Employer resonsibility?

[Maremma]

What is the responsibility of a Nursing home/ rehab facility to protect staff from sexual harassment by a patient if the patient is also bipolar with dementia involved?

I can no longer take the abuse and asked that this patient either be moved to another hall with a male nurse or to move me to the other hall and ask the male nurse to take over my hall for a while.

I was told "it is a complicated problem" and I have not been moved nor has he. Indeed it is a "complicated problem" as HE is an over all problem and should not even BE in our facility at all. We do not have a psych unit. We do not have a dementia unit. He has to be in a private room due to his violent behaviors and so is on my "rehab unit" so he can be in a private room.

I cannot afford to quit work to end the abuse.I can't find another full time job. I have been trying for quite some time. I also cannot take anymore of it. I am exhausted. I go home crying and can't sleep. I can't eat right. I am shaking and dread going anywhere near work. I have even considered finding a Dr (I don't have one right now as mine retired) and asking for ativan or something to help me be able to keep going there. I do not have an anxiety disorder. I am not a depressed personality or anything that would actually justify ativan though. It is JUST this job.

This patient becomes verbally and physically abusive to not only me but everyone around us every time I have to tell him I am not his girlfriend I am his nurse and that is all I am. He needs to stop being inappropriate.

He makes threats to kill me and others or himself whenever he has to be told not to do something or he can't have what he is demanding. He started in on me as soon as I got on the floor yesterday. Another staff heard him and told him "Don't even start that" Well that was all it took to throw him into a rage. He was cursing, calling names and suddenly decided that a female resident had taken his money and tried to go after her in her room. I was able to intervene before he go to her but I took a physical beating KEEPING him away from her. He was punching and kicking and made contact before I could get behind him to avoid any further beating while trying to redirect him back to his own room and show him his money is exactly where he left it.

THIS is my daily routine with this man. It is a constant battle to protect the other resident and staff from his constant barrage of abuses.

They changed his meds in an attempt to help with his violence but all that did was make him worse and hyper sexual against me instead.

I am having to deal with this from the time I get there until I leave. All the while also trying to do my job effectively and take are of everyone else and their family members as this is supposedly a physical rehab unit so there is always a LOT of extra paper work and family to content with on top of everything else.

why is it that it is the "norm" for employers to expect staff nurses to be able to take this kind of abuse day in and day out and still manage to get everything done and act like everything is wonderful? Is there no legal responsibility of the employer to protect us from these things?

[CrunchRN, ADN, RN]

How about calling the people you report nursing home patients in danger to? Because he is a danger to the other patients also. He needs specialized Geropsych care.

If they do not care about staff maybe that would be a way to get action.

[icuRNmaggie, BSN, RN]

Oh honey call the police.

Tell 911 he is beating up the nurses and dangerous to other vulnerable pts.

They will do an emergency petition for a psych eval and shove him in the bus.

My motto with violent patients is act first apologize later.

I would not hesitate to press charges if he is in control of his actions.

[scottaprn]

He hit you call the police and press charges. If he is hitting you there is no real choice at that time.

This is not only in your best interest it is in the best interest of the patient as well. He needs a different level of care. It is either prison if he understands his actions or a psychiatric unit if he doesn't. If the facility refuses to determine what he needs then let the justice system decide.

You don't want to be a witness for the prosecution when this guy is under your care and he hurts a patient and a family presses charges. You dont want an investigation against your license that could accompany that. Nip this right now.

Never ever apologize for protecting yourself. Everyone has a right to a safe working environment.

[jschut, BSN, RN]

Oh my goodness!

I would call his Dr, explain the situation and have him sent off immediately!

[heron, ASN, RN]

Failing that, call your state ombudsman - seems to me they would have a little something to say about a facility that endangers its residents this way.

[VivaLasViejas, ASN, RN]

It's not quite that simple. I had a similar problem with a resident years ago when I was a care manager, only this fellow was cognitively intact---he was just meaner than a snake! He'd go around in his wheelchair and deliberately stick his cane out to trip other residents and staff, he attacked several females in their rooms, and kicked and beat staff. We took the usual measures and called 911 when he was violent, and they'd just bring him right back....the hospital didn't want to admit him, and the cops wouldn't do anything at all.

It took an entire weekend's groundwork, but I finally got his doctor to agree to send him to a geropsych unit in a nearby city for evaluation and treatment. He had no family or friends (can't imagine why) so at least I didn't have to fight anyone else. But two days after he left, along came his Medicaid case manager who was FURIOUS, and she told me I had done the wrong thing in sending him out---apparently I violated his rights. Well, what of the rights of the other residents to be safe? What of the rights of the staff not to get beaten all to hell and back by someone who had all his wits about him? And besides, I'd even had HIS permission to get him into geropsych (he wanted out of my building anyway).

