i need some help -- DESPERATELY!!

Nurses General Nursing

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i need advice from all you nurses here with so much experience in so many areas. I've been a nurse for appox 10 years and went to LTC about 18 months ago. I work really hard and I'm not a regular call off person. I pick up shifts all the time to help out when we're short. All in all, i feel pretty much married to this facility. I lOVE my job though and adore the people I take care of. The families really like me too and seems like they are always coming to me to get things resolved. Okay, now that u have some background on how I work. -- A few weeks ago we had an issue with a res. that is in a w/c w/ a seat belt to hold her in to prevent falling. she is leaning forward to the point of her face touching her knees and was c/o back pain due to her positioning. we tried putting her back to bed, but she kept trying to come out of the bed head first so we got her back up to prevent the fall. the c/o back pain d/t positioning continued and res. was asking us to hold her up so she could see and be more comfortable. We just don't have the man power to devote someone to holding her up. Lap buddy was tried but didn't work either. I decided to try to hold her waist up with a sheet tied loosely around her waist, it worked, was soft and she was so grateful she could sit up again. she was in it less than an hour and was put back to bed and never used again. She's back to the same position and c/o all the time for someone to help her.

Now, we have a new position available for a night shift manager and there are a few girls in the running for it, myself included. Anyway, one of the girls also in the running for it picks up shifts from time to time but only with the stipulation that she work the same halls she typically does, which are also my usual halls too. If she comes in and I'm on my halls she throws a royal snit, as she did this past week. We exchanged some words on the topic and i heard her say something to her husband about getting rid of this problem. I wasn't sure what she meant and just went back to my duties. I saw her later that night meeting with all the aides down one hallway and thought that was strange, but just dismissed it. Anyway, to make this story somewhat shorter, some one called our corporate offices anonymously and complained that i was tying this resident up to her chair. NOT TRUE. from what I can accumulate from all this she wants me out of the way and is gathering up as much as she can to make sure it happens. I just don't function in this way, and I don't know how to combat this issue. i've told my side of the story, but I didn't tell about my suspicions with this other nurse and her motives. i honestly don't know how to fight this and I need some advice. there are other issues too but I didn't want to turn this post into a novel. I have seen this nurse do mean things to other nurses as well, writing them up for med errors that never happened, stuff like that. Please give me advice!

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Are you allowed to use a sheet like that? I was under the assumption that we are not allowed to do that anymore. I think there could be some trouble by doing that. I hope not for you. Did you document that you did that to her? Have you talked to the DON about it? That kind of thing is not allowed at my facility. I would be talking to someone about it ASAP if it were me. I know that you did not hurt her et it might have helped the situation but I think it is against the regs.

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I am so sorry that this is happening to you. If it is any consolation, we are being taught in nursing school right now that interventions that improve patient functioning (including tying a patient's torso to a wheelchair) are NOT considered restraints. I can see how these types of interventions could be misapplied in LTC but does that mean they shouldn't be used? I know nurses need to cover something, but should the patient suffer? I think you did the right thing. Document.

By the way, I can't speak for your situation, but management is often already aware that some staff members have their own agendas. Let's hope that's the case here.

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This patient all ready had an existing restraint that was ordered by the Doc and implemented, being the seat belt. I wasn't trying to restain her, I was trying to improve her quality of life and relieve her discomfort. Honestly, i wasn't aware at the time that back in the days some people used sheets as restraints and they were mis-applied just to keep the patient out of the nurses hair. this wasn't the case. i adore my patients and would never do anything to hurt them. i didn't document the use of the sheet since it wasn't an official item of use. I wasn't planning on implementing it for further use other than the 30 minutes we used it. I had tried to put her back into bed, but she kept trying to crawl out head first. I feel I've made a grave error here, and my job is on the line, just as the nurse who reported it was hoping for. She knows me very well and knows i would never do anything to harm anyone ever. I'm off work until the "investigation' is completed. Who knows what the outcome will be. I'm just emotionally ill over this. In my career i've never been fired and have always felt as a valued employee. I've also never encountered such back-stabbing and pure meanness to get a head.

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Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.

I truly believe you when you say you adore your patients and would never do anything to hurt them. But the simple fact is that you cannot use a sheet to tie a patient into any position. Even if you were trying to keep her safe. It's a sad state of affairs when you hear from admininstration that the pt. "has a right to fall". It's insane. But that is just the way it is. You cannot even put a bedside table in front of someone unless you put something on it so that it is viewed as a table and not a restraint. :o

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Specializes in Critical Care.
I am so sorry that this is happening to you. If it is any consolation, we are being taught in nursing school right now that interventions that improve patient functioning (including tying a patient's torso to a wheelchair) are NOT considered restraints. I can see how these types of interventions could be misapplied in LTC but does that mean they shouldn't be used? I know nurses need to cover something, but should the patient suffer? I think you did the right thing. Document.

