Accusations of Patient Abuse

[MisMatch, LPN]

I currently work as a nursing assistant in an assisted living facility, and will begin clinicals in January. My concern is regarding accusations of patient abuse, after an incident I experienced over the summer. Let me begin by saying that I am extremely sensitive to issuses of abuse, as I am a survivor of domestic abuse, having divorced my abusive spouse after over 20 years of marriage. I returned to work and began college at the age of 50, after spending 20 years as a full time homemaker.

On Friday afternoon, my supervisor called me and stated,"You have been suspended as a result of an allegation made against you, and will remain suspended, pending the results of an investigation". She refused to tell me what the allegation was, or who made it, and suggested that I call her supervisor, which I did. That person gave me no more information, other than I would be contacted for questioning, but would not tell me by whom. On Monday, I was called by my supervisor and told that "Mary", a resident at the facility had made an accusation of abuse. I came in to meet with both supervisors, and was asked in detail about my getting "Mary" dressed on Friday morning, which I did. I was told that "Mary" said that I had grabbed her left arm and "threw" her back down on the toilet when she tried to get up. I told them that I held her by the right arm, as her left arm was against the wall, with her left hand holding onto the guardrail. When she stood up, she was very unsteady, ready to fall forward, so I lowered her back down to sit on the toilet, preventing her from falling. There were no bruises or injuries to her left arm, or anywhere else. She is very thin and frail. Wednesday AM I was called, and told that the accusations were unfounded, and I could return to work.

The facility's policy is that an employee is immediately suspended when an accusation of abuse is made by a resident, and you are guilty until proven innocent. "Mary" is in the advanced stage of dementia. Her doctor has numerous notes that she is dellusional and experiences hallucinations, along with statements that she believes the staff are rough with her and rush her. There are pages of nursing notes that state the same. Still, I was guilty until proven innocent.

Is this the "norm" - to be assumed guilty until proven innocent, and automatically suspended? How do you protect yourself from such accusations? What are the policies at other facilities? How do you deal with such allegations? Any imput or suggestions would be greatly appreciated. Thank you.

[leslie :-D]

when it comes to allegations of pt abuse, an immediate investigation has to be done.

yes, the accused is removed/suspended, pending the outcome.

when this happens, i've advised the (vindicated) to work in pairs.

one may be changing the linen, while the other is cleaning the pt.

i'm sorry this happened.

wishing you the best.

leslie

[meownsmile, BSN, RN]

I agree, and if this lady has a history like this, the facility shouldnt let peope be working with her one on one anyway. If nothing else to protect them from any accusations. Dont let anyone tell you that you have to tend this lady by yourself. I wouldnt go near her without someone else with me.

[SuesquatchRN, BSN, RN]

Always have a witness.

[MisMatch, LPN]

Thank you all for your imput.

As a result of this allegation, I am no longer required to provide care to this person, which solves the immediate problem. Although her chart was full of references to the staff "being rough" with her, I was the first singled out by her, thus the first (and only one) discpilined for it. My disappointment was in the callous way it was handled and I was treated by supervisors.

I am looking ahead, to my future career in nursing, and this is my first position in a health care facility. Is this the treatment I can expect from supervisors/administrators in health care? How do you protect yourself from being the first one accused?

I appreciate everyone's imput.

[Daytonite, BSN, RN]

the facility handled this correctly. the only thing i would question is that they should have put you on an administrative leave and paid you for your time off while they were doing their investigation. actually, you are protected by the facility acting as they did. you say in your second post that you were disciplined. discipline is correction. how were you corrected? i would ask that you be paid for your forced time off since it was done at the request of the facility for the purpose of their investigate, but don't push for it.

you should never enter this patient's room alone again unless you have a co-worker with you for your own protection.

i worked in a facility where we had a crazy old man who occasionally would accuse the orderlies of sexual abuse. all the orderlies were told not to go into his room alone, but occasionally it happened, or a new orderly forgot. when one of these accusations came along, the same procedure was followed. the orderly was placed on a paid administrative leave while the facility investigated the incident. and, these orderlies would feel very upset and angry about it. the investigation consisted of interviews of the orderly involved, the patient and any alleged witnesses. the patient was also given a thorough assessment by a physician that included a sexual abuse evaluation. when the decision was made that the abuse was unfounded the employee was allowed to come back to work. it was a standing joke around the place that if you needed a day off all you had to do was go into this patient's room alone--not funny really. a lot of people thought the patient liked the attention he got as a result of the physical exam and interviews.

[Jo Dirt]

Unfortunately, that is the way it works nowadays, and it's kind of sickening. The proof should have been in the pudding (no bruises or skin tears) but some supervisors don't have enough sense to put two and two together.

Paranoia is very common with dementia patients. We went through the exact same thing with my father-in-law and even with his documented

paranoia and delusions with intermittent episodes of psychosis which he was seeing a doctor for he was able to create tons of trouble for us with his accusations of abuse.

The only solution for us was to get him out of our lives as much as possible.

I wonder how many lose their licenses for no good reason?

