Patient abuse, difficult situation

  1. Hi,

    I am looking for guidance.

    I am an lpn that works on a unit with complex behaviours. Essentially , to sum it up ,early onset dementias ( so they are still young and ambulatory enough that physical threats are real) and these patients have been sent to us after repeated incidents that regular interventions have not been succesful.

    Safety is an issue, nurses are injured on a fairly regular basis. We currently have one out for a shattered pelvis, as an example.

    I understand the extra stress can influence staff behaviours.

    There is a HUGE problem though, where i can see sometimes staff have escalated behaviours.

    I am relatively new to the unit. ( 5 months) but have extensive experience in dementia care. I also happen to love it, know it is my niche in nursing, and while i am not a perfect employee, at every job I have had, have received high praise for my ability to deal with said patients, and my willingness to try different approaches. I am not a new grad that is blind to how challenging some patients can be.

    There is an intense bullying dynamic on the unit. I have heard staff say " we will make sure they leave" and witnessed the fall out. They lose good nurses all the time due to this.

    We currently have one lpn suspended for that reason.

    I went to management two months ago to express my concern over some patient care ( being held down by four staff face down to do care) faces being covered with blankets, and other things. I refused to give staff names because of fear of co workers.

    My co workers mistakenly thought it was someone else who brought it up, and bullied her off the unit. Thankfully, she was casual and has full time work full elsewhere, but i still feel awful.

    Nursing jobs are scarce here, and i am a single parent. I need to work full time.

    This weekend at work was awful. They placed a woman in a pinel restraint after she became aggressive while doing care . Hitting, kicking, spitting. Five staff doing her care ( she regularly refuses) and talking about how disgusting she smells, how tbey arent allowed to hold her face down anymore...etc. I would want to spit as well, had i been her. This is regular treatment.

    She was not my patient, and remained in the pinel for the remainder 6 hours of my shift. I came back 12 hours later and she was in same restraint, same chair, same spot. The night rn said while signing off to us " i didnt chart it and if anyone reports it i know it was one of you guys" no idea if it was supposed to be a joke. She did pass it along in taped report, and i noticed the night lpn had done appropiate charting.

    I received her as a patient that morning. As soon as report was done, i immediately went to release her. My co workers could tell i was upset. When asked where i was going i said " she has been in there for 18 hours, this is wrong".

    I also expressed that i was upset with myself for letting it happen for the six hours yesterday, despite her not being my patient. As an lpn though, i take direction from the rn's.

    I went for morning break and when i came back she was in restraints. After the two hours was up ( which is the policy but still in ghis situation unnecessary) i said " ok, she's coming out". She slept most of the afternoon.

    Come suppertime i was charting and heard a loud thunk that we all know is a fall. Said patient was on floor as another patient had pushed her down. The psw told me she had hit him ( no doubt) and then he retaliated. I immediately redirected him, and then came back to assist the staff with her.

    The charge rn said to put her in the pinel restraint. While doing so, the charge nurse said " if you dont stop i will f ***ing punch you " and told us to put her chair " over there and let the sun burn her". Amongst other niceties.

    This all makes me sick to my stomach. Along with sll the charting that happens on the unit that is false.

    This is regular treatment of her, and other patients, although she gets the brunt of it, being so challenging.

    I can't report this and go back to work, because of how staff would treat me.

    I can't let it keep happening.

    There is also the false documentation that if an investigation happened we would all be guilty of ( even though it comes from direction) and i fear losing my license.

    I dont know what to do.

    I apologize for the length of this post.
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  2. 17 Comments

  3. by   caliotter3
    I see no recourse but to find another job, now or when you are forced out of the job.
  4. by   Scottishtape
    1. File a report with the state and local agency that deals with elder abuse (name is escaping me at the moment). You absolutely CANNOT let this continue without doing anything.

    2. Document everything you see and hear in regards to patient abuse to give to the state.

    3. Keep your head down and find a new job ASAP, even if it's a crappy one in the interim while you find one you're happy with.
  5. by   Here.I.Stand
    I've said this in other threads, but you are a mandated reporter. There isn't a dilemma about what to do. I get that's not easy especially given your situation as a single parent, but if all you say is true, you have to make vulnerable adult reports.

    I would start looking for a new job immediately. If it comes to it, look for a waitressing job -- years ago while I was on maternity leave with my 4th child, my husband took a 2nd job as a server and made decent money. You would have a very reasonable explanation for a gap in nursing employment. You reported systematic pt abuse and feared/experienced retaliation.

    Again I get it's difficult, but doing the right thing sometimes is difficult. Plus if you keep quiet, you become complicit in the abuse. That would be a much bigger threat to your livelihood -- you would be risking your LICENSE. Here's a virtual ((((hug))))
  6. by   Here.I.Stand
    Duplicate
  7. by   Castiela
    I agree. You have to report. These patients are vulnerable and being abused. Go directly to your BON, keep a detailed record for yourself including names and what you've seen (I would be worried that your co workers would say you were party to the behaviour and try and take you down with them -they sound like they would be vindictive like that). I would go to your manager as well with the details but explain your concerns about staff attitude after last time you had reported to her. I, so sorry that you're in between a rock and a hard place. I wish you the best finding a new job.
  8. by   macawake
    Quote from Joyfulnurse79
    This all makes me sick to my stomach.
    Quote from Joyfulnurse79
    I can't let it keep happening.
    I'm am so very sorry this is happening. I'm sorry that you have to witness this because it does rob you of some of your faith in humanity, but even more importantly, people who are in a very vulnerable position are being treated egregiously and they lack the autonomy and capacity to protect themselves against the abuse.

