workplace violence with geriatric residents

  1. I'm an agency RN who specializes in geriatrics. I have been working for a facility for a few months now and am pretty familiar with the residents. There is a resident at this home who has been becoming increasing violent with his dementia. We had an incident tonight where he became violent with the staff (me included). The upper administration has known for a long while about his violence with residents and staff and just kept getting him new roommates and just recently a private room. The family of four sons are not very happy with me because I went and filed a 302 to have him taken for a psych. eval. I need to know what I should do now - report the workplace violence and be shunned from my profession, continue to work for them (oh, by the way his daughter-in-law works there - how will she be feeling about me) or go to the county commissioners with the problems. HELP!!!!!
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  2. 9 Comments

  3. by   Blackcat99
    That's a tough call to make. If you do the "right thing' and report the workplace violence then they will probably stop calling you to work at that facility anymore. It's all about "customer service" these days. They don't care if staff gets hurt. It's a tough decision to make. Good luck.
  4. by   unknown99
    Workplace violence should not be tolerated. The administration chooses to kknow about the violence and do basically nothing. Sounds to me like they are in it for money only; like protecting their residents comes last. I would do everything that you could to see that this man gets his psych eval--- maybe there is an underlying medical problem that is not being caught.
    If they do not call you to work there anymore, well, than so be it!! At least you know what you did was in the best interest of this resident and all the other residents there.
    There are always other places to work at.
  5. by   debRN0417
    If this resident is violent toward staff, then this violence could ealily become focused on other helpless residents who are not able to defend themselves or get out of the way. If administration knows this and has done nothing (getting psych eval, med adjustment, social services looking into more appropriate placement, family care plan meeting, meeting with physician/medical director) then you did the right thing. Did you call the administrative person on call and let them know what happened? Is it documented in the nurses notes/residents chart of all the behaviors that have been manifested over the time frame when this person has been acting out? I'm not trying to put you on the spot, just asking questions that I would ask. As a nurse, our responsibilities are for the safety of all our residents, and our staff, and administration is ultimately responsible for this.. This person is a danger not only to others, but to himself as well. You did the right thing as you are responsible for his safety as well as the safety of the other staff and residents.
  6. by   CoffeeRTC
    How did you get the 302 without your ADM or SS? 302 ing someone is very difficult for us in our area. Heck they darn near have to kill you (just kidding) Did you try calling the ombudsman? What have you all done to prevent or deal with his abusive behavior? Care planning..etc. Just what does the family expect staff to do? Do they have suggestions or imput into his care and what causes or precipitates his agressiveness? All these things need to be tried first befor a 302 would stick.
  7. by   debRN0417
    Where I am, our medical director and consulting psychiatrist work very closely with us. When we have a resident who is displaying acting out/aggressive behavior, we are usually following them closely (unless it's something that occurrs without warning...then we do a complete medical work-up first) we usually can get the psych to come in and get us a bed at the local hosp psych unit, or the medical director sends to the Er with instructions to admit to psych bed. We usually do not have to, what we call here, TDO (temporary detainig order). If that is necessary, we call the CSB (Community service board) who sends a pre-screener to evaluate. They contact the magistrate, who grants the TDO, but all of this can only be done IF the person is deemed a danger to themselves and others. It is a challenge sometimes when you have someone who is aggressive and the CSB says they're not a danger...duhhhhhh...so that's why we try to go the route of the medical director/physician/psychiatrist. Any licensed nurse can call the CSB to have them evaluate for the TDO, but of course the MD as well as the administration on call must be notified. As an administrative "person", if I receive a call from my facility regarding this type of behavior, I will immediately go to the facility to help. My staff do not have to deal with it, I take care of it. I am sorry that you have not had support from the places you work. I will not let my residents or staff be harmed...that goes for the "acting out" as well as the "acted upon". We had a case of huntingtons chorea that was violent that was a challenge, and finally were able to obtain appropriate placement with the help of our medical director and psychiatrist. It really helps to have the support from the medical and psychiatric team.
  8. by   Antikigirl
    I think you did exactly what you needed to do using your own clinical judgement! We have to give ourselves a heck of a lot more credit for good choices in nursing..and I think this one was right on the mark.

    I do report violent behaviors no matter what...and I document like crazy about each incident! I also have my staff do the same, because I find it is in everyones best interests! If family or administration has a bit of denial of resident agression going on, it doesn't mean that my staff or patients aren't getting hurt...that is a safety issue and outweighs anything!

    I am currently investigating a couple at my facility (residents) that seem to have quite a dynamic past...serious wife abuse in the past, but now the tide has turned since the gent is disabled. I feel for the poor lady, but she can't go hitting and slapping him. People think I am mean..thinking that she deserves to abuse him, but I disagree, and her dementia is growing and soon she will not know husband from staff or other resident! I am sticking to my guns on this one!

    Good luck to you!
  9. by   kferber
    Quote from michelle126
    How did you get the 302 without your ADM or SS? 302 ing someone is very difficult for us in our area. Heck they darn near have to kill you (just kidding) Did you try calling the ombudsman? What have you all done to prevent or deal with his abusive behavior? Care planning..etc. Just what does the family expect staff to do? Do they have suggestions or imput into his care and what causes or precipitates his agressiveness? All these things need to be tried first befor a 302 would stick.
    I had to go to the local hospital E.R. and file the 302 due to his abusive behavior towards me and the staff. The police did go and transport him to the E.R. but they sent him back due to his nonaggression at the E.R. I am no longer allowed back in the facility due to my actions that night and that the administration did not respond to my calls. I suppose they are trying to cover their butts!
  10. by   nightmare
    Like triageRN34 says document like crazy!We have a resident who can be really violent with staff especially when they are attending to him,his daughter did not believe us even with the documentation.One day however she happened to come in as he was being attended to and heard the comotion through the door,the upshot was that when she went into the room he tried to hit her as well so now she is well aware of what we have to put up with.We have had other residents transferred to more secure units especially if they are mobile and violent because they are a danger to other residents as well as the staff.We are all well versed in challenging behavior methods and try and calm down situations before they develop into aggression if possible.
    Documenting each incident can add weight to getting a transfer much more quickly.
  11. by   CapeCodMermaid
    If a resident is violent toward the staff, he or she will eventually be violent toward another resident. We try everything we can to try to stop the behaviors...psyche, meds, change of room....BUT, if the behaviors continue, we section 12 them.

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