AIBU to think I can be a mental health nurse without being physically attacked?

[Treebauble]

I have been thinking about going back to university now that my children are a little older to go to university for nursing. My dh says I should do adult nursing and I was really interested in doing mental health nursing, specifically with the aim that I could work with youth with issues such as severe autism. My DM thinks if I go in to mental health I will be forced to work in a ward where I will be physically attacked and it will be understaffed, so it could be quite dangerous. I don't know if I am being naive. AIBU to assume there is adequate staffing levels of nurses in mental health so there would be many people around if any patient were to get violent and that it would be safe? For those that know, is adult nursing less risky?

After a recent stay on a psych unit I saw things being thrown at the nurses them being scatched and bitten and the verbal abuse towards staff was horrid to hear. But just to say I’m classed as a patient with complex needs but I’ve never assaulted anyone or been verbally abusive

I currently work as a physio with people with learning disabilities, including autism. I've also worked in mental health in the past, as well as 'mainstream' hospital work. I have been assaulted no more in the mental health situation than I have in mainstream services. I think one of the advantages of working in mental health is that people are receiving the appropriate care, whereas on general words, you can get very mentally ill people being admitted, and it isn't recognised, so they are not getting the help. It was an orthopaedic ward where I was picked up and thrown across the room.

Also in mental health you get the training to spot the early warning signs of potential violence. Although I have to say it is nowhere near as comprehensive as the NAPPI (Non-Abusive Psychological and Physical Intervention) training I've received in my current job. The place where I work uses lots of techniques that mean physical intervention is rarely needed - but I now am completely confident in using those techniques in response to violence, and so I feel safe at work. It's also a really supportive team.

Yes, low staffing is usually an issue (otherwise I'd literally never have to use safe restraint - no-one has ever responded violently during physio), but the attitude and training of your team makes a huge difference.

I do chew gum sometimes though, so I am clearly lucky that people don't lamp me on sight.

I would say you are being a bit naive, sorry. I've been assaulted a few times over the years by a variety of different people in different settings. None were due to understaffing. Most were due to the unpredictability of working with mentally unwell people with learning disabilities and autism. Or having to support confused and poorly people in difficult environments like A&E.

As others have suggested, you may find learning disability nursing more up your street. RNLDs are sought after at the moment and our trust have a number of unfilled posts.

Assaults of staff do happen, but LD nursing and MH nursing are worthwhile and rewarding jobs. Some settings have a lower risk of violence, I see less in the community than I do on the wards. But it still happens and there have been many more near misses when I've been able to de-escalate things, or just made a hasty retreat.

I wouldn't want to put you off, because it's a fantastic job (MH or LD) but I think you should go into it with your eyes open .

Almost all of my family work in psychiatry and yes, assault is very common, definitely on wards but also they’ve been assaulted in the community when dealing with psychotic patients or those under the influence of illicit substances. Some have been very serious...a fractured skull and a strangling, both in community settings. The strangling came out of nowhere. The person was extremely calm with no history of violence and as my relative was passing in the corridor, they were pinned against the wall and strangled until the point of losing consciousness. They would have died if another service user hadn’t passed at the same time and alerted staff. The fractured skull happened as medication was being given out, my relative said “come on x, time for your meds” and the next thing she was getting beaten by a 25 stone man who’d been taking poppers whilst out in the community.

On the other hand, I’ve taught children in SEN settings and been physically assaulted far more frequently than my mental health professional family members. It was rarer to have a day where I wasn’t hit, punched, scratched, had things thrown at me, hair pulled out, spat on etc. It was day in, day out and several different children. It was really frightening at times. There was one child with Down’s and ADHD who from the age of 10 could have merrily killed you, I have no doubt. One minute she’d be hugging you, the next sitting on top of you pinning you down and either having her hands round your throat, covering your mouth and nose or grabbing your hair and repeatedly slamming your head against the floor. She was extremely strong and I was terrified of her. The ASD spectrum is huge and you won’t get to control which individuals you get to work with. About 5% of the ASD children I worked with were frequently extremely violent to staff and other children. In a specialist behaviour unit that percentage would shoot up. These were children and it was scary. There’s no way I’d work in a similar setting with adults.

I’m afraid if you are going into this field you do have to accept that you will be assaulted. It’s naive to think you won’t. I never realised how high the risk was working with SEN and the regular physical assaults left me with mental health problems (depression, anxiety, low self esteem) myself no matter how good the rewards were of working in that field too.

As someone who isn't involved with medicine at all, I'm really shocked that nurses experience such high levels of violence. I realise that often this is due to patients being ill. I think you nurses are amazing for dealing with such difficult circumstances.

As PP have alluded to, there's different types of aggression and assault.

You can be badly scratched and bitten whilst trying to provide personal care to an elderly, frail, frightened woman with dementia. Then you can be screamed at, finger pointed right in your face by an articulate man about (for example) why his mother hasn't had her MRI yet and it feel a million times more scary and soul destroying.

What I'm getting at is that it's not always the obvious violence and aggression that really gets to you. There's a reason that there's 40,000 nursing vacancies in the UK and I don't think it's down to the understandable risk posed by patients with mental health problems, LD, dementia etc.

