Aggressive residents?

TurtleCat · Jul 3, 2013

Do these residents have dementia? If they have dementia, I'd say this is probably par for the course but if they are alert and oriented, absolutely not. If they know what they're doing, something should be done about it.

MedChica · Jul 3, 2013

I am a new grad and started in a SNF 2 months ago. I had 5 days orientation for 3 halls, I am a float. They have already made me a charge nurse/on call for weekends (which I don't like...I haven't had a weekend off since I started).....and now I am finding all the new residents they are allowing in are really aggressive. The past few weeks (about 8 shifts for me as I am part time), I am getting punched, kicked, sworn at and having things thrown at me multiple times every shift.
I am hating my job right now and am regretting becoming a nurse. Is this what it is like at every LTC?? I had never experienced behavior like this during any of my clinicals.
I think I am going to make the move to a doctors office. Please tell me hospital nursing is not like this. I want to go on to RN but not if the only choice for work is LTC (which it seems to be around here, Bellingham WA).....only BSN with experience get hired in our hospital.

Of course, you didn't experience behavior like that during your clinicals.

No, every LTC isn't one in the same.

I love my geri's but elders aren't always nice. LOL However, nursing means caring for people at their best and their worst. Establish boundaries, yes (which is easier to do with some vs others because some are so far gone that they can't truly be redirected) but you can't take it personally.

Your new admits? It could be dementia/Alz OR a combination of this plus fear. Some people will self-isolate. Other people will adapt easily. You speak to them and they're pleasant. Talkative.

Others will sometimes 'act out' aggressively due to fear and whatnot.

Elders are no different.

Imagine waking up in a room. You can't remember how you got there. You don't know where your family is. Everywhere you turn, there are unfamiliar faces...trying to push pills on you (poison, perhaps?), waking you up and bothering you, trying to 'clean' you, trying to stick you with insulin needles, bothering you about your 'blood sugar' and constantly wanting to take your blood pressure, observing you, checking up on you.

To make matter worse? You got the folks 'in charge' to contact your family but no one picks up and no one 'in charge' will allow you to leave.

You've got to establish boundaries, yes...but you've also gotta understand where these guys are coming from.

When a resident's new to the facility, it's an adjustment period for everyone. They're afraid. They may not recall where they are. They don't understand what's going on. If they lash out in anger? They can't help it.

I haven't been at it that long. Almost got my first year down so don't think I'm some expert.

It's like this at my facility but we're geri-psych. Non-restraint facility. Mood disorders, dementia/Alz, schizo's, PD's, cog deficiencies, you name it. So, we tend to take on what your avg nursing home won't deal with and what 'the state' shuffles our way. Although, some like yours will accept residents that have dementia. So long as they're non-violent, I think?

It's difficult to offer advice because I don't know the dx of your residents. Here's what I wonder, though:

How are you redirecting these residents? How's your approach? Cursing is one thing but I don't understand how you're 'constantly' getting things thrown at you and openly physically engaged by several new admits throughout the shift. Even by one.

What are you doing? What are you saying?

If they're agitated but no threat to self/others? Leave them alone. Let them settle down and try again later. Maybe ask them if they want a cup of coffee or a diet soda or a snack or something.

If they're wandering in and out of rooms or dangerous areas, never just walk up to a wandering dementia pt and start grabbing/pulling on them.

That's a fight waiting to happen. LOL Actually, you don't approach anyone like that...LOL

You walk to them, speaking in a gentle voice 'No, Mr. James. Let's go this way'. Guide them away with a hand against their body...or if you need them to come away from area ASAP, come from behind speaking grab hold of their upper arms and lead them away.

A 'show of force' is seldom used. Sometimes, it's necessary. Most times, they see themselves surrounded and allow treatment or care. I only use it as an option if I'm dealing with a known fighter (alert but disoriented x3) or someone who is filthy and resistant/aggressively refusing to be changed or showered. I pick and choose my battles but sometimes...?

You can't imagine how many w/c-bound alert & oriented to self+place folks out there will just lie in excrement/urine and get insanely hostile when you try to clean them. You seem them and they're wheeling out to smoke just soaking in urine. They've just cursed the aide out about it, too.

You take care of these guys the way you'd want someone to take of you or your loved ones...and I surely wouldn't want someone to let me lie on my poopy sheets just because I 'wanted to'.

That's not good nursing, as I was taught.

freesia29, ASN, RN · Jul 3, 2013

Thanks, I am actually pretty soft spoken and not very aggressive at all. I usually have about 6-10 residents all surrounding me at the med card all wanting their pills at the same time...then the diabetics are there before meals, 8 of them......meal time is chaotic and insane, and I tell them I am going as quickly as I can and to please be patient with me. The spitter has cerebral palsy and acts like a 2 year old....defiantly going against what you have asked her to do, like to please stop backing into another residents legs in her w/c. The thrower has hit 2 other nurses in the head, he has an explosive temper, and is a new admit, the puncher is on hospice and punches everyone who tries to help clean him or turn him over.

I am just surprised that these are daily occurrences here, and I am not the only one it is happening too. It is making me realize that LTC is not for me. I don't have the thick skin to suck it up and deal with, and I don't want to develop thick skin for that. I would prefer to work in an environment where daily abuse from residents is not the norm.

I don't think that makes me less of a nurse. I do want to help people, but I don't need to let myself get hurt in the process.

CapeCodMermaid, RN · Jul 4, 2013

MedChica----excellent advice. Your facility is lucky to have you.

brandy1017, ASN, RN · Jul 4, 2013

MedChica while I congratulate you on your caring service and understanding, I have to say I would agree with freesia29 and vote with me feet not to work with people that harm me, whether or not they meant to is beside the point! Your compassion and helpful ideas are laudable, but I have a hard time being sympathetic to someone that is hitting, kicking, biting and cursing at me whether due to dementia, etoh, bipolar, etc, etc. When patients are acting this way I think actions need to be taken to stop the behavior including sedation with tranquilizers or antipsychotics and even restraints! It is just these type of patients that really get me down about my job and we are not a psyche ward but you wouldn't know it from some of the patients we care for! My last few shifts I've had a etoh patient swearing at me, calling me a *****, threatening to hit me. It is not OK! I didn't become a nurse to be abused and disrespected! I have refused a patient assignment on occasion rather than be abused, but that is not always an option because someone is going to have to deal with them, but I think it best to rotate staff and also to use all available treatments besides redirection to medication and tranquilizers as is needed for the safety of all concerned!

SuesquatchRN, BSN, RN · Jul 4, 2013

It sounds as if the OP's facility is understaffed and accepting everyone.

Often, people who won't allow themselves to be moved for cleaning hurt and their pain isn't being adequately treated. And now that MRDD folks are living longer lives and are being interpolated into the general geri population there are other problems - demented elders dealing with childlike elders. It isn't easy. And that the OP is being called in every weekend as a PRN - this is a facility that is avoiding paying bennies/FT money for a weekend nurse.

She's getting screwed.

Nursing is NOT all like this, nor is LTC. Your residents are being neglected, and not by you.