What are you supposed to do when even the emergency line is tied up with emergency calls?

A while ago, I wrote a couple of posts about night shift, especially about how patients can get at night. On my unit, many of our patients are older and very sick, and because of that, they often become confused and combative overnight. Usually, that looks like throwing things, scratching, swinging, or kicking. It’s unpleasant, but it’s generally limited to the patient’s room. We can usually dodge it or simply leave the room.

If a patient is a danger to themselves, we’ll call a safe team to help manage the situation. But most of the time, the threat to staff doesn’t extend beyond that one space.

This one night, though, was very different. I remember it clearly because it felt like a full moon kind of night, one of those shifts where something is always happening. I never actually checked if it was a full moon, but it sure felt like it. All night long, we were hearing emergency calls, safe team calls, and trauma alerts over the overhead system, far more than usual. It was like half the hospital’s patient population collectively decided to lose it all at once.

At one point, I was in the break room eating when I heard yelling. Yelling isn’t uncommon on our unit. Someone is usually screaming at some point on most shifts. But this was different. This was raw, full-volume screaming, like someone holding absolutely nothing back. It was incredibly loud, almost primal.

I got up and ran toward the sound, and there he was: a patient standing in the doorway of his room, completely naked, screaming obscenities and insults at the top of his lungs. I’ve had plenty of screaming patients before, but this was next level. It was actually impressive, in a terrifying way. We could all see that the situation was escalating quickly, so we called the emergency line and requested a safe team.

For context, a safe team usually includes security, behavioral health specialists, sometimes doctors, and administrative staff. They come together to secure the situation and keep everyone safe, whether that means restraints or, in extreme cases, escorting someone out. It all depends on the patient’s mental status, what’s happening in the moment, and how sick they are.

While we were waiting for the safe team to be announced overhead, the patient continued screaming threats and obscenities. I ran around the unit closing everyone’s doors because the screaming was so loud. He was still standing in the doorway with a couple of nurses behind him, swinging at anyone who came close.

Unlike most combative patients, who are usually confined to their beds, this man was very mobile. He was walking around, and for the first time in a long time, I genuinely feared for our safety. I then realized one of my closest friends and favorite nurses to work with, who is close to retirement age, was trapped behind him in the room. I had to grab her arm and pull her out because I was terrified he was going to hurt her. He then marched out into the hallway, dragging his lines behind him. He yanked out his IV, so he was bleeding everywhere (I later found out he was HIV+). Still naked. Still screaming insults at us, calling us horrible names.

And still, no overhead announcement.

“Did someone call?” I asked. They said yes. Several minutes had passed by then, which is not normal. So we called again and asked if our safe team request had gone through.

The dispatcher told us they were handling multiple safe team calls at once and that we would have to wait.

I remember thinking, Can you come here and tell the patient to give us a minute? Because we didn’t have a minute. He was in the hallway, physically threatening us, and we didn’t feel safe.

It was a terrifying moment that really drove home how chaotic and dangerous this job can be. I understand that resources can get stretched thin, but it’s deeply unsettling to realize that security and emergency support can be completely maxed out, leaving you to wait for help that may not come right away.

Eventually, the overhead announcement was made, but by the time security arrived, the patient had already retreated to his room. He didn’t calm down so much as exhaust himself. He laid in bed, refused to let anyone near him, still naked, with no IV access and no monitor. If anyone tried to approach, he would swing, but he no longer had the energy to roam the halls.

By the time security arrived, the worst of it was over. If they had arrived five minutes earlier, they would have seen absolute chaos.

What still alarms me is the fact that we had to wait for an emergency team to even be called. At the end of the day, we’re mostly a group of young women with inhibitions. We can't restrain people however we want. We don’t have weapons. We can’t physically fight back. All we can do is dodge, stay out of the way, and hope help arrives in time.Meanwhile, this was an unhinged and uninhibited patient, bleeding, enraged, screaming, and swinging, holding nothing back. What are you supposed to do in that situation? What do you do when the resources meant to protect you are maxed out? When the emergency line is too busy to answer your SOS? When the system simply can’t handle it?

I guess all I can really say is we were lucky he tired himself out. That could have gone much differently.

Moral of the story: Healthcare has the highest rate of workplace violence of all fields, and while facilities try to have ways to protect staff set up, it's not always enough. At the end of the day, every staff member has to look out for themselves first. We spend so much time protecting and healing others, but we can't do that if we aren't protecting ourselves first. Never be afraid to run or resist an imminent threat, especially when you're just out of options.

• Bella, RN