Psychiatric Patients in the ER: Challenges Faced by Emergency Nurses

While emergency nurses and ER physicians are highly trained at dealing with acute trauma, there’s one area where many don’t always feel comfortable: working with psychiatric patients. A 2013 white paper from the Emergency Nurses Association highlights the challenges that nurses deal with when faced with patients who suffer from mental illness or substance dependence.

A Challenge for Emergency Nurses

Emergency nurses are highly educated and trained professionals, but in many cases, they haven’t had extensive experience working with mentally ill or substance dependent patients. This can leave them feeling poorly equipped to treat psychiatric patients effectively, potentially lowering the standard of care that they’re able to provide. There are several contributing factors at play here.

• Societal attitudes and personal biases. Outside of the clinical psychology and psychiatry communities, many people — even nurses and other healthcare professionals — have a limited understanding of mental illness. There are also stigmas and biases that many people hold, which can color their ability to communicate with these patients and provide the right treatments.

• Inadequate educational preparation. Without enough of a solid foundation in psychiatry, especially hands-on clinical experience, many nurses aren’t adequately trained to deal with mental illness.

• Safety concerns. Some psychiatric patients can be aggressive or violent, due to conditions like psychosis or substance intoxication.

• Crowding. Many emergency rooms are too busy for the number of available staff, making it difficult or impossible to give psychiatric patients the attention they need.

• Lack of confidence. Emergency nurses and physicians may be able to adequately handle the situation, but due to a lack of formal training, they may question their competence.

• Lack of guidelines. Many ER facilities may not have clear-cut guidelines about how to deal with situations like suicidal patients or acute drug intoxication.

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