What to do with these kind of patients?

Nurses General Nursing

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Ok, I work on a SNF (inside of a hospital) but we get mostly med-surg patients when the hospital is full. Ok, so when the census gets to 16 or below we only have 2 nurses and 2 cna's on nights. On this floor NO ONE is allowed to get up alone at all, so we are almost always out of the nursing station. Patients have to call for anything. More than half of these patients are always confused. Well, what do you do with a patient that you can't leave alone? Especially when management doesn't listen. He's constantly trying to get up (every 10 seconds), so he's at the nursing station sitting beside me. I spend my entire night trying to keep him from groping me, stopping him from pulling out his 6th IV and PICC line in 3 days, keeping him off the floor, keeping his gown and underwear on (he likes to go 100% naked), stopping him from picking and scratching his skin causing skin tears. We are a restraint-free facility. Family refuses to stay. Family refuses to hire a sitter. Our floor refuses to spend the money on one.

Our 4 supervisors just laugh it off, but won't even help, even though they are "required" to work the floor if needed. Maybe I just needed to vent but this has been a horrible weekend. I haven't been able to get anything done. We had 12 falls last month, and none of them could have been prevented because each time we had a fall on my shift we were all in other patient's rooms responding to bed/chair alarms. Even though we asked for more help, they just told us to deal with it. Just ridiculous. Any other suggestions on how to handle this? Sorry for the ramble.

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Specializes in Geriatrics, Hospice, Palliative Care.

Sounds so familiar! If you've checked that all of their physical needs have been met (food, water, toileting, etc), might be time to get orders for a sedative. Can he walk? I've had some patient who settled right down after I took them for a walk up and down the hall a few times. Any meds that might be interacting poorly/causing agitation?

It really stinks that your mgmt won't step in to help, and I don't have any helpful ideas for that ):

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Specializes in Wound Care, LTC, Sub-Acute, Vents.

wow it looks like a no win-win situation. patient falls. management blames nurse. patient does not fall due to unordered 1:1 by the nurse and things don't get done, management blames nurse. :banghead:

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Specializes in Cardiac.

Take them for a walk to tire them out. If they can't walk, make them do some sort of strenuous activity to tucker them out.

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He cant walk no more than from bed to chair. We got him up the other night and he decided he didn't want to stand up and there went my back! I gave him all kinds of things to entertain him but to floor they went, right with his food, gown, and depends. The doctor has changed his meds 3 different to help him get some rest. None of them help. Thank God I'm off tonight. lool

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Specializes in Cardiac.

And let me guess, all he wants to do is get up, right?

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Nope. He walks a lot during the day. We are a therapy floor. They get PT twice a day, OT, and ST.

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Specializes in ER.

Incident reports on the supervisors that you request help from when they refuse, just to start.

Do what you can to keep him safe, document the close calls, email your boss and keep copies, but you can't let one person prevent your care for the rest of the unit. Pad the floor around him, so when he falls he will get as little injury as possible. Make sure family and management know about the falls, perhaps fear of further injury will get you a sitter.

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Specializes in Oncology.

Document, document, document. Cover your butt. It's a very frustrating situation. We frequently have people who are ordered to be sitters, and then laughed at when we tell supervision we need a sitter.

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Specializes in CAPA RN, ED RN.

Don't forget to document your attempts to get help. I wouldn't put it in the patient's chart but as a written request to your bosses. I have gotten an amazing number of things when management realizes their tail is on the line because a paper trail can lead to them if any problems come up.

Make sure you describe the situation accurately, outline risks of continuing as is and suggest some alternatives.

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We have "patient safety rooms" on a few of the floors at my facility. 4 beds to each room and one CNA in that room at all times tending to patient needs. It seems to work well.

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Specializes in Med-Surg, Home Health, LTC.

Simuliar situation at facility where I am temping. If I was not so busy alert charting on the pts that have already fallen and or the continuous run of UTI"s it would be easier for me to get down the hall, so as it is sometimes I take a chart and sit in hallway so I can more quickly get to the one of 10 bed alarms going off. CNA's are overloaded maybe 1:12-15 pts.

Personally the way I am going to handle this is remove myself, maybe before scheduled shifts

are completed and certainly not take anymore shifts there.

I liked your post because it so clearly reflects a reality in many facilities. :-)

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