'Persistent state of fear': Seattle Children's nurses ask leaders to address violence in behavioral unit

Over 40 nurses at Seattle Children's Hospital are urging the hospital to do more to prevent violence in the psychiatry and behavioral medicine unit. 

In a Nov. 27 news release, the Washington State Nurses Association, which represents the hospital's nurses, said nearly every nurse on the unit signed a letter urging the hospital's administration to have at least three safety officers on the unit during the day, add additional nurse roles, decrease nurse-to-patient ratios and increase pay. 

The call comes after police were called twice in two weeks to quell violence on the unit, the nurses' association said, a rare occurrence and "a sign of systemic crisis in pediatric mental health." In one incident, several staff members on the unit were sent to the emergency room with injuries when a patient struck a nurse in the head 16 times, according to the news release. 

The acuity and aggression of some patients have increased since the pandemic, the nurses said. According to the news release from the nurses association, Seattle Children's psychiatry and behavioral medicine unit was designed for short stays of three to seven days, but some children have remained in the unit for months because of a lack of residential care space in the state. 

"Staff work in a persistent state of fear as they come into each shift expecting violence and debilitating abuse," the nurses wrote in their letter to management. "Patient care has been compromised to an extent that our milieu is no longer therapeutic, but rather dangerous and detrimental for all who enter the PBMU, staff and patients alike." 

In a statement shared with Becker's, a Seattle Children's spokesperson said the hospital has implemented several improvements to address the increasing acuity of behavioral patients, including establishing an emergency operations center to streamline communications and decision-making and increasing leader and security presence on the unit. The hospital is also actively seeking travel nurses to provide supplemental staffing. 

"The demand for youth mental and behavioral health services remains alarmingly high, and the impact of this crisis is felt not only at Seattle Children's but across the state and the entire country," the spokesperson said. "The safety, security, and well-being of our patients and workforce is our top priority." 

The hospital is working with local, state and federal partners to pursue short- and long-term solutions for the high numbers of children in need of behavioral and mental healthcare at Seattle Children's and across the state. 

"Greater investment in youth mental health is critical to building a pediatric mental health system that encompasses upstream prevention to the highest acuity and complexity in order to meet the needs of Washington's youth," the spokesperson said. 

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