Chemical and mechanical restraints are primarily found in psychiatric care facilities and psychiatric units, where staff members generally have a crisis care plan mapped out before a situation escalates. But that doesn't mean nurses in the ER or in hospital psychiatric units don't run into problems.

Huang says that nurses who aren't trained to properly handle psychotic patients or drug-induced psychotic patients tend to use restraints as the first line of defense.


"[Nurses] don't really like to use restraints, but if they're not given other skills to know what they can do instead of restraining patients, they don't know what else to do," says Huang. "You really need to have these training strategies to prevent the use of [restraints]."

In general, nurses are trying to move away from restraints, says ENA's Gurney.

"Many hospitals are trying to get to zero use of physical restraints because those also can harm patients," she says. "There's a fine line between therapeutic treatment and having to employ a process that's going to be harmful to patients."

Other strategies, Huang suggests, include calming a patient in a comfort room or offering sensory calming devices like a blanket. Of course, it takes training and working closely with patients to understand how best to deal with them, and that is generally found in psychiatric care centers.

According to a study by Kevin Huckshorn, a nurse and director of the Office of Technical Assistance at the National Association of State Mental Health Program Directors, it is possible to reduce restraint, which ultimately reduces violence in the workplace.

Fixing the situation

Plain and simple, nurses want their employers to take notice of the rapidly growing problem of workplace violence.

"It's swept under the table," Casey says. "Nobody wants to talk about it."

Once recognized as a problem, nurses seek proper training programs, adequate support and equipment.

Casey says her hospital needs surveillance cameras, metal detectors, security staff - the hospital has just one security officer - a panic button that calls the police directly and an overall awareness of what the ER atmosphere is like. She points out that ER greenhorns don't realize what actually goes on in the ER until they get there, usually unprepared.

"Nobody knows what goes on behind the doors," she says.

But ultimately, it comes down to training, nurses agree, and most importantly, informing a nurse to keep herself between the patient and the door in case a situation escalates toward violence.

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