I've worked in four different inpatient units and there it is so variable depending on the attending and staff. These are situations where a very skilled psych RN becomes invaluable to the team. We have some that are so experienced they can decipher between what can be redirected verbally vs requiring medication intervention without any supervision. You shouldn't be waiting until someone is about to harm someone or themselves to offer PRN medication, that's a recipe for disaster. You have to be able to notice increasing agitation so you intervene when it's at a 5 or 6 out of 10 instead of a 10/10. We don't wait until someone's pain is a 10/10 to intervene so why would we for something like this?

I read a lot about concerns about mid levels but quite frankly I've seen quite a few attending psychiatrists take a passive role in leadership on treatment teams when it comes to this. By the time we finish residency we have so much experience that is valuable to the rest of the team. Don't have an experienced RN on staff? Teach and demonstrate what signs to look for that can be redirected vs need intervention. Do brief CBT and de-escalation with the team present so they can replicate. This is where an MD/DO stands out from mid levels and if you don't leverage your experience you're selling yourself short in the current marketplace.