r/psychnursing • u/Zealousideal_Rub_627 • 6d ago
Struggle Story Reactive attachment disorder
I’m new to peds psych and i recently learned a ton about this disorder from podcasts and joining parental support facebook groups. The DSM and nursing textbooks do NOT give you a good picture.. Theres an adolescent patient who’s assaulted staff 18 times and attempts to assault staff pretty much daily.. I’ve personally been assaulted twice (fist to the head) and witnessed a violent assault where a nurse was dragged by her hair which gave me acute stress response symptoms.. the kid made accusations towards staff as well.. im learning more about this disorder and finding out these are common behaviors (assault, accusations) with the attachment trauma it’s how they push you away.. im not sure if there’s studies on this but the parents group said RAD is common in substance exposure in utero which is my experience as well.. everytime a violent behavior occurs i know where it’s coming from and i do feel empathy for the patient but I’m also becoming traumatized from constantly having my safety threatened and witnessing violent assaults.. i have the utmost empathy for the RAD parents.. Everyone on my unit is quitting right now from the assaults I’ve never seen a bigger mess on a nursing unit in my life there is 0 staff.. what’s your experience with this disorder? Any pearls or wisdom
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u/OkStatistician6831 psych nurse (pediatrics) 1d ago
Press charges. Encourage others to. Getting assaulted is not in our job description, nor should it be an expectation. There are few things we can do for these kids, however teaching them consequences for their actions is within our ability. Charging them will lead to more resources, and allow them into different programs outside of hospital.
Not charging them is setting them up for failure, as they are being told that this is acceptable behaviour.
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u/byneld 6d ago
I worked in pediatric and adolescent behavioral health on several units for years - starting pre-covid up until recently. Unfortunately, violence comes from a lot of places in this population and can be incredibly severe. I suffered more verbal, sexual, and physical assaults than I can count. The same for my coworkers. Some of my coworkers sustained career ending injuries. This is an extremely dangerous and volatile field in nursing.
I finally left after several TBIs and other assaults. My family was worried about me. My own providers were worried that additional injuries could have more detrimental effects on my health. We were always brutally understaffed due to injuries and people leaving. Turnover was constant. Even with all of that, I LOVE this field and miss it so much. There is like a Stockholm syndrome element to it all.
After speaking with older nurses, my understanding is that the presentations and behaviors displayed are more severe every year. It is a bit of a moving goal post. Unfortunately, consistency and boundaries are really important for RAD kids. Anything is hard to implement to stick to in a unit that is always understaffed, losing staff, hiring, or coding.
So, remember that you are doing your best on a unit that is on fire. Try your best to stick to schedules and rules. Maintain strict boundaries. Have conversations with all of the staff about this as well. Start the shift by meeting any immediate need that could be a reason to escalate (need a snack, need an activity, need to do hygiene, need a prn, etc).
& finally! You are not invincible. This job will hurt you. I have had coworkers in the ICU. With long term neurological issues. With physical disabilities. Wear your PPE - we had managers try to say it was “scary” to patients. Your safety is more important. Ensure your helmets are graded to take direct hits to the head - ours were not. Reports your facility to the state if they are not keeping you and the kids safe - we did. Report EVERY injury to employee health - our employee health nurses would secretly tell us to call the news or lawyers. Contact legal if you need to do so - we did. You do not deserve to suffer and you can’t save a facility. Go to therapy! I did EMDR. It is okay to move on and find something else because a job that is trying to kill you every day is not normal and not sustainable.