Or and re your original question about whether adult nursing is less risky, in my opinion it's a different risk. I got a fantastic punch square in the face from a distressed 90year old with Dementia, who had a broken hip. So she was on a surgical ward being cared for by adult nurses. A&E is often the first place distressed people may go before being admitted to a MH ward. People coming off sedation in ITU can be confused and disorientated. Patients with LD or MH problems may become physically unwell and require treatment. You may have less training in de-escalation, keeping safe, physical interventions/restraint. So on a surgical ward assault may be less likely generally, but they might be less predictable and you may be less confident in dealing with it for instance.

I generally feel safer with more predictable risks. I have never felt safer than on a forensic ward because patient's risks were well known, staff were well trained, there were excellent safety procedures. Yes assaults sometimes happened, but it was less frequent and often less damaging than on an open ward where patients were generally unknown and being assessed. In the community, I often feel safer visiting my patients who have convictions for violence, than some who look less risky on paper but are very unpredictable.

I'm a Learning Disability Nurse! 👋

I agree with pps that it's probably true that if you want to work with people with "severe" autism you would probably fit with RNLD better than RMN. I've been assaulted at work but it's certainly not "part of the job".

Oh also a pp had a very good point. Its not necessarily violence from patients which is difficult to cope with. Some of the most awful experiences I've had that made me feel the most scared and vulnerable, were with relatives or friends of patients. That will be the same in any setting. My teacher husband often says that he would enjoy teaching more if it wasn't for the parents (A minority granted, but the minority cloud your judgement if they are awful). I feel the same sometimes about my patients. I dread going to see one person because I often end up crying in my car afterwards because his family are so awful. But he needs nursing care and he is my priority for now and so I go. Often with some backup.

I'm a 3rd year Adult student nurse and I have been assaulted a fair few times. I don't want to be assaulted but sometimes it's because a patient is delirious or scared.

I have been punched by a stroke patient who was busy telling me that his arm didn't work... The stroke took away his ability to recognise his arm but my face knew it was there.

A lovely lady who had post op delirium that went on for days. We never told her because she would have been mortified if she knew.

The patient with dementia who tried to strip me.... Thank goodness for my uniform ties and 2 members of staff who came to my aid. I laugh at this one now.

There are risks like this with any job we do. But we still do it.

Uni will give you semi adequate training on breakaway techniques and you will be great most days.

I don't feel any hurt or upset. What is happening to them is far worse than what happened to me. I got to talk through with a mentor and I'm due to qualify soon.

I value the experiences. I won't stand so close to a stroke patient in future and I now can recognise post op delirium so it's all good.

Your husband just has a fear of the unknown. Fear can be healthy as it keeps us safe but it can also hold us back.

Apply for uni.... Its worth it

I didn't say it was acceptable in my post. Re the shop assistant comment, shop assistants don't assume the mantle of being professional post graduate people. I expect better from someone who asserts they are highly educated.

I would never ever use physical voilence but I can see why some, through sheer frustration might. That doesn't mean I condone it but I do think some reflection is required.

Really hope I won’t be dogpiled for saying this but have seen some PPs saying “working with autism” or “working with ASD”, which feels quite dehumanising. We’re “autistic people” (the overwhelming majority of us prefer that to “people with autism” although I think the NHS is big on “person first language” so I appreciate that might be tricky)

My ex worked as a mental health nurse in a facility for children and young adults with severe autism, amongst other issues. He was attacked several times, the worst resulting in a back injury which left him disabled and with PTSD.
I am completely in awe of people that have the patience and compassion to do the job, even knowing that they're likely to be put in physical danger. But definitely go into it with your eyes open.

I was a mental health nurse, predominantly in inpatient environments for children and young people. I have been hit, headbutted, scratched, spat at, often by teenage boys who were much bigger than me. Sometimes it was because they were psychotic and were so unwell they didn't realise what they were doing. Often it was because they were attempting to harm/kill themselves and my colleagues and I were trying to prevent them from doing so. I still loved my job though and I was lucky I was never badly hurt.

Two very close friends of mine have been seriously injured at work and had to take significant time off (one for a head injury one due to a broken jaw) following assaults from patients. In both cases it was found that lack of staff was a factor.

When I was a student nurse on an adult acute ward I was sexually assaulted by a patient. I was told to "have a cup of tea and a sit down for 5 minutes" then got on with my shift. No one asked if I wanted to talk about it or how I felt about having to come into work and care for that patient for the next two months. The attitude was very much "it goes with the territory".

When I worked in the community I never got attacked, but I know others who have. It is a myth that community MH nurses don't have to deal with high risk patients and going into people's homes can be very risky as you have no back up. For me it was was the verbal abuse, almost always from the parents, not the young people I was working with, that got to me. Being sworn at and threatened because of things that were completely beyond my control, like waiting times for ASD assessments or because I wasn't able to return phonecalls straight away due to being in clinic with back to back appointments. I think, over time, the verbal abuse, finger pointing and people constantly berating you for problems caused by cuts to the service and a lack of staff that actually grinds you down more than being physically assaulted.

