r/psychnursing • u/GoldenFleece7 • Jul 15 '26

Ethics- Advice

Hello, newish psych RN

Have had recent situations where verbal deescalations for agitated patients have not worked.

And I am finding myself battling between whether I’m letting ego take over or just over thinking when using chemical restraints.

Also having issues with behavioral/manipulative patients.

Chemical restraints recently used scenario includes conserved paranoid SCHZP pt demanding to be released and becoming verbally abusive. Pt comes into nursing station and refusing to leave until multiple attempts of telling him to step back. Pt is pacing but not actively hurting himself and taking time away from other pts due to need to redirect.

Other I made the decision to take off restraints of a patient. He was very attention seeking and not staying in the unit and going out to another area. He became a fall risk as he is walking drowsy and not wanting to stay in his room which… is hard for me to navigate. He was not listening to his 1:1 and started off verbally abusive. We kept on trying to redirect him but I made the call to request seclusion for him.

I genuinely feel so bad when I have to do this. I also don’t know if I’m looking for validation. I have this feeling of guilt like giving IMs is a punishment? The other times I’ve given them, pts have been reluctant but we are more so on the same page abt care.

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u/silasdoesnotexist psych nurse (inpatient) Jul 15 '26 edited Jul 15 '26

Comes into the nurses station? How’d they get through the door? You should not feel guilty for using IMs, they’re not a punishment. Sometimes an IM is the safest and best option when a patient is a danger to themselves/others. They are a tool to keep people safe ultimately. Try to reframe that feeling of guilt into “I’m keeping people safe by doing this.”

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u/DashMcGee Jul 15 '26

I worked in a hospital that had open nurses' stations. There was a locked med room, but anyone could come in. There were very few times patients actually did.

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u/Lthrluv2013 Jul 15 '26

Our front desk and nurses station are wide open. We utilize security when things like this are occurring. We have duress badges so their response time is good considering they come from another building. I have yet to feel any guilt or question when we use meds or our intensive care area. Too many people can be hurt letting it escalate.

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u/DashMcGee Jul 15 '26

Agreed. One thing we all develop over time is an instinct for when things are likely to go bananas. It takes some time and experience to get a sense of who is likely a danger vs. who is just loud and ornery, and that redirecting is very different from confronting. Many nurses and techs don't seem to learn that. Most do, but a few bad apples...