Dangerous patients - page 3

Just looking for some help to find written law for a situation. I work in LTC. We have a new resident who on their first day on the hall attacked one of our nurses by strangling them and telling... Read More

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    Quote from TeleRN44
    Shredding... blasting...
    You have very low standards for such extreme labels... You should hear me shred and blast... it contains a whole lot more energy and color than anything you've read here by me.

    I will point out that (1) the OP's resident had been at that SNF for a day or two, (2) evidently had no emergent medical problems (as they were returned in a few hours), and (3) she had a gripe with the ED for not holding the resident for 72 hours.

    It doesn't sound like "UTI psychosis" or acute schizophrenic decompensation... just a nasty and/or demented old person who didn't want to be where they were and decided to act out...

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    Defintely call the police. Bodily injury is not ok, even if lots of folks think because it's a nurse that was attacked it doesn't count. There are laws out there that protect EMT's if they are attacked doing care, I believe it is a felony. I would think the facility who knowingly puts an employee in danger would be liabile for harm. Most facility's will not accept someone who is dangerous due to worker comp issue and liability. Defintely do not put yourself in harms way. Call for help!
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    Well to clarify to the person who thinks I'm blasting an ER...I wasn't. This resident was sent to the ER on Dr's orders for a mental health eval. This ER she was sent to has a special mental health section and and an in patient psych ward, both geriatric and regular. She was not being sent to a run of the mill rural er or such..and it was dr's orders. She was returned without having the mental health eval done, no documentation whatsoever. I found out today they actually tried to stick her in a cab and send her back to us. Obviously that did not happen. Since my original post, this resident has not had a behavior change unfortunately but has continued to hurt staff and did have resident-resident altercation. When she "acts out" our facility has zero we can do for her. All we can do is move other residents out of harms way and hope we can keep her from accessing things to hurt others with. The family wants us to keep her, but we are trying to direct them to other LTC facilities in the area that are made for this type of situation. These BX are apparently not new, but the family lied to us when they brought her --leaving her, the staff and other residents in an unsafe situation.

    Anyway, I'm so tired after dealing with her today that I can't even remember what my point was.
    smartypantsnurse and BrandonLPN like this.
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    Im also an ER nurse. The only person that can place a patient (any patient) on a 72 hour emergency detention is a police officer or sheriff. EDs cant we do tests and say well nothing medically wrong, and send her back.

    Im not sure if the hospital the patient was sent to has a inpatient mental health area or not, but even then maybe the doctor needs a suggestion for a direct admit for a inpatient psych eval? not sure how well the doctors take to suggestions but its worth a shot... Im trying to think of any other suggestions... Are you an RN or LPN? Because (i dont know all the LTC rules), but i dont see why an RN couldnt give an IM med... Perhaps shes needs a daily medication (geodon? ativan? Valium?), perhaps a daily PO med will help curb her outbursts? Also sounds like its time for a meeting with staff, family and doctor to discuss these actions.

    I know in my area, nursing homes or LTC can "kick" a patient out for behaving in the way you are suggesting because she is unsafe. I would completely call the police and file charges if she would act that way towards me, i have on ED patients. Luckly, there are sheriffs close by always.

    Just because we are nurses and there to care for the patient does NOT mean we have to take abuse; even from elderly patients. There is a law against attacking healthcare workers, it includes nurses not just EMTs and it is a felony.

    Im very sorry you are stuck dealing with her on your shifts is exhausting to anyone...
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    LPNs can give IM injections. That's not the issue. The issue is that we cannot by law (at least where I live) give powerful IM sedatives or use restraints. ER departments can. That's what I meant when I said the ER has more resources.
    smartypantsnurse likes this.
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    I see the logic behind both sides of the "dumping" debate, however, I would like to know what an experienced ER nurse would suggest we in LTC do with these patients? An assessment of a problem is no good without a plan for a solution.
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    Ah i see. Like i stated i do not have much knowledge about LTC. Like i stated in my previous post those are some suggestions, because if that one resident is making it unsafe for the rest of the residents wouldnt the DON or or Director of the Facility have to keep the majority of the residents safe, meaning tell the family they have to find a more suitable place for that person (not sure if like a title 19 facility can do that or not?). Either way, Im not sure if anyone else has any suggestions besides what i stated above?
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    My experience is that if a LTC patient is well to do and is "private pay" they can hit the staff all they want. Those patients are not asked to leave the LTC no matter what they do.
    txredheadnurse likes this.
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    9:10 am by Blackcat99 My experience is that if a LTC patient is well to do and is "private pay" they can hit the staff all they want. Those patients are not asked to leave the LTC no matter what they do.

    I hear you and understand. Sounds like they needed a psych consult done "like yesterday" and work closely with the Psychiatrist along with trying to reason with the family.
    sweetlilwolf and Blackcat99 like this.
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    Check with the Labor Board in your state...notify appropriate management personnel, make sure the police report is documented correctly (include notification of management by name and other witnesses), contact an attorney. Nurses are now suing their patients along with the employer.

    Quote from dallet6
    Just looking for some help to find written law for a situation. I work in LTC. We have a new resident who on their first day on the hall attacked one of our nurses by strangling them and telling them they were going to kill them. They also took their stethescope and threw it into the nurses' chest. Our facility got an order for an IM med, which the resident could not be given.

    Eventually, EMS was called and the resident was sent for a psych eval at hospital. The hospital sent them back just a few hours later. So, two questions--if someone attempts to strangle someone and says they are going to kill them-isn't that one of the qualifications for a mandatory 72 hour psych hold?

    And 2--isn't our facility liable if they readmit this resident and they then attack someone else? It could just have easily been another resident. Am I wrong to say that I would have filed charges if someone attempted to choke me and threatened to kill me? (it wasn't me it happened to).

    When I came in today and read the chart I went and told my charge nurse that if this resident did this again today that I wanted them sent back out. And that I would call the police if this happened.

    Anyone know the legalities here? thx!
    Blackcat99 and sweetlilwolf like this.

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