Assault?

[joe007]

Hello. I am a relatively new ER nurse and thinking of leaving the profession. I was in a round about way accused of assaulting a pt. by coworkers.

A pt. came in around 2200 last night high (had blue powder in his nose), drunk, and in restraints. The pt got in a fight with security and spit on them before he was restrained on our ER stretcher. When I took over at 2300 (beginning of my shift) I went in and talked to the pt. who had already been given geodon but was not sedated yet. He wanted the restraints off. To use the good cop tactic, I took off his R wrist restraint and told the doc, who had ordered the geodon and knew about the restraints that i would need an order for the restraints to keep them on. He agreed and put an order in. by 0000 I discontinued all restraints and the pt. was sleeping. I pretty much monitored him all night. I didn't notice, but somehow my charge nurse knew he had swelling to his L eyebrow and told me to document it (pt was sleeping on side where swelling was). I put it in an observation which the last shift had yet to put in. I set the obs. time for 0230 which is when I noticed the swelling on advice of the charge.

Anyhow. Later that morning I see the charge and another nurse in my pt's room taking photos etc. and at the morning meeting the doc asked me off the cuff if I punched the guy in the head, which I denied and didn't do at all. Later that morning my manager wanted to talk to me. She told me the charge told me to document the swelling and that I refused. I told her that I documented it in an observation and that the charge didn't explicitly tell me to put it in a note (which she hadn't). I had been asked by the charge 2 times to document it. The first time she told me to do it, I went and looked at pt. and put it in the obs. the second time she brought it up I told her it was in the observation and she didn't say anything else. Anyhow, it seems the charge must have been telling people she thinks I may have done something to this pt. and may have been covering it up or something because I didn't put it in a nursing note right away. I really feel it's ridiculous that she would think I would do anything. I didn't have any problems with the pt. all night long and was the on who took off his restraints. I never had a violent interaction and all the action (security, EMS, geodon) etc. occurred before I arrived not to mention it's pretty obvious that if anyone did punch him he may have gotten it during the struggle with security.

[Esme12, ASN, BSN, RN]

Wow...this is serious...if you have malpractice insurance call them RIGHT NOW! They can take this the whole 9 yards.

I am curious was the charge in the room during the struggle?

I hope you documented you behind off that you FOUND this on the patient. What made the charge go in your room to notice the swollen eyebrow?

I would also not discuss this too much online...AN is anonymous but it is public and can be seen by anyone.

[joe007]

Thanks.

[psu_213, BSN, RN]

I'm not a lawyer…maybe someone who is more legal "savvy" can answer this--if indeed the charge nurse is telling people you punched this pt, did she commit slander?

Anyway, speak with an attorney and make sure your charting is in order.

[joe007]

Thanks. I already wrote down my narrative and emailed it to myself with time stamp as to what happened last night in case there is any issue in the future. I also informed nurse manager and charge nurse that I did put the bruise/swelling in a nursing note and did not understand that charge nurse preferred note instead of observation (which has the exact same info in it which is double charting, but they prefer it that way.) I also made a note as to what I walked in to and who knew when I came on shift indicating Dr. knew pt. in restraints at time I took over shift, etc. per advice of nurse manager. I always type a lot of progress notes during a shift so as far as pt sleeping or being awake, that's covered and I of course documented restraints and when they were ended etc.

It sounds like your charting is accurate and thorough... you should be fine.

The atmosphere around your joint sounds toxic... We end up going 'hands-on' on a routine basis and I can't imagine it going the way that you describe.

I also need to point out that - without knowing all of the details of what you're sensing from those involved - you might be reading more into "it seems the charge must have been telling people she thinks I may have done something to this pt. and may have been covering it up or something because I didn't put it in a nursing note right away" than is really there.

I would approach the involved parties and ask them directly.

Esme: One question that I've had pertaining to malpractice insurance (and my recent incident) is whether you flag yourself for rate hikes by contacting them *before* you know that things are going sour. In my case, I chose not to contact them simply because it seemed premature.

[Emergent, RN]

I agree, I think there is a problem with a toxic workplace here. Where I work, no one would ever side with some crazy patient who is high as a kite, requires restraints, needs psyche meds. This charge nurse sounds like she's out to get you, unless there's something you're leaving out here.

[foragreatergood]

Wow. That's a serious accusation. I would consider contacting Human Resources if Charge discussed her concerns with anyone other than management. If charge had even the slightest concern that you may have somehow injured a patient, why did she leave the patient in your care? Telling someone to document something does not protect a patient. I have seen violent patients get injured during the application of restraints. But if restraints were applied before you assumed care, they should be talking to the staff that applied them.

These are the situations we learn from, regardless of how this unfolds, this will make you insist on bedside report so that any issues can be addressed immediately.