Non compliant residents

[fairyluv]

there is a resident on my hall, who is aao x 3, incont of b/b, has behavior probs, takes a number of psych meds, but very alert and oriented. knows what she is doing.She is a manipulative person. She is very non compliant with care, will not let the cna's perform incont care on her and when they do she kicks and screams like they are killing her . When it's her shower day, she says she doesn't want a shower, but the cna's are told that she doesn't have an option and they need to shower her anyway, so she screams and carries on like she's being beaten. she has sores on her bottom that she won't lets us treat, the only time we can do the treatments are when the cna's are putting her to bed. and again she , hits and kicks and screams that there is nothing wrong with her bottom and she doesn't need that medicine on it. She is also diabetic and recieves fast acting sliding scale and long acting insulin. The other night, the cna's got her into bed and I was trying to do treatment while passing meds. So I had her meds ready for her, got her treatment done, gave her her pills and when it came time to give her insulin, she said she wasn't gonna take it. i told her she needed to take and she told me no that I couldn't make her take it. then she drew back her arm and took a swing at me. So I said fine. I won't give it. the last thing I want is to get hit with a needle in my hand. So I chart her behavior and her refusal of her insulin. I call the doc get his VM leave him a msg, call the DON and tell her, told her I left doc a msg and he hasn't called back, she tells me not to chart that i left doc a msg, just chart that he was notified. So I do that. But this resident has been moved from every hall because she threatens to get the nurses fired. She tells the administrator that we are abusing her, which results in the nurse getting suspended. At what point does it truly become abuse or neglect ? Our administrator won't stand up for any of the nursing staff, he has gone so far as to give family members his personal cell phone number and tell them if they have any probs with any of the nurses to call him. One resident's family member (in the rehab unit) has called him the last 2 nights about 2 different nurses with the same complaint, saying her mom hasn't gotten her medicine yet. Her medicine wasn't even late, so the admin calls the nurse and chews her out. then the DON calls the nurse and chews her out also. So naturally I'm scared and worried that this resident is going to say that 1 she was being abused because the cna's were cleaning her up or 2 she's being neglected because i didn't give her her insulin. She's not a brittle diabetic, her blood sugars run predictably between 180 - 200 and she's on med. dose sliding scale, but her long acting is 58 units. I told the night nurse and she retook the cbg and texted it to me saying it was 203 at 1 30 am.

So what advice do any of you have for how best to deal with this situation ??

[sallyrnrrt, ADN, RN]

care plan, care plan, care plan, and i did not read where you notified her responsible party

document,document,and document, your DON was wrong, you left a msg., pending dr. response

[SuesquatchRN, BSN, RN]

What Sally said, except I would also say notified instead of message left.

Is this resident adequately managed for pain?

[morte, LPN, LVN]

where I work; you can't say notified until doc has responded......acknowledged.

[amoLucia]

As sallyrnrrt said, is the family aware of her behavior? She needs to be care planned/conferenced for her behaviours. Perhaps they can be of some assist?

I bet if they get enough phone calls, they might intervene. At least they won't be screaming that 'they didn't know'. Families seem to think that we can just wrestle with the pt and force them to do anything & everything that they themselves couldn't accomplish. Then they take an accusatory tack when things go south with the pt - like it's all our fault! Same with MDs.

She's got health problems that pose significant risk for deterioration r/t to her refusals/behaviours. Everybody needs to be on the same page!

[CapeCodMermaid, RN]

She needs to have a care plan which spells out unfounded 'accusatory behavior' and your administrator needs to get a clue.

[ktwlpn, LPN]

You should have a witness in the room for your protection

[fairyluv]

you know when the state surveyors where in for the annual surveyor, they wanted to watch the wound nurse do the dressing changes on this particular resident. When the DON, Administrator and Social Services director (don't know why she was involved) found out, they all went to the resident and told her that they wanted to observe the procedure and if she would not throw a screaming fit they would buy her a pizza and some soda, (KNOWING THIS RES IS DIABETIC). So she got her pizza and pop, and the surveyors left deciding not to observe the treatment procedures. I was appalled that they would do that just cause the surveyors where there.