safety for home health nurses

Nurses Safety

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Hi,

I was recently sent into a home as a home health nurse, which had a mentally ill family friend. I was warned he could be hostile, so before I went I called administration for assistance and was refused, 3 times as a matter of fact. I made the visit, the "friend" was out of control. My supervisor said I could not call the police, the family would have to, and I still could have no backup. I had some bruised arms out of it, and was able to get through the visit successfully, the family called the police, and he was taken by ambulance to the hospital. I finished caring for the patient and left.

I am looking for any actual policies regarding employee safety in homes. Several agencies have told me no one is to go alone if there is any reason the situation is unsafe. I have not yet seen an actual policy.

Hopefully someone out there can help me out, please!!!! I really need some actual policies that would defend me in further occurences. Our agency has no such policy but we're told to call for backup, never to go alone, in such cases. But it isn't in writing, and should be. Thank you for your time and help.

Sincerely STM

Many years ago, when I was a nursing student, I was put in a similar situation. I had a job in a group home for mentally retarded patients. The job paid well, and had health benefits. I desperately needed it. Neighbors had tried to stop the group home from opening. One resident was also mentally ill and had a history of violent behavior. He also sometimes injured himself. After he hurt himself once, and staff called 911, the manager actively discouraged us from doing so in the future, on the grounds that it would give the neighbors an excuse to have the group home closed down. (!)

I survived one really dicey night shift with this guy. I don't feel like getting into the details. Suffice it to say that I found another job as fast as I could. Anyway, the point is, that I decided that I would never, ever allow someone else to make those kind of decisions for me ever again, no matter what the consequences were, including being fired and facing financial ruin. If I was in the same situation again, I would ignore my manager and use my own best judgement about what was necessary to protect the safety of that resident, the other group home residents, myself, and my coworkers.

The way I look at it now is that if you are not going to be defending me in court, if you are not going to be supporting me financially when my license is taken away for negligence, or when I am disabled because of workplace violence, than you have no right to tell me what to do.

While the details of this incident are still clear in your mind, write down everything you remember. I would definitely attempt to get a copy of the police report. Have someone take a picture of your bruised arms. Ask the police what your options are in terms of pressing charges against the person who bruised you. See your doctor and whoever does employee health for your agency, and have your injuries documented ASAP. Don't do stuff verbally. Establish a paper trail. Keep copies of any correspondance you send to your managers. Keep a dated diary of what happens, including conversations with managers regarding this issue and any symptoms, such as physical pain, PTSD symptoms/psychological suffering, and financial burdens, such as doctor and medication copays, costs of searching for a new job, costs of legal counsel etc, related to this incident.

I would refuse to go back to this home, accompanied or not. I would look for another job ASAP. If I was forced to go back to this home while still employed, I would call for a police escort, if an agency escort was unavailable, and let the consequences be damned. I'd rather be unemployed than seriously injured. If you don't think that that is a real possibility, read the thread about the ER nurse who was stabbed.

P.S. I would love to know what the violent friend's rap sheet was like! I don't know if there is a cheap, easy way to get this info. Maybe someone else can comment.

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What did you do to make him so angry? I worked at a state hospital during college and I was never assaulted and neither were any of the other students.

Originally posted by Dolphin777

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What did you do to make him so angry? I worked at a state hospital during college and I was never assaulted and neither were any of the other students.

O.K., now you're actually starting to p#$% me off. Every post is about your limited experience as a student at a state hospital. Do you realize that you can't generalize from that to everything else? I am willing to listen to you and to answer you when you make legitimate comments. This one does seem deliberately provocative. I fail to see how anyone reading this post could ignore the writer's obvious agony and respond with such a callous comment. Do you realize that we live in a society where EMT's responding to shootings have been shot at themselves by gang members as they attempted to save rival gang member's lives? Have you ever had to do anything one-tenth as dangerous as this writer has had to do by going into that home? Even a cop wouldn't go into thast situation without a partner, a gun, a walkie-talkie, and available backup.

By the way, I have worked on a locked psychiatric ward, and been a home health care nurse. Both jobs are dangerous. And, in home health, you are on your own. In another post, you stated that you frequently travel on business, staying in $200 per night hotels. Somehow, I doubt that you would ever voluntarily even drive through the inner-city neighborhoods where I have worked.

By the way, what was your job title and description, what kind of state hospital did you work in, how long ago did you work there, and how long did you work there for? I'd really like to know.

I also developed an arrythmia soon after and spent 3 days in Coronary Care, where my executive director left messages for me to call and talk to her ASAP. So I do have plenty of documentation. And I was eventually terminated as a result. Thanks for your replies.

Originally posted by STM

I also developed an arrythmia soon after and spent 3 days in Coronary Care, where my executive director left messages for me to call and talk to her ASAP. So I do have plenty of documentation. And I was eventually terminated as a result. Thanks for your replies.

OMG! Hope you are speaking to an attorney as it sounds like you may have a good case!

My good thoughts and wishes are being sent your way...hoping for good outcomes for you!

