Exposing Patient Neglect, Emotional Abuse, False Documentation and Other

It’s exhausting just thinking about where to start. But to begin, I am a current nursing student who is more than half way through my nursing education. Not too long ago, I started working at a psychiatric facility as a nursing assistant (not certified yet, but I do intend on getting certified eventually since I am eligible). Besides clinical rotations, this is my first job actually working in healthcare. Nurses Announcements Archive Article

Exposing Patient Neglect, Emotional Abuse, False Documentation and Other

I was so excited and grateful when I got the job. And although I don't have much experience with psychiatric patients yet, I do know that the issues I am expressing concern about SHOULD be taken seriously. The work environment is not very professional at all. Majority of the people are only there for a paycheck and it really shows in how they treat the patients and simply don't do their job.

While training, my shift supervisor refused to give me any type of direction as to what I am supposed to do. Obviously, care for the patients, but when it comes to paperwork, needing help finding something or simply general questions to ensure that I am doing my job right, all I get is short, disrespectful comments as if I am stupid. But I feel that it is a legitimate question to ask about whether or not we separate or wash all patient clothing together or if we have any additional paperwork or tasks which I was not made aware of. I take my job seriously and feel like I should be taken seriously as well because I am still new and still trying to learn how things are done around there.

But yep, I get those smart comments and have no time to ask any other questions before he walks off. Not only that, he disappears from the unit for sometimes an hour or so at a time and we are left unsupervised. And when he is actually there, he sits down playing on his phone or sleeping. I don't mean disrespect when I say this, but do you really call that being a supervisor? I don't.

Moving right along though. As