still a bit scary.

The background stuff is exhausting too, lots of background reports trying to work out why this happens and it’s never pleasant. People never come to us with a simple background. It’s fascinating but it’s just exhausting sometimes. Dealing with people who’ve committed sexual offences etc.

Today has been a v, v long day, we don’t formally debrief and I’m just so bloody tired.. Does it get easier?

Yeah it gets easier I used I be a,mental health nurse I worked in acute mental health including PICU for years the verbal abuse isn't normally personal having a good team helps

Mittens67 · 26/11/2024 21:45

I am a retired learning disability nurse and also did post reg qualifications in working in secure environments.
I never did exactly enjoy working with clients who were aggressive or dangerous and was much happier when I moved to other client groups before going into management.
I had a very short placement in Broadmoor which tbh scared the pants off me and I declined the extra pay on offer to work there longterm in favour of my ongoing mental and physical safety. I then continued to work with people who had challenging behaviour in smaller community based settings.
Best bit of advice I was ever given was always know where the exit is and if in doubt make sure nobody is between you and the door.
Try to build a relationship and learn what a person’s triggers are and read the signs of trouble brewing so that you can to diffuse a situation before it peaks.
The most dangerous patients were the few who were very controlled and seemed perfectly calm until suddenly they weren’t.
Working cooperatively as a team is essential to keep everybody safe.
Control and restraint training and breakaway or whatever it is now called needs to be practiced enough so that it is muscle memory to you in case of real need although of course you hope to avoid needing to resort to physical interventions,
Sadly some staff attracted to work in secure environments were there for the opportunity to bully and control. I hope there are less of those these days.
If I had my career to start again I would avoid working with people with challenging behaviour. One of the injuries I received still troubles me from time to time thirty years on.

ThisWarmQuoter · 26/11/2024 22:02

Firstly any newly qualified position are difficult, the transition from student to nurse (if you are a nurse) is incredibly difficult, the responsibility feels all consuming at times! I promise this does ease, I would say around 6 month mark, however it can take longer. I think I started to feel semi confident at 12 months but confidence started increasing after 6 months.

A notebook is so useful to write things down, it’s easy to refer back to, it can help you when things are so busy you can’t think straight.

My biggest tip is building trust, the more trust you can build the more likely you will be able to de-escalate any potential violence or current violence. The best way to build trust is do what you say you will do, even if it is as small as yes I will make you a cup of tea now. If you can’t do something you tell them as soon as possible and explain why if appropriate.

Remember these people are stuck in the ward day in day out, what may seem small for you (sorry I can’t change the tv channel this second) is huge for them.

Encourage lots of activities with the patients if they can engage , ward meetings are also a good place to start engaging patients and can help raise problems before they start.

Realise it is a life long learning job, you won’t know the answers to everything and that’s ok!

Supervision- psychiatric nursing is so stressful the violence, name calling, lack of resources can take its toll. Make sure you have regular supervision to discuss your current work stress and also it provides a good place for growth and development.

Basics- make sure you take your breaks, or at least make sure you have time to eat and drink on shift, when the shifts are busy it’s so easy to neglect yourself. When you are tired and or hungry it can be even more difficult to process and deal with.

I know it may not feel it right now, but it does get easier. The more experience you get the easier it is to deal with things. I remember being vile at home for the first few months as I couldn’t deal with what you have mentioned in your original post, however in time it gets easier.

Lean on your more experienced colleagues for guidance and wisdom and support, however also remember you got the job for a reason and that you are liable for your own actions, by this I mean don’t let anyone tell you what to do if it doesn’t feel right. I remember my early days I was doing a night shift and another more experienced nurse on the morning shift lambasted me in handover for taking a patient out of seclusion said I was a bad nurse etc, they lasted 9 hours out of seclusion on my shift and was back in within 40 minutes of their shift, they took great pride in telling me this on their next handover to me. On my next night shift the patient came straight back out as they were settled. I remember panicking what the experienced nurse would think of me, then I realised I must be doing something ok as the patient was fully settled on my shifts and the other nurse probably just wanted an easier shift which is not ok by any stretch of the imagination. If it was now I would have told them so but I was very young and inexperienced!

sorry for the long post, hope this helps in some way! Every newly qualified has felt the way you have felt xx

ThisWarmQuoter · 26/11/2024 22:06

Also you should get debriefs! Maybe it’s something you could raise with the manager of the ward. They are really helpful as you can see if there is any potential learning to come from incident.

Also some more things to add sorry- always make sure you have an alarm, if something doesn’t feel right trust your gut and remove yourself from that situation if possible. Try and get on observations with patients if possible it can get you to see and feel things before issues arise at times! Plus it gets you to know your patients and for them to know you too