    You know what you need to do. I understand that you are concerned about your livelihood, your license and that you fear retaliation. I get it, I really do. But you don't have a choice. As I understand the law, it's clear regarding this. But also, from reading your post, the impression I get is that your conscience demands that you do something to protect these patients?

    Quote from Joyfulnurse79
    I understand the extra stress can influence staff behaviours.

    There is a HUGE problem though, where i can see sometimes staff have escalated behaviours.
    I think you've drawn an accurate conclusion. I have no doubt that this patient population due to the nature of their disease process, would be challenging even under optimal circumstances. However as you've identified, the way some members of staff treat the patients are sure to aggravate and escalate their behavior. I suspect that they are the architects behind some of the scenarios you've described, they effectively create situations that "allows" them to use more force.

    I know that you are familiar with and understand the stress that healthcare professionals who work with this patient population face. I must say though, that I don't think that the things you've described are solely a response to stress. Many healthcare professionals, including yourself I suspect, would never treat human beings the way you describe, despite being under intense and/or prolonged stress. In my opinion you have to have an innate cruel streak or sadistic trait to go there. When a group of people who fit that psychological profile work together, it can have devastating consequences.

    There are certain milieus were these individuals can do much more damage, than they can in others. Psychiatric facilities and law enforcement are two prime examples. Both settings share several characteristics. Both groups of professionals have a relatively far-reaching mandate to use force/restraints. They both deal with a population that can be extremely challenging. Another factor that can facilitate an abusive environment is that these populations are also often seen as having a "weaker", less credible voice. Will you trust the word of the criminal over the police officers'? Will you believe the psychiatric or cognitively impaired patient over the healthcare professional? Add to that the fact that both incarcerated criminals and inpatient psychiatric patients are found in places that are "secluded", where other people than the patients and caregivers have restricted access. These factors taken together, can provide a fertile breeding ground for abusive behavior and a "sick" culture can develop when the wrong type of people are put in a position of authority/power.

    Quote from Joyfulnurse79
    There is also the false documentation that if an investigation happened we would all be guilty of ( even though it comes from direction) and i fear losing my license.
    A piece of general advice, be careful about how much details you reveal here, or on any other forum/social media.




    I agree with other posters, you need to report this to the proper outside authority. I honestly think that you'd already arrived at that conclusion yourself, even before you posted here. I understand that it's hard and that you're worried about the potential consequences. You have my sympathy.

    Other posters will have to weigh in on if the following is a good idea, or not:
    I think that you might benefit from legal counsel to help you figure out how to best protect yourself going forward with this. Do you have whistleblower laws that can offer you some protection? (I'm not an American, so I am not sure at all how to best proceed, so I hope that "local" nurses have a better understanding of this).

    If this happened to me, I would take detailed notes of what I witnessed (date, time, location, who said and did what, who was present) and immediately start looking for other employment.

    Watch your back! Don't trust anyone at work, not even that nurse that you get along with and think is your friend or who sees things the same way as you do (I don't know if such a person exists, but if s/he does, you have to be careful who you confide in).


    Best wishes, hugs!
  9. by   Karafair
    File a report with the state. Patient abuse is not acceptable. You can do so anonymously.
  10. by   quazar
    Quote from macawake
    A piece of general advice, be careful about how much details you reveal here, or on any other forum/social media.




    I agree with other posters, you need to report this to the proper outside authority. I honestly think that you'd already arrived at that conclusion yourself, even before you posted here. I understand that it's hard and that you're worried about the potential consequences. You have my sympathy.

    Other posters will have to weigh in on if the following is a good idea, or not:
    I think that you might benefit from legal counsel to help you figure out how to best protect yourself going forward with this. Do you have whistleblower laws that can offer you some protection? (I'm not an American, so I am not sure at all how to best proceed, so I hope that "local" nurses have a better understanding of this).

    If this happened to me, I would take detailed notes of what I witnessed (date, time, location, who said and did what, who was present) and immediately start looking for other employment.

    Watch your back! Don't trust anyone at work, not even that nurse that you get along with and think is your friend or who sees things the same way as you do (I don't know if such a person exists, but if s/he does, you have to be careful who you confide in).


    Best wishes, hugs!
    This is excellent advice. Please take it.
  11. by   cardiacfreak
    If the patient that is challenging was your sister and you witnessed such behavior would you report? I understand finding other employment is sometimes a challenge in itself, so I would start looking immediately, and get the heck out of dodge before I lost my license permanently. I wish you well and hope you report this atrocious behavior.
  12. by   dansamy
    Always do the right thing. Sometimes, the right thing is the hardest thing to do.

    Regarding documentation, it's your license. Not theirs. Do not chart anything that you didn't do and accurately chart what you did do.
  13. by   TriciaJ
    It is up to management to create and enforce the culture on the unit. They have let everyone down. By not properly supporting their staff, staff have had to take matters into their own hands. This means the more aggressive among them are calling the shots, and maintaining a pathological culture.

    I concur with the others. Get out now. There is no way to effectively navigate this situation from within. It is a matter of time until word gets out and if it didn't come from you, then you are complicit and will go down with the ship.

    Please keep us posted. We are all in your corner.
  14. by   FolksBtrippin
    You are in a hellish situation. Being broke and unemployed is not worse than the moral distress you are experiencing in keeping quiet about the abuse. I've been broke and unemployed as a mother. It is an uncomfortable but temporary situation.

    You know what you need to do. I am praying for you, for strength, for a better job opportunity, for justice.

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