The topper of all toppers!!!!!

Specialties Geriatric

Published

Specializes in Geriatric/Sub Acute, Home Care.

Had a new patient....had to forage through all her notes and everything just to get a GOOD REPORT on my own.....she was somewhat fine at the start of the shift....and so was her roommate who has psych problems....and had abused a previous roommate not too long ago......then...the SHEET hit the fan.....the roommate hits this resident in the face....this resident is hemiplegic and just got out of the hospital with pneumonia....the fierce battle that ensued was unwitnessed and the hemiplegic resident said that she was HIT in the face or rather Punched..by the other roommate...and the reason was? over the setting of the air conditioner...one wanted it on, the other off......so.....staff barreled in there like a Tsunami....and started asking her a barrage of questions....I stood there and wondered about my staff....do they have any idea that this woman just got hit and she is not well and they are asking her numerous questions at once????? I stopped all that and said....let me ask her one question......everyone shut up......What exactly happened? She explained and said it all in 2 sentences flat.....there were no open areas or obvious wounds or injuries on her at that time...not that anything cant show up in about an hour or so.....so.....I called the Nurse Manager first....cause the roommate that hit this woman had a history and I wanted to know what protocol to follow.....I was told by a RN...ie...Wound Care nurse to send her(the abuser ) out to the ER.......I said.....I need to call the doctor and get an order...she says.....just send her out......I told her...shes not a doctor and I need an order from the doctor......she didn't want to argue....I KNEW I was right......I called the doctor....he questioned what happened and asked if there were any witnesses....I said no..outside of the 2 women.....he said....well...looking at the both of their psych historys we cant really take what they say as truth..."....I said...no........I told him I spoke with the Nurse manager on call and she said to me...send the one patient out to the ER"......he said...have the nurse on call call me.....I called her and she says this to me...I don't want to speak with Dr So and so......I said....I NEED AN ORDER and he wants to talk to you!!! this went on back and forth and I was just about to quit.......in the meantime I separated the residents quickly and put the abused one in another room......she wasn't bleeding or complaining of out of ordinary pain or discomfort from the confrontation. She was resting comfortably and there were no complaints thereafter......but the phone tag I was playing with the higher ups about this, Including the Adminstrator....who chimed in later on all this...was obsurd.......my question is....I had the ADministrator and one Nurse manager telling me to send this patient to the ER( the one who did the physical abuse) and the doctor was very hesitant about giving me an order to send her to the ER......I chose NOT to send her cause the doctor was not sure on the matter....he said....it was unwitnessed...and what is the ER going to do for her? What I right for not listening to the Administrator and Nurse manager on sending her out...I think I was.....I take orders from the doctor only...but if the doctor is questioning his own knowledge about proper procedure in the facility....then where do I stand? I had no procedure book either to direct me in such a case....and the management has not approached me about this at all......I think theyjust don't care in a nutshell.....this was outlandish...

Specializes in LTC,Hospice/palliative care,acute care.

When we deal with problems like this we have to medically clear a resident before we can pursue a psych admission.The often go out for the full work up and 9 times out of 10 have a UTI. Our docs don't like to treat UTI's and don't recognize the impact they have on the demented.

I work with lots of psych behaviors and this is a fairly common occurrence in my facility, we get a couple throughout the year. I have had only 2-3 cases where we sent them to the hospital to be detained. Most of the time, you give the aggressor a PRN, if she doesn't have one, you ask for one. Sending her to the ER is not the correct answer in this case, in my opinion. Dip her for a UTI, give her a PRN. Good job in keeping them separated.

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