Whilst I can see why people took umbrage at OnTheRoses’s initial comment, I think it is really important to hear from those on the other side of things. It’s hard to imagine the level of perpetual fear you exist in as an inpatient in a MH unit until you’ve been there. I never so much as raised my voice at a member of staff, but I do have PTSD from the experience.

Patients are at risk from each other on wards as well... I worked on one where a patient was killed by another patient... so I can imagine its terrifying for patients as well.
It's a difficult job to be a support worker on a ward as many struggle to get and keep staff... and the problem is there absolutely cannot be understaffing as it becomes dangerous.. they need enough staff to cover all observations and any patients placed on levels, some of which will involve 4 staff to one patient at arms length 24hrs, so you need loads of staff.... they bully you into working because they have to, but then you get very tired very stressed staff.... I once worked two weeks back to back 12 hrs shifts (which were more like 14hrs due to how things would trail on as you cannot just walk out you have to wait till someone else comes do handover etc etc) one week was days so over 75hrs of days, then I swapped onto nights for 7 nights... it was ridiculous and at the end of it they were still ringing me to come in the next day and I could barely string a sentence together... I've also seen support staff doing back to back day to nights and just sleeping on the chairs in the staff room in their hours break.... that is obviously very dangerous but they just turn a blind eye because they need the staff...
It's extremely hard work for very low pay... yes it can be incredibly rewarding but you do get quite a lot of abuse from patients and family members... nurses too. It's a bad political climate to work in any public service to be fair. Things are barely treading water in some places.

I am the nurses also recieve abuse not that they give support workers abuse!! Sorry that was a badly structured sentence there!

So, your child eeds ugent support due to cutting and overdosing:

Your child faces before getting care:

Attidues that say "we don't care"
Being patronised
Lies over waiting times
They lose your contact details
They write inaccurate reports including lies
They parent blame
They blame the government when their own systems are rife with ineffiency
All the time your child is getting worse
PALS are no help at all
You are dealing with a jobsworth inefficient and inflexible culture

If any professional worth their salt thinks that is acceptable makes excuses for it and continues to lose or misrepresent information and then has the audacity to claim they didn't say x y or z and to infer it is all the parent's fault, with all due respect I reserve the right to respond in a way that may be interpreted as difficult rather than assertive, especially when the people responsible fail to take ownership of their mistakes, to apologise and put them right. Especially if they are reductive enough to turn around and say "now mum". I have a name and I gave birth only to my children - never to a nurse.

And if such a professional tells me I am obstructing my child's care by being pedantic when I am not the one who has been disorganised, rude and dishonest then with all due respect I reserve the right to open all barrels in response.

As an RN you can be attacked anywhere anytime it's just the nature of acute care ward nursing-the highest incidents are A&E and mental health and Labor and delivery but I've worked cardiac,stroke and vascular medical surgical and I lost track how many times I've been threatened,hit or scared I would be. I've experienced it the most with dementia or delirium patients. I love my job and I make excellent money here in the states but it's not for everyone you have to have a passion for it

OhTheRoses you are obviously very unhappy with the care you recieved. I'd encourage you to make a complaint and let it be investigated.

I disagree that all mental health staff do not care. I cannot tell you the extra unpaid hours spent looking after people because the nurses care, or the regular amounts of my own money I spend providing activities on the ward that the NHS no longer covers. Because I care and want to best for the young people I look after.

When you say staff "parent blame", is it possible that they linked mh problems to the home environment rather than blaming you? I realise this can be uncomfortable, but most mh issues are linked to what is going on for a patient at that point in their life, or during the years they grew up. That does not mean that their parent's were not trying their best.

Sorry stompy but married, stable parents, loving home, nice older brother, beautiful house, best school possible, lovely holidays, nurtured and loved. Doesn't strike me as a need to parent blame. ADHD/ADD was the issue but the patronising twit dd saw said "well now I think at 17 she's a bit old for that diagnosis". Once sorted anxiety and depression became manageable and the self harm abated. Looked for every possible issue except the neuro developmental disability.

I'm sorry but in those sorts of circumstances my charm becomes a little strained.

Our CAMHS service is now subject to an independent review and I suspect may shortly be in special measures. I did complain. I did eventually get a formal and full apology from the CEO. DD is now well, at one of the two best universities in the UK. She recovered because her parents had £6,000 to spend on private psychiatric assessment, diagnosis and therapy. There was no choice. CAMHS were uncaring, incompetent and discourteous and I saw very little evidence that they did anything other the bare minimum. I am sure their standards are not isolated in the MH world.

Despite all that, I disagree that violence is justified.

And I do not believe that what you are describing is standard.

I've been physically attacked more times working in a care home for the last 15 months than I was in the 4 years I worked in mental health.

My ds gf always wanted to work in mental health and did a summer in a local mh ward. She was 17yo and left alone regularly to look after the patients, was given the worst shifts where she was also virtually alone.
Yes, she was regularly attacked - and spat at.
She loved talking to the patients when there was enough staff, but its ultimately made her change her uni course.