And Then it Got Violent

This weekend was interesting.  Or you could just call it crazy.  Friday night we admitted 5 patients before midnight, which is unheard of, then Saturday we admitted 7 patients by midnight, so I guess it's just becoming the norm.
Friday we had a patient that decided to leave.  Patient just got up and opened the fire escape and started down the stairs outside(note: we can't always keep eyes on all our patients, sometimes they're sneaky).  Of course the fire alarm sounded which sent everyone running.  We called a code over the intercom system to get some help, but in the meantime it was up to my staff, you know being charge nurse and all (ick), to deal with it.  We got the patient back inside, but then Patient decided to get mad.  Patient started getting a little frisky, throwing things and such.  So we call over the intercom system another code to get our security guards.  Super dramatic stuff, I know. So of course a couple of big meatheads show up with their security gloves and cargo pants on.  This only escalates the situation.
Side-note: The thing with nursing is you don't get to slink away in a corner in this circumstance.  It's my job to take care of the patient, to keep the patient safe and its the security guards who keep me safe, and sometimes the patient too.
So I calmly approach the patient, lightly rest my hand on Patient's shoulder and ask, "What can I do to make you more comfortable?"  This is always my approach to establishing rapport with a patient.  Surprisingly it works.  No punches are thrown in my face, the patient gets back into bed, apologizes, and begs me not to tell Patient's spouse.  Patient wasn't quite operating on all four cylinders there.

Saturday night was much of the same.  Quite busy.  Another patient getting heated and angry, but not quite as powerful and intimidating as afore mentioned patient.  This one was older, but very quick and wanting to escape (a recurring theme in the hospital).  My priority was to keep Patient #2 safe.  That is always a big priority.  Unfortunately, this patient wasn't taking any medications or letting me give any care.  Patient #2 was so aggravated and paranoid that any time I got close, Patient #2 would take a swing at me, almost got me once too.  Again, no slinking away in a corner where it is safe and quiet.  It was time for full throttle.  So I call my security guard friends, again.  They probably just thought I was trying to find excuses to have them around.
I tell them, "Hey I need to medicate this patient to help Patient #2 calm down and keep safe, but Patient #2 won't let me near, so I need you to hold Patient #2 down, gently, so I can do my job."  This is not usually my form of care.  I don't like forcing things on patients, but this patient was completely confused and would not remember me from Adam later.  Patient #2 was too close to the edge of something big and unfortunately my only option was to sedate the patient.  So Meatloaf #1 and Meatloaf #2 come help me.  In the process a few syringes went flying, but all was safe and secure.   We got the patient comfortable, with my supervisor present so everything was "kosher" and I had lots of witnesses to what was going on.  Needless to say..... rough night.
I'm thankful to have a job that keeps me on my toes, even if it is running in to a patients room who is throwing punches, kicking and spitting.  It comes with the territory.  Not everyone is going to be sane.  But I continue to be thankful for every shift that I don't come home with a black eye. :)