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.

[Esme12, ASN, BSN, RN]

thread moved for best response

[Whispera, MSN, RN]

If something happens to a patient, your facility and those there when it happens will be held responsible. This is huge. It doesn't matter if the behavior is baseline or not. It has to be stopped. Patients have a right to be safe in a treatment facility, even if it's long-term.

I don't think you're safe there either. A patient who will harrass or touch or do more to another patient could easily do the same to you.

[Not_A_Hat_Person, RN]

I saw similar behaviors in LTC. Longtime residents would shout at people, gang up on residents (or their families), and generally cause mayhem. It wasn't a geripsych issue, they were just mean old people. It often ended with the target being transferred to a different unit or facility. I didn't agree with that because it rewarded the bullies, but since their room was their home, our hands were effectively tied.

[greenbeanio]

All residents have the right to be safe and free from harassment. To say that this is baseline and do nothing about it is negligence on the part of the management towards the "non-bully" residents.

I feel that there should be consequences to bullying behavior such as being restricted to their room for a certain length of time or a loss of social privileges. Not necessarily as behavior modification since they may be beyond learning anything much at this point, but just as a way to have some peace and safety for even a little while. And who knows - the behavior mod might just have some effect.

[Retired APRN, MSN, RN, APRN]

Wait - management won't allow you to implement consequences for inappropriate behavior? That's nuts, if you'll excuse the expression. What if it's not framed as a consequence, but as a therapeutic intervention, documented in the care plan and explained to the patient in advance by doctor, therapist, social worker, primary nurse?

[lauriejlin]

In no uncertain terms , this behavior should not be tolerated! I believe the behavior mod would at least send the message that this abuse will not be allowed. The other pts. have the right to feel safe, and, so do you. I think you should bring it up as a "treatment" rather than a punishment for management to accept it. Good Luck!

[Mn nurse 22]

If there is a sentinel event and you have documented a history of problems without interventions the facility may be held responsible.

[Cackalacky]

What do you mean you can't intervene?! "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." Then why aren't they working to fix the problem? What are the patients there for?

For the safety of the patients and to maintain the therapeutic environment, it has to be dealt with. Maybe you should be documenting somewhere to show that you've approached management about it and then keep moving up the chain to get something changed. Our units never allowed horseplay or patients to even come in contact with each other, other than a hand shake or fist bump; even then, they were closely watch to prevent that privilege from being abused. Patients who couldn't follow the rules of no horseplay and no touching had a behavioral plan put in place.

[Vedder316]

Thank you all for the responses. I have been ill the past 4 days so I apologize for the delay. Yes we are told that they (the patients) are here for the reasons of my concern and that we are unable to do anything about the bullying and horseplay due to not being able to "punish" or have "consequences". I have taken the adding interventions to treatment plans but when the residents see that they can go back and refuse treatment it is only successful for short periods of time. I will be taking the matter up the management chain and if that doesn't work I will be going to the county/area on aging.

[Retired APRN, MSN, RN, APRN]

What sort of patient population do you care for? Do they have dementia or other organicity? Are they intellectually disabled? What is the reason for management's decision besides "that's why they're here"? Are these patients going to spend the rest of their lives in a residential facility or do they have treatment goals aimed at some kind of community integration?

I should have asked these questions first, and I apologize that I didn't.

[Cackalacky]

I just reread my post, sounds mean. I meant it to be harsh against the facility, not you! haha :)