u/NurseAndrei03

I am an emergency ward/critical care nurse from a non-US/non-commonwealth country. I recently joined my hospitals behavioral emergency team. We respond to behavioral crises on the medical wards, psych, really everywhere. We’ve gone through some milieu management training, verbal intervention training revolving around MI/DBT/SFBT, additional restraint training, we have a training night 1-2x per month…

I’ve gotten ahold of the flow for single patient crises on medical units. We show up, single provider leads verbal intervention, physical or pharmacologic intervention if it comes to that, treat or transport any resultant injuries, get called off by the patient’s assigned nurse, and we all leave simultaneously. Quite straightforward in my opinion, usually fairly short activations.

Responding to our inpatient psych units can be a little more complicated. It is not always clear who is the primary patient, sometimes there are multiple… there often are chain reaction type events & cascading disruptions. It also is less explicit how long we’re needed, and the common practice is for behavioral emergency team members to slowly leave, scaling down as things feel calmer. This has led to repeat behavior emergency codes though. Does anyone have advice for managing these milieu-wide crises/tense milieus from a nurse responder perspective?

Hi, I’m a younger (non-US/non-commonwealth) male nurse with about 7 years EMS experience at the AEMT-equivalent level, 3 years in nursing, and ~1 year as an emergency & casualty + critical care nurse. I do consider myself quite calm & professional. Excellent reputation for it, I am very frequently given difficult patients because I do well with them, I’m even on my hospitals behavioral emergency team. I can be quite warm but I generally have no issue detaching, being non-reactive & pragmatic, giving clinically solid care without getting too clouded by emotional responses.

One patient comes to mind who seems to be an exception. Overlapping slew of both significant psychiatric & genuine serious medical diagnoses, including both somatoform disorder & malingering, as well as personality pathology + antisocial dx + borderline intellectual functioning. It can be genuinely difficult to decipher what is “real” and what isn’t, as well what flavor of “not real” it is if so. Everybody is beyond exhausted with her. Law enforcement & court system has been involved to little avail.

Personally I have lost pretty much all objectivity. Unfortunately I do have very strong emotional reactions even just to her presence in the department (even when I am not assigned to her), it is impacting my ability to provide objective & fair care to other patients. When assigned to her, I find myself compelled to treat her poorly in a way that is uncharacteristic of me — I obviously resist those urges, but they are preoccupying & intense. I’ve had multiple occasions where professionalism has slipped. Coworkers & supervisors are aware, they make an effort to not assign her to me when practicable, I have trade agreements with various coworkers revolving around her… I would love some advice on what to do from here, especially as we are a small department.