Nursing Director removed my pts restraints - page 3

So I had a disagreement with my director recently. She was doing her rounding when she came into my pts room. He was in soft wrist restraints for being confused and super violent. The first time I... Read More

  1. by   Nurseneurorn
    I work on a neurology floor and most of those meds you listed they don't order for stroke or tbi patients. We use 4 Pt soft restraints immediately for safety, call the physician regarding incident then if no new orders or they manage their way out security is called and they are put in leather restraints. Then call again. Every morning we have care conference on the floor patients, we ask for psych to consult on their Med's if we feel that's appropriate.
    It is constant calling until someone does something, documenting and reporting. We have three patients that have been in the hospital over a year because their aggressive behavior keeps them from being placeable. We care conference on them weekly with the family involved. It's not great but patient is safe we are safe and none of them are in restraints.
    I would write that incident up with everything you heard, saw and witnesses.
    We are in a different age of nursing unfortunately
  2. by   nursemike
    I don't believe it's acceptable for a nurse to intervene in a patient's care contrary to the will of the primary nurse, unless the primary nurse is abusing or neglecting that patient. If a superior disagrees with your plan of care, they have every right to relieve you of that assignment and discipline you as appropriate, but as you are the assigned nurse, no changes should be made without your consultation and consent. Strictly speaking, your director committed assault by intervening with a patient not under her care. That interpretation is bit too literal for my taste, since supervisors are accountable for every patient under their delegation, but as a charge nurse I would not undermine the staff nurse in that way, and as a staff nurse my attitude would be: fire me or keep your paws of my patients.
  3. by   hppygr8ful
    I haven't read all the posts here but something is clearly missing. I can only speak for California here but in this state a patient cannot legally be kept in in states continuously. It's considered a violation of patient's rights. A periodic (Usually every 24 hours) trial of having the restraints off is required to see if this type of intervention in still warranted. ROM exercise and circulation checks have to be done Q shift and sometime q hourly. The physician must be present to assess the need for continued restraints every 24 hours. There also must be documentation of other measures that have been tried to make discontinuance of restraints possible. In most jurisdictions short staffing is not considered a reason to keep a person in restraints. If all of this is documented properly there is no legal issue but I have done chart audits where absolutely no documentation on the continued need for restraints has been documented in days. While the nurse manager was wrong to take off the restraints and leave the patient unattended she was likely trying to follow the spirit of the law.

    Hppy
  4. by   xoemmylouox
    Restraints are a tough topic. So often nurses are not well educated on them. We also do not always have the staff or resources available to use the correct restraints to meet the patient's needs. The manager was wrong to remove the restraints and not notify the Primary nurse. The manager left a patient who was a danger to himself and other, without proper supervision or safety measures. I would do an incident report and move up the chain of command. Often there is some sort of safety or compliance officer, I would involve them as well.
  5. by   Here.I.Stand
    Quote from ChrissyCasualty
    Easy. Call out the door or, if the place is equipped, hit the button to call the charge desk. There is NO excuse to leave a patient who is already a fall risk ALONE in a room.
    What exactly was she supposed to SAFELY do while alone in the room with this pt, waiting for help to arrive? It sounds like if she was in arms reach he was going to hit or kick her -- hence not allowing his hands to be free during cares.

    It also sounds like you're speaking in general terms though, not specific to this situation: "no excuse to leave a patient who is already a fall risk ALONE in a room. Or from your other reply: "But did you really leave a confused and combative patient with restraint orders by themselves?!" Again, the powers that be did not staff for a sitter. And pts do NOT have a 1:1 RN unless they are VERY critically ill. So pts on ECMO or CRRT, brain dead prior to organ retrieval, etc. This doesn't even sound like an ICU pt, so again, it has nothing to do with the OP's competence as a nurse: unless they staff a 1:1 sitter, this or any other high fall risk pts WILL HAVE TO BE left alone while the RN cares for other pts. It's a fact of biology that a human is not able to be omnipresent. Can you explain how you would go about never leaving a floor (or even typical ICU) pt alone while caring for other pts?
  6. by   silasozzie
    this is TYPICAL of management staff who take a 30 second peek at a situation that you have obviously struggled with for many hours. I hear you sister!
  7. by   silasozzie
    nailed it NuGuyNurse2b
    Last edit by silasozzie on Sep 20 : Reason: comment in wrong place
  8. by   Beth1978
    Grrr, such a frustrating situation. Yes, patients have the right to not be physically or chemically restrained, but nursing staff (should) have the right to not be physically abused also. I had a very large patient, 6'6", A&O×4, with a history of domestic violence, pick me up by my ribcage and hurl me into a wall. He laughed while he did it. I got 3 broken ribs and extreme fear from that encounter. OP, your boss is an ass, and I wouldn't have stepped foot into that room by myself either. Maybe some of the posters that advocate for caring for these patients alone can become sitters themselves.
  9. by   Swellz
    My old NM took it upon herself to contact a doctor to have a 1:1 d/c'd because the patient was sleeping and it was "not a good use of staff". She did this without telling the nurse, who was in with another patient. Yes, the patient was sleeping at the time. It was 7am. It happens. Guess what happened when she woke up? They then had three staff members sitting with her when she woke up because she was constantly climbing out of the bed or chair. Three staff members that didn't have a pt assignment because they had other responsibilities, among them, assisting those of us who had pt assignments. It wasn't my patient but I was livid. The chaos it created was so unnecessary.
  10. by   tferencik
    No one should die in restraints because of Terminal Restlessness.
    Any Palliative/Hospice Nurse and doctor can relieve restlessness, pain, anxiety, shortness of breath, so keeping the patient comfortable without restraints. Music, soothing words, human touch, lavender oil, repositioning and massage can also help this transitional phase of the dying process.
    Identifying the cause of such behavior is imperative.
  11. by   CelticGoddess
    Quote from tferencik
    No one should die in restraints because of Terminal Restlessness.
    Any Palliative/Hospice Nurse and doctor can relieve restlessness, pain, anxiety, shortness of breath, so keeping the patient comfortable without restraints. Music, soothing words, human touch, lavender oil, repositioning and massage can also help this transitional phase of the dying process.
    Identifying the cause of such behavior is imperative.
    I don't recall the OP stating the patient was terminal. I do recall her saying that he was violent and a fall risk. When his restraints were removed, the patient was attempting to climb out of the bed. No nurse should have to put herself at risk because a patient is violent.

    I worked on a palliative care unit for 2.5years and I am now a hospice nurse. I know how important it is to keep terminal patients comfortable. I also know that most (I'd say over 95%) of terminal patients with terminal restlessness were NOT violent, nor were they actively attempting to crawl out of bed. Typically meds coupled with soothing voice and touch were enough to calm my dying patients.

    I would caution you on the use of lavender oil. It can trigger asthma symptoms in some people, completely defeating the purpose if that person is your patient. And as we don't typically know the medical history of the family, they should be asked before use.
  12. by   JKL33
    Quote from tferencik
    No one should die in restraints because of Terminal Restlessness.
    Any Palliative/Hospice Nurse and doctor can relieve restlessness, pain, anxiety, shortness of breath, so keeping the patient comfortable without restraints. Music, soothing words, human touch, lavender oil, repositioning and massage can also help this transitional phase of the dying process.
    Identifying the cause of such behavior is imperative.
    One thing's for sure - it's probably not a good idea for otherwise-uninvolved people to make executive decisions about such things and then walk away without further attending to the patient or helping troubleshoot the problem.

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