Advice needed

[tatgirl]

I am a LPN working in an LTC/Rehab unit. I have been on the job for 19 months now. I recently had an experience that has got me quite worried.

I have a resident who is a paranoid schizophrenic. she has halluciations and can become verbally abusive and physically abusive. Last month she fell out of her bed (she is a very large woman and has a habit of laying on the edge of bed despite us trying to discourage that) She refused to go to the ER, but she went after much talking to. The DON told me that they were trying to get her out of the facility and made the situation sound worse then what it really was. She told the ER doc that the patient threw herself out of bed in an attempt to kill herself. Long story short, no psych consult at the hospital and no xrays done.

Two weeks later, the 7-3 shift had her out of bed in her powerchair to swap out her "big boy bed", I was passing meds down the hall when one of our MDS nurses comes by and said that she heard the pt saying that she was "dying" and to make sure that I document the behavior. (like I wouldnt!!) 15 minutes later this lady was on the floor. She admitted to putting herself on the floor b/c she didnt want to sit in the chair anymore. The ADON reams me and the cna for not being psychic to know ahead of time that this would happen! the lady had no injuries and it took 6 of us and the hoyer lift to put her back in bed.

The next day the ADON comes to me while I was passing meds, and said why didnt you document that the patient was overheard saying she was going to kill herself??? WTH!!! I was never told this. The mds nurse only told me she heard her say she was dying. No suicidal ideations were ever mentioned. The adon goes on to say, that the mds nurse said she told you of this. I go to the chart and below my entry for the previous days events, the mds nurse had put in a late entry stating that the patient had been overheard saying she was going to kill herself and that she had notified the charge nurse (me) immediately. The adon also told me that they were trying to get a tdo on this resident. I remember from psych that in order to get a tdo, the patient has to be a danger to themself or others. I am convinced that they doctored the chart in order to try to get this lady out of the facility. I am disgusted and dissapointed in my management. This patient has never once threatened suicide. What should I do? And since the mds nurse is a nurse and supposedly actually heard the resident say this, why didnt she document it in the chart before my documentation of the fall????

Sorry for the ramblings on!!

LPN:angryfire

[ktwlpn, LPN]

It really does sound as though the resident needs help that she is not getting in LTC.These residents can be very difficult to manage and in my opinion don't belong in the LTC population when they are acting out as this one seems to be doing. If you did not hear any suicidal ideations then stand by that and don't let anyone intimidate you into documenting otherwise.I don't know of the legalities regarding the MDS nurse's entry stating she informed you of this-maybe some other experienced nurses can give you advice on that.-My gut feeling is that I would do a late note myself and document exactly what the mds nurse said to me regarding the resident.Do you have a policy regarding suicidal ideations and what to do with a resident that verbalizes them?? If so,why didn't the admin make sure it was put into place when this resident supposedly made her statement to the MDS nurse? You did not do anything wrong-I can understand everyone's frustration and can see where it may seem to you as though your admin's concerns are not based on the resident's well being but rather on her being "inconvenient" .But she really needs some psych help.I think I would ask to speak to the DON and ADON regarding the documentation by the MDS nurse-make it crystal clear exactly what you heard her say.I would not get into the rest of it-there is alot involved in getting a resident psych help on the admin level and they really are doing what is best for her.She can't keep throwing herself on the floor. We have a morbidly obese middle aged resident with psych issues-she acts out,manipulates her family,peers and staff and demands the focus of the entire unit regularly.And she has a cell phone which she uses to call the ombudsman and the state dept. of health..I'm sure I am not exaggerating when I say we would all like to see her transfer to another facility.It's tough to see to the needs of everyone else while a resident like this is sucking the life out of you-and they are miserable creatures, too...Good luck

[fultzymom]

If you did not hear the patient make statements about killing herself then you can not document that she did. I think that they are trying to get her out of the facility and going about it about it in the wrong way. You could have documented something like, "MDS nurse reported to undersigned that patient making statements that she is dying. Undersigned went to check on this patient et ______________ was stated." and just document what the patient told you in reference to what the MDS nurse overheard.

I work in LTC and I hate it when they put psych patients or MRDD in this type of setting. It is not always beneficial to the patient as we are not set up to provide the support that they need and it is worse when those patients are put on the secured unit (ex dementia unit) as their behaviors usually upset the dementia patients. It can also take away your care from other patients.

If that other nurse thought that she was a danger to herself then why did she not implement something before she fell since you were trying to pass your meds? I do not think that you did anything wrong. They are just trying to get her out of there and changing this situation enough to help accomplish their goal.

[Simplepleasures]

Oh you poor dear, I know what you must be going through right now.Sounds like you are being made a scapegoat.You actually dont have alot of options right now, if you chart what the MDS nurse said to you it will be in conflict with what the DON and the MDS nurse charted. I would still stick to my guns and chart truthfully, it may end up getting you fired though. It is gut renching to hear these stories of unscrupulous management,and it is worse living that reality as you are now doing.I have been where you are now and actually DID get fired for refusing to falsify a document,I am now in a lawsuit with these people. I am not saying they will fire you, but be prepared for any eventuality.

It takes a very strong determined person to go through such a process, but have found it to be well worth the stress and everything else to hang on to my self respect. I suggest looking up employment lawyers, the kind who represent the EMPLOYEE, not the employer, and ask if they would be willing to give you a free consultation, some actually will. Private message me if you want.

[tatgirl]

Our policy here if a resident states suicidal ideation is to notify the md, and then they are on suicide watch. Personally I feel that the mds nurse since she supposedly heard the patient say this should have charted it immediately, then notified the md. This woman does need serious pysch help, and we cant give it to her. There is only one geri-psych facility in the area, and it is a booger to try to get people into it. My don hasnt said anymore to me of the incident, but I do believe they are pulling all the stops to get this patient out of here. Unfortunately, I just happened to be on duty when it hit the fan. lol. Thank you for all of your replies and advice.

Wendy

LPN

[jan7749]

I have worked in long term care a long time and unfortunately this is not uncommom. The problem is actually two fold as I view it. #1 The person who heard the "dying" comment should be the one to document it. This is due to the nonverbal signals the resident may have given which would have led to a "intention" feeling from the MDS nurse that she did not communicate to you. #2 In order for a resident to get the psych help they need in our state, there has to be a long documented history of what the resident is saying, what behaviors, if there is any illness--uti, pneumonia, pain--that could be impacting. Frequently floor nurses-me too--just don't have the time to document routinely for long enough to get the resident into a psyche unit. Good luck.