By the way, I can't speak for your situation, but management is often already aware that some staff members have their own agendas. Let's hope that's the case here.

Search the internet or find an article that professionally justifies this above position: patient functioning is NOT the equivalent of restraints.

Use it.

Try THIS article, which explains things along the same lines, from Federal Law:

http://www.usd.edu/elderlaw/student_papers_f2004/nursing_homes.htm

Or, this:

Medicare Law, Facility Operations Manual Page A-182:

http://216.109.125.130/search/cache?p=interventions+that+improve+positioning+versus+restraints&btn=Search&tab=Web&ei=UTF-8&fr=my-vert-web-top&u=www.cms.hhs.gov/transmittals/downloads/R17SOM.pdf&w=interventions+improve+positioning+versus+restraints+restraint&d=LCcZovmdOeuf&icp=1&.intl=us

"A positioning or securing device used to maintain the position, limit mobility, or temporarily immobilize during medical, dental, diagnostic, or surgical procedures is not considered a restraint."

I would challenge any use of the word, 'restraint'. I would maintain that you used a 'positioning device', not a 'restraint'.

~faith,

Timothy.

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Is the pt with it? Can she testify on your behalf?

As for her positioning, maybe she needs to have a reclining w/c ordered for her, so that she can't tilt forward.

The trubblemaking nurse: not much you can do about her except hope that management knows how she operates. What about the rest of the staff? Will anyone stand up for you?

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I realize your question is not just that of protocol of using a sheet to sit a patient upright - there are several questions involved. I am only going to comment on the sheet question. In our clinical orientation for 3rd semester of my RN program we were clearly told of the current use of restraints. My instructor made it clear to us (state of CA - last week) that this is not ok anymore. Just wanted to mention this. Best wishes

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Well considering that it was several weeks after the incident, why the heck did it take her so long to report this if it was such the issue she is trying to make it out to be......

Hoping all turns out okay for you.

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I am just curious why a Geri Chair wasn't used for this resident.

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It's a very tricky situation, in OH, with the existing order of the self releasing seatbelt AND the added use of a sheet (without a Dr's order and proper assesment and documentation for three consecutive weeks and repeated falls and injuries.......you get the picture:angryfire ) would constitute double restraint....period, and double restraint means bad news. You were doing what any good nurse would do, try to relieve pain and discomfort and keep your resident safe. With our litigation happy society, nurses are caught with a double edged sword, if the resident fell then you didn't do enough to protect the resident, but if you try to protect them your interfering with their rights........

As for the situation with the other nurse, your documentation of res care is your proof of proper care. Talk to your supervisor or DON, if you have a good working relationship with either or both, thaey can provide ideas and suggestions for this res. This will also show them that the other nurse is just stirring up trouble.

Wish I could offer more help but I don't know your situation. Good Luck

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hey everyone, restraints are defined by the patients ability to remove them. a lap buddy is a restraint if the patient can't get out of it easily, either because of confusion or any other disease process. however, it's a positioning device if the patient can remove it with ease; same thing with the seat belt and the sheet. if your patient is alert and has problems with balance, you have no problems.

as far as the nurse that seems to be out to get you; leave. i hate to say that, it actually makes me kind of sick to say it. but i have been a nurse 25 years and i honestly believe that when we deal with people we should assume innocence. meaning, i believe that most people that hurt us or do something that affect us negatively don't get up in the morning and put us on their "lets get them" list just to make our lives miserable. however, they can and do hurt us; it's just not as intentional as it seems or feels. i believe we have every right and obligation to tell people that they are hurting us and make sure they don't keep hurting us. you however, are in that rare situation where someone is out to get you. when that occurs, you then are working in a hell created by a coworker who obviously has some kind of problem. unfortunately, most people where you work probably know what she is doing and how much she obviously hates you. for someone to report you to corporate, bypassing their own management, says a whole lot about the culture you are working in. after 25 years i found most places you work at are basically the same; benefits, rules, supervisors, etc.... so my best advice to you and to anyone looking for a job or looking to leave one place for another, make that decision based on who you work with. it is going to be the people that you'll spend 8-12-16 hours at a time with, it's those people that you need to be able to count on and they need to count on you. i will never again work in a place where i actually feel sick when it's time to go in because it is so hostile and so lacking in support that i know the care and the level of work i perform suffers; it has to, because half your time is spent looking over your shoulder. the management must be aware of her, the aides obviously are, and i feel very sorry for you. it sounds as if you love what you do and you shouldn't lose that because of one person. we have so many elderly people who would love to have someone like you care for them and you can do it while getting support from your coworkers. best question to ask in an interview; what is the staff turnover rate?

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