Combative dementia patients

[Old and New]

I have just been suspended for several days because a patient of mine became combative and my med nurse, the tech and I had to hold him down. He now has significant bruising, but is otherwise ok. I charted the incident at the time, and passed it on in report. The bruising didn't show up until my night off. I don't want to get punched and I need to look out for my staff. As it is, I get home with bruises more days than not. Now it's costing me job security and pay. How do you handle this situation?

[NurseCard, ADN]

There should be a protocol in place for what to do when a patient, or resident?,

becomes combative, to the point of being a danger to others. However, I'm more

than willing to bet that there isn't.

I may post later; I'm at a slumber party, my daughter's.

[loriangel14, RN]

Why exactly are they blaming you? How was it your fault? Do you have adequate meds ordered for patients like this? We hold them down as well, just until we can get the IM in.

[IowaKaren]

It's always the, "what did YOU DO to cause the combativeness, who abused this resident?" Couldn't be that there is some sundowning or a UTI brewing or anything like that, could it (here the irony in my words which WAS the cause, UTI). Have been there before and the only thing that saved me and my shift was the resident held onto the reporters arm and the bruising matched that residents hands to a tee when holding onto the reporter. I know they have to investigate but after all the statements we had to make and bring the statement back to the facility immediately, I had to ask what they found out and was told the allegation was unfounded and what happened. Of course, no apology for "who abused this resident", and if I didn't ask, would not have been told. The constant CYA is so stressful these days. What in the heck is this world coming?

[Old and New]

I'm in a behavioral unit, and this kind of behavior is exactly why the patient is here. He has no medical issues. If another nurse hadn't called to give me the heads up, I wouldn't have even known until HR called and said a complaint had been filed (by another nurse, yet, who could have asked me what happened, instead of filing a complaint). I agree, the CYA is draining. If I could make a decent living doing something else, I think I would just move on.

[Anne36, LPN]

I just had a resident grab my arms and push me the other day. He also threw a walker at one of my CNA's. A third CNA came in and was able to get him to sit quietly. Im new at this facility and noone has told me about a protocal for this type of situation. At least half of these residents have psych issues. Is this what all LTC are like? If someone is not screaming and swearing at the top of their lungs, they are hitting or getting into something.(By the way I have been slapped in the face, run over by wheelchairs and had residents come up behind me and try to deliberatly knock me down, and I am a new Grad, only been working for 2 months.)

[loriangel14, RN]

Our stance is that we are not at work to be punching bags.Our patients get medicated appropriately. We have the right to not have to work in fear of getting hurt.

[CapeCodMermaid, RN]

Just as the resident has no right to hit you, YOU have no right to hold him down to inject him. That's considered abuse and in some states it is considered to be assault. If a resident is combative, back off and let them calm down. If they continue to be a danger to themselves or others, section 12 out to a psych facility.

[loriangel14, RN]

Just as the resident has no right to hit you, YOU have no right to hold him down to inject him. That's considered abuse and in some states it is considered to be assault. If a resident is combative, back off and let them calm down. If they continue to be a danger to themselves or others, section 12 out to a psych facility.

We can't back down when they are actively trying to assault us. Unfortunately we have no where to send them We have to deal with them as there is no psych beds for them usually.They are usually in grave danger of hurting themselves or others.

[cwgrlup85, ASN, RN]

Yes, I agree with CapeCod. There must be some place you can send them if they are unsafe. Call their physician and then call ambulance. I am a director of a dementia unit and when a resident is combative we are not allowed to hold them down. Yet you must keep other residents and themselves safe. It is a sticky subject. Usually backing away from the situation helps, try approaching with a different staff member. Maybe the resident's physician needs to adjust medications, as a last resort.

[loriangel14, RN]

Call an ambulance to take them where? I work in a hospital.

[cwgrlup85, ASN, RN]

Sorry, thought you were referring to a LTC setting.