[pagandeva2000, LPN]

I have not seen this happen at the facilities I worked for unless there was physical evidence. In most cases, they did move the employee to a different unit while the investigation was taking place (which is a bit fairer to me). If there was evidence of bruises or suspicious behavior, some were placed on administrative leave with pay, others may not have been. I work for civil service, so, even the horrible people would clearly get away with murder.

My personal opinion is that if it is a patient that has a history of making allegations that are not true, then, the employee should be moved until the investigation has completed. And, as in your case, that accused should not have to work for that client again.

[MisMatch, LPN]

Daytonite,

Being suspended was what I considered to be "disciplined". Yes, I was paid my base salary for the time missed, but not the shift differential or overtime I would have made.

[JBudd, MSN]

Paid administrative leave is not discipline, and as upsetting as all this was (God knows I would have been upset and frankly, obsessing over it); they did it correctly. They aren't supposed to discuss an investigation (so you can't influence witnesses or change charting, etc.); so they really couldn't tell you what was up. You were cleared, you said yourself it is the facility's policy to suspend.

You got paid, and don't have to deal with her anymore. Let it go. Easier said than done, I know, but try. :icon_hug::icon_hug:

[VegRN]

Thank you all for your imput.

As a result of this allegation, I am no longer required to provide care to this person, which solves the immediate problem. Although her chart was full of references to the staff "being rough" with her, I was the first singled out by her, thus the first (and only one) discpilined for it. My disappointment was in the callous way it was handled and I was treated by supervisors.

I am looking ahead, to my future career in nursing, and this is my first position in a health care facility. Is this the treatment I can expect from supervisors/administrators in health care? How do you protect yourself from being the first one accused?

I appreciate everyone's imput.

Ok, you were the first singled out but I doubt you will be the last. I really don't think anyone should be going in her room alone after she is accusing people of abuse. Allegations of abuse are hard to prove one way or the other. It is a he said she said deal. Who knows who will be next? Or to what extreme she could take it. Are there any male CNA's working at the facility. If I were them, I would be very leery of caring for her alone.

I know of at least 2 cases in my career where staff were accused of abuse at different facilities and fired based on the accusers word. Both of the caregivers were male, one was a nurse, one was a CNA.

In one case the pt had a huge psych hx and had a history of lying and attention seeking behavior. CNA was accused and fired because of it, in a unionized facility no less.

In another case, it was an elderly confused woman in a long term care facility and the accused was a gay male nurse. Now come on, he doesn't even like women, why would he do this!!?

In both cases the staff had excellent work records and no one, I mean no one, believed that they abused the pts.

Just seeing that this can happen makes me worried, especially for my male coworkers. Male drs have a female nurse during pelvic exams but what do the male nurses and CNA's have for foley placement, baths and peri care? It simply isn't standard for a female staff member to be present for a male nurse doing these cares but, I wonder if it should be.

I have been accused of being "verbally abusive" and pts have threatened to report me but it has always been in the context of pts with psych histories that are upset with me because I am setting limits with them. If I get ANY comments/threats that the pt is going to sue/going to report me or an accusations that I am being "abusive", I get a buddy to go in with me each an every time I do cares. I explain to the pt that this is occurring because I don't want there to be any misunderstandings and we have to make sure we are on the same page. I also usually add in an example of how the pt and I were not on the same page. This also gets put on the kardex and gets followed with every caregiver. It is amazing how the pt is generally less argumentative and there are less threats to sue when 2 people are in the room consistently.

Bottom line, don't risk it. If there is any history of accusations, get a partner to go in the room with you with cares. (then you can help them with some of their stuff too). It simply isn't worth risking your career, reputation etc.

[DeLana_RN, BSN, RN]

Is this the "norm" - to be assumed guilty until proven innocent, and automatically suspended? How do you protect yourself from such accusations? What are the policies at other facilities? How do you deal with such allegations? Any imput or suggestions would be greatly appreciated. Thank you.

Unfortunately, yes, you are "assumed guilty until proven innocent", but not all facilities suspend staff for unproven allegations. But if they do, I wouldn't consider it disciplinary action.

I do urge you to do one thing: Please get your own Liability Insurance! Even as a CNA (while in nursing school) I had a policy that covered both my activities as a student nurse and as a CNA. You get a low rate (about $50/yr) and the coverage is priceless.

However, one caveat: Liability may not cover you for any criminal (rather than negligence or malpractice) investigation that may occur. Still, no nurse, aide or student can afford to go without. So if this should ever happen again, please call your liability carrier for advice/counsel before talking to anyone else.

I'm glad to hear this is over, but I think I know how you feel. I have a close friend who was (wrongly, of course) accused of pt abuse and ultimately cleared; however, the scars ran deep and she required counseling. I'm sure you feel violated, and probably feel a lot of resentment toward your employer as well. So please get counseling if you have a hard time coming to terms with this.

Yes, modern health care puts us all at risk; sad, but true. CYA all the way, with meticulous charting, chaperones if needed (absolutely for male nurses who do female Foleys and similar procedures!), and witnesses with problem pts and families (who can be the biggest problems!)

But please don't let this discourage you from pursuing nursing; it is still rare to be accused of any such thing. We just have to be aware of the possibility and protect ourselves.

Best of luck to you,

DeLana :icon_hug: