Patient on patient abuse?

[Vedder316]

I currently have been working as an LPN at a long term locked residential psychiatric facility for five years. Recently we have seen an increase in what I believe is patient on patient abuse. I wanted to get some advice from the community here.

Frequently our "bully residents" are harassing verbally and and placing their hands on others that do not want to be touched. It is usually is just horse play but often one party expresses that they do not want to be touched. Our hands are tied because we are told we cannot implement and sort of consequences for any type of behavior. When the residents see that the are no consequences for their actions it quickly becomes a free for all. I understand we as staff will have to deal with this but it is my feeling that the patients should not have to worry about being touched or verbally harassed by other patients.

We are told by management that this behavior is baseline for the residents. We are also told that if they could follow direction and keep their hands to them selves they would not be here.

I know that the bullying and the harassing is effecting some of the patents who want to take their treatment seriously and try and get better. In fact we have had several patients decompensate from what I believe is the harassment going on.

As nurses are we not obligated to report what we believe is to be abuse or harassment? Any input would be greatly appreciated.

[chevyv, BSN, RN]

I immediately step in and say "We all need to keep our hands to ourselves and respect each others personal space". Or something like that. If you don't step in right away, it will escalate. If State gets wind that there is pt on pt violence, it will not be pretty at all. Everyone has the right to be safe where they live.

I worked in a place not to long ago that would tell us workers "You know where you work." That would be the end of it. Then a family member called State and they came in a group and tore the charts apart! Although the correct paperwork was done, management did nothing to keep the residents safe. The same pt that hurt another would be on the same unit with the pt that they hurt. There were fines placed and I recall the term I.J. being used (immediate jeoperdy), before changes were made. Now the pt that assaults another pt spends some time in acute and then they bring him/her back to the unit. Most times they will seperate them to different units, but not always. State is gone so the "mice" (management) will play....again.

[Vedder316]

Our population is mainly severe schizophrenia. They usually are at our facility for approximately a year though some much longer. We have eight beds in our facility. We step in constantly verbally but cannot physically remove them from each other. They know we can do nothing so they keep doing the behavior.

[Retired APRN, MSN, RN, APRN]

I spent most of my career working with people who suffer from severe, chronic psychosis. There are most certainly therapeutic interventions that can be applied. It saddens me that your patients are prevented from benefiting from them.

[elkpark]

I agree with the other posters that, if something goes wrong enough that the state or Feds come in to investigate, the facility and staff will certainly be held responsible for any abuse and/or injuries suffered by clients. It is the responsibility of the facility to make sure clients are safe from abuse or neglect, including that inflicted by peers.

I worked as a psych hospital surveyor for my state and CMS in the past, and we certainly cited facilities for not keeping clients safe from each other.

[chevyv, BSN, RN]

I was just wondering if you are able to use ambs or 4pnts? If not, how do you gain any resemblance of safety on your floor once pts get into it with each other? They can't just battle it out until one pt bleeds out.....Just wondering what policy and procedure are?