I tried home health for a short time and quickly realized the dangers with little backup....went back to the hospital.

Those of you who continue home visits have my respect. I am not as brave as ya'll are.:stone

I'm no longer in HHC partly b/c of the danger involved. I have found myself in less than safe situations on more than one occasion. I have never seen an actual policy re nurses safety in a home with a potential for violence. I had a guy one time grab me to feel my private areas. I left immediatly, called my super and reported the problem. I told them I would not be seeing that patient again. They had no problem with my refusal but they kept the case and sent other nurses, like it would be different for them. I made sure that the other nurses knew what this guy did before they went out. About a week later I was checking out the sexual preditors in our area and there he was! I told the agency and they still refused to DC him.

I've made the midnight-2 a.m. IV visit in the most dangerous part of the city. (bars close at 2). Not a comfortable place to be. I have had to deal with the danger by either not accepting the case, which is not always a good thing to do if you want more cases, or by devising my own measures. My own measures have included self defense training, carrying mace, talking on my cell phone while I'm walking or even driving in a bad area- I tell hubby exactly where I am, who is walking toward me with description, addresses of the house I'm walking up to or by and what's going on in the area. I ALWAYS wearing my uniform to ID myself as a nurse, and never carrying valuables or my purse. I have also carried 5mm despite policy.

One agency had a specific policy that stated the employees were not allowed to carry guns in their cars or on their person. They also gave classes on safety, self defense, etc but no policy on the patients and their home environment themselves as r/t when a nurse "should and would be allowed" to refuse or close a case immediatly. The policy also said that if a nurse was in a position of personal threat to their own safety that they should leave the area immediatly.

The problem with discharging the patient or just stopping the visits is d/t the nurse practice act and is considered patient abandonment. There are laws protecting the patient and for discharging a patient prior to completion of service, in my state an agency must give 2 weeks notice in writting before they can legally d/c.

It is up to the agency and their liasons to accept safe patients by reviewing the patients records. This is key to nurses safety.

Many nurses notes I've seen have a section re patient safety and this is where I've documented any and all safety issues including things like whats already been mentioned.

I hope this helps. Write your own policies and submit them for approval. Talk to the admin and liasons about how they look at the nurses safety when deciding on weather or not to accept a case. Remember that it is all about the bottom line and an agency accepts a difficult, sue happy, or unsafe environment, makes the referrer very happy and keeps the referrals coming.

Yikes!! I am very new to this site and am getting ready to start as a student nurse. I live in northern Michigan, very rural. I am hoping to work for Hospice, which would mean lots of home visits. Just wondering if anyone has had any problems while working for Hospice. Thanks for any info!:)

linfull: " Yikes!! I am very new to this site and am getting ready to start as a student nurse. I live in northern Michigan, very rural. I am hoping to work for Hospice, which would mean lots of home visits. Just wondering if anyone has had any problems while working for Hospice. Thanks for any info!"

The patients that have these issues that go with them are the same patients as the ones in the hospital, mental health facilities, and other places where they are violent or have violent family or freinds. They just go home and take it with them. It doesn't matter what area of HHC you choose, you will still be visiting patients in thier homes. It's their environment and it is where they are even more likely to show their true capabilities. People who need HHC or Hospice live everywhere, including unsafe neighborhoods.

ANYONE can call the police for a dangerous situation. I understand that the employer may not want the negative publicity or complaints from family/patients stemming from the incident, but there's a bigger picture here. As nurses, we see violence daily and we need to make sure that we do not condone nor tolerate it and that includes protecting ourselves. If the employer wants to take action in response to the incident, well then, perhaps a visit to an attorney to research a wrongful termination claim would be in order.

Advocate for ourselves as we do for our patients! MMB

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Just curious, but are nurses afraid to work in neighborhoods with minorities? And what is so scary about making a home visit where a family member/friend happens to be mentally ill? Mentally ill folks are no more dangerous than regular folks.

"Just curious, but are nurses afraid to work in neighborhoods with minorities? And what is so scary about making a home visit where a family member/friend happens to be mentally ill? Mentally ill folks are no more dangerous than regular folks."

Of course not. I have been to many minority neighborhoods that were family oriented and as safe as my own neighborhood. I have also been to neighborhoods where drug dealers and hookers are standing on the street corner, gang graffitti is everywhere, boys and men are showing their gang colors, homes are delapitated, gun shots are heard. Those are the type of neighborhoods where I get scared and rightly so. Our area has been a hot bed for racial issues. When riots start or there is tension in the air, bad things happen. Not safe.

Again, not all mentally ill patients are dangerous, thankfully most are not. But, there are some who stop taking thier meds and not only are they a danger to themselves but to others around them. Throwing things, biting, kicking, hitting, verbal outbursts do happen and it's the HHC nurse who many times, is the first one to find out the patient stopped meds. It is then up to the HHC nurse to start the baker act process and call for backup-ie: Police. So who is monitoring the unstable mental patient until help arrives? The nurse.

Some mentally ill patients ARE more dangerous than "regular folks" as you put it. I hope this answers your question.

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