I finally found time after retirement to clean out my nurse’s book bag. It contained items such as a stethoscope, extra playing cards for patients, highlighters, various pens, a penlight, a notebook with important phone numbers throughout the health care system, tourniquets for IVs, and a plastic whistle.

This health care system, which has a revenue of $5 billion per year and spans throughout America, is quite complex. Let me explain.

The behavioral health unit I worked in had the highest acuity level, with patients suffering from paranoid schizophrenia, bipolar disorder, psychosis, delusion, and paranoia. To make matters worse, some prisoners feigned suicidal ideations to be transferred to our unit. In such cases, a pillowcase wrapped around their neck, speaking out loud to “voices,” or smearing feces on the wall could earn them a two-week stay in our Behavioral Health unit, which was more like a hotel than a prison. These prisoners were often murderers, rapists, kidnappers, or perpetrators of domestic violence.

Each year, we were required to attend a mandatory class called CPI (Crisis Prevention Institute) to help us improve our de-escalation skills and manage patients safely. This training was essential, as we needed to be ready and aware at all times, especially during potential assaults.

We repeatedly raised our concerns and complaints to upper management, asking for security guards to be present on our unit 24/7 for the safety of both staff and patients.

We were all given a plastic whistle to carry in our pockets in case we were attacked by a patient. However, this whistle was not an electronic gadget that could be easily pressed, but one that had to be pulled out of the pocket and blown, hopefully before the patient attacked.

Despite our repeated requests, 24/7 security guards were not provided as they were not in the budget. We tried to escalate the matter by emailing our manager, assistant nurse managers, and even the CEO, begging for security guards to be assigned to our unit.

However, the CEO never replied, and our manager verbally reprimanded those who added the CEO to the email chain, stating that he was not part of our chain of command. As a result, staff and patients continued to be physically assaulted, spat upon, subjected to attempted strangulation, beaten over the head, and punched in the face. The list of incidents is long.

I knew it was time to leave when I realized that a patient could snap my neck with a random gesture at any given moment. After being physically attacked twice on that unit, I retired for my own safety.

I realized that management and the CEO did not care about our safety, despite the $5+ billion in annual revenue generated by this hospital system. I knew that the plastic whistle would never save my life.

Debbie Moore-Black is a nurse who blogs at Do Not Resuscitate.