Bottom line, it's just not as easy as it sounds to get a violent patient out of a nursing facility. And if you have to fight family or guardians, it's even worse, if not impossible. But it's ALWAYS worth trying, because violent residents don't belong on a unit where they can't be monitored closely, and if you're very, very lucky, you'll succeed in getting them out. My troublemaker never came back to the facility even after he was released from geropsych; IIRC, he went to a secured facility somewhere out on the coast.

So when management says "It's complicated," believe them. In the meantime, keep advocating for your other residents and yourself, and whatever you do, document every single aggressive move this resident makes---every curse word, every raised fist, every attempt to harm another person. There has to be meticulous documentation to prove that a resident is unsuitable for a particular placement. Good luck.

[Maremma]

I most certainly do document everything he is saying and doing.

Sending him out is useless. They give him a shot of IM haldol and send him right back. They "can't" admit him. No other facility will take him (or has room for him or whatever). He is very manipulative and has learned to threaten to kill himself to get things he wants.

He WAS admitted to a psych unit for 10 days when he said he was going to use his call bell to hang himself.(which of course everything was promptly removed from his room) He says "I have to kill myself, I don't have any money" "I can't even buy pepsi or a candy bar when I want it".THAT gets him a psych unit visit. The solution they sent him back with? Hand him soda and that will "solve his behavioral problems" Umm NO. He GUZZLES it down woofs down one candy bar after the other and simply demands another one as soon as he is done. He is a diabetic sooo I find this ludicrous that that is what they think is the solution. Not that it works anyway. So if he wants to kill himself suddenly he can be placed in a psych unit. (where he gets all kinds of one on one attention all day) But when he tried to kill other people there is no need for psych unit?

What is MOST ludicrous to me is that I have discovered that it is ALREADY documented in his chart that historically he has this reaction to ativan and rather than take him off it and KEEP him off it they had increased it instead. U/a? Negative as always.What responsibility does the psychiatrist have in this situation?

Of course they also were aware he was behavioral before ever accepting him to our facility but took him anyway. Its not like they aren't fully aware that we do not have a psych unit or even a dementia unit. He is not the first patient they were fully aware was behavioral and accepted anyway. "well they need care too" is what we are told! Wow really? We are not equipped to handle them THAT is the problem.

It seems that we need LAWS to force these places to do the right thing and not accept patients you are not equipped to properly handle and are unable to protect other patients and visitors from.

I can say that I am not going to be the one paying my medical bills when I have to do to a Dr to get meds to be able to keep working in such an abusive environment. That much I am sure of.

[brandy1017, ASN, RN]

Police should have been called when he beat you trying to get to the other resident. He was a danger to you and the other residents. The police should then have taken him to a hospital preferably psych and from there other placement arrangements should have been made as in refusing to take him back! This is what happens where I live and while the family and mental health experts are not happy with this arrangement, I think it is the best for both the staff and other residents! Let the family and mental health experts deal with him hands on, not going to happen, but why should we take the brunt of the insanity! Also this patient needs to be sedated with the appropriate anti psychotics for the safety of all concerned! The mental health experts think we can be trained to calm down these patients and handle them better, but I don't think so! If they want to step in and work one on one with the patient I'm all for it, but I don't think they would touch them with a ten foot pole!

[VivaLasViejas, ASN, RN]

At the last LTC I worked in, we had a male resident who was combative like that, and after he came back from a psych hospitalization we were given orders to swack him up with 5 mg. of Haldol IM whenever necessary, because he often refused oral meds. Of course, these are the days when State frowns down on the use of such drugs and calls them chemical restraints, but the need was well documented, so on those occasions when he raised hell with staff and other residents, we used the Haldol.

Then somebody got the bright idea to put him on Abilify, an atypical antipsychotic with fewer side effects than the older drugs. At first it was a struggle to get it into him, but we were successful enough times that it actually began to work. A few weeks after starting the Abilify, he was comparatively docile, and the PRN Haldol went away after a couple of months. He didn't need it. Oh, he was still ornery as all get-out, but he stopped hitting and biting and punching. :) I'm not saying that it works for everyone, but it sure did for this fellow.

[icuRNmaggie, BSN, RN]

I most certainly do document everything he is saying and doing.

Sending him out is useless. They give him a shot of IM haldol and send him right back. They "can't" admit him. No other facility will take him (or has room for him or whatever). He is very manipulative and has learned to threaten to kill himself to get things he wants.

If the crisis intervention people are too lazy to find this guy a bed in a geri psych unit, then they and the ER staff are going to be liable when he hurts someone.

the police will soon get sick of having to deal with this individual.

I would send him out every night until they get his meds right.

Do start looking for a better job.