Safe Harbor situation?

Nurses General Nursing

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Specializes in Flight RN, Trauma1 CVICU STICU MICU CCU.

level 1 trauma center, high acuity tele med/surg floor. 6-1 ratio at night with charge nurse taking 3 patients and 2 floor nurses each with 6 patients.

Pt is rule out TIA vs CVA.

Pt is has a left bka and is in 3 point soft limb restraints. L BKA is unrestrained because they didn't figure out a way to restrain it.

Pt kicked charge nurse in the head, shoulder, arm and side. Pt intentionally trying to kick, saying "I got you that time." Pt punched the primary nurse in the crotch.

I entered the room and immobilized the leg and arm so that a new iv could be started so we could push some haldol.

Pt required approximately 4 hours of direct RN interventions. Several times all RNs on the floor were in the room for more than 30 minutes.

I'm afraid tonight is my turn. I will accept the assignment, but when 5 of the other patient's are acutely ill, is this a situation that you all as my peers would deem as a proper safe harbor?

I left late due to charting 2nd to spending a good bit of time defending my two female counterparts. Before I left, day shift primary RN comes into the break room nauseated from a kick to the stomach.

Please post up, i'm going to sleep right now and have to be at work at 1845. I just want to know if i am going to screw myself by calling a safe harbor.

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Specializes in ICU, Research, Corrections.

This guy needs to be in 3 point leather restraints and have at least a sitter at

all times. He meets the criteria in my state and any hospitals I have worked in

for leather restraints. See what your management has to say about that!

They already know he tries to injure nurses. How many does he have to injure

before he deserves leathers?

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Specializes in Flight RN, Trauma1 CVICU STICU MICU CCU.

but is it a safe harbor situation?

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I'm from OH, and unless I've just not come across it, I'm fairly certain I've never heard of a "safe harbor" situation. This may be a regional/state only thing?

As far as the hitting is concerned, I'm sorry that's happen(ing) / (ed) as it's never fun. I'm wondering myself if he does this to everybody? If NOT, I wonder if it would be beneficial to attempt dress casual clothes (SUCH a PITA, but ...)? For no reason at all some mammals are infuriated by certain things. (ex: some dogs go after cars/wheels, others after people in uniforms especially mail man and utility workers) Could this possibly be the case? Does he do it to docs as well?

In addition to the wrists I would recommend the restraint alternative mittens that prevent people from picking at their IV/dressings. This way when he punches he won't hurt as bad, and he can't GRAB ... any man would attest that this is a fantastic idea, especially if the patient is being turned TOWARDS said man ... crushed manhood is not a fun thing, either.

BTW I'm not comparing your patient to an animal, I'm just using a crude example...

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Specializes in adult ICU.

Texas Nurses Association: ADV Safe Harbor Conditions

I don't live in Texas and I'm not an expert but that is what I found on the web re: conditions for safe harbor.

From my interpretation of the small blurb that was there, I don't think that just having a combative patient qualifies you to call safe harbor. I do think that if you can't get out of that patient's room and that impacts/negates your ability to care for your other five patients (and, it sounds like, the patients of the rest of the nurses on the floor) that would be a safe harbor situation I think.

We have a similar "safety net" sort of mechanism in place at my facility if we think that staffing is unsafe. I would call it out in this instance if that happened where I work if they were unable to provide a sitter for the patient.

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Specializes in Peds, PACU, ICU, ER, OB, MED-Surg,.

I don't think it applies for safe harbor but I think administration should be looking at getting you a sitter for this person, preferably male. I'm curious does he behave this way with male nurses?

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Specializes in ICU, Research, Corrections.
but is it a safe harbor situation?

There is no such thing as safe harbor in my state. Sorry, I can't help you

out there.

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Specializes in Medical Surgical Orthopedic.

It doesn't sound like one to me....

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You should definitely fill out the Safe Harbor form, especially if caring for that patient will remove you from your other patients for an extended period of time. This way if anything were to happen to any of your other patients while you were attending to the combative patient you will not risk losing your license.

Make sure you are ready for the consequences. Facilities don't like for their nurses to invoke Safe Harbor as it involves a lot of paperwork and the peer review committee. In many cases they will attempt to revise the assignment. Even though you are protected from retaliation you need to make sure that you properly document any incidences that may occur from this time forward. Fill the form out as soon as you start your shift and request the signature of the person making the assignment.

I am a firm believer that you have to advocate for your rights. As TX nurses this option is available to us in order to protect our livelihood. If you chose not to fill out the Safe Harbor form and anything were to happen to one of your patients you may have to face further disciplinary action.

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Specializes in Flight RN, Trauma1 CVICU STICU MICU CCU.
You should definitely fill out the Safe Harbor form, especially if caring for that patient will remove you from your other patients for an extended period of time. This way if anything were to happen to any of your other patients while you were attending to the combative patient you will not risk losing your license.

Make sure you are ready for the consequences. Facilities don't like for their nurses to invoke Safe Harbor as it involves a lot of paperwork and the peer review committee. In many cases they will attempt to revise the assignment. Even though you are protected from retaliation you need to make sure that you properly document any incidences that may occur from this time forward. Fill the form out as soon as you start your shift and request the signature of the person making the assignment.

I am a firm believer that you have to advocate for your rights. As TX nurses this option is available to us in order to protect our livelihood. If you chose not to fill out the Safe Harbor form and anything were to happen to one of your patients you may have to face further disciplinary action.

This is exactly the point I am getting at. I have other people who are terribly sick and to spend so much time on him is unsafe for them. He didn't have that reaction to me, but, I was also the only one strong enough to hold him down. Once the haldol took effect, but he's there for a rule out Tia / cva how do you assess that if he is chemically restrained into oblivion? Thanks for the thoughts... Here we go.... Wonder if this is going to blow my chance of internal transfer at his hospital...

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A full body net, as someone else suggested, should restrain the free leg.

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Specializes in Flight RN, Trauma1 CVICU STICU MICU CCU.

So on my way out of work before i posted this, I saw the security guy who i'm friends with, told him what was up and he went to scope the situation. Then I accidentally had lunch with the house supervisor. By the time I got back to work, our manager had been called and the person having to take this madman had their ratio dropped, so that they could spend more time in the room. He was completely restrained with haldol... like unresponsively restrained... limp... then suddenly at 330 in the morning my charge says... go in the room and look... (as she's dialing the CRT) I go in and I can see it instantaneously... he's breathing 40 a minute. I took one look at the sitter and i said, listen. He's gonna die tonight, are you ok with that? She just blinked.

Luckily we got him all cleaned up suctioned 3 softball size mucous plugs out of his oropharynx and he actually started breathing again.

Next day I came in and they had removed his scopalamine patch. Dude was awake, alert, oriented, pleasantly talking, had had a great conversation with his son and was no longer a violent threat to our entire unit. Not even in restraints any more (but still with a sitter).

Oh and I never had to take him, luckily i got all my patient's back... all 4 nights in a row... hehe. Maybe my house supe, or my charge reads allnurses.com and they knew i would call their a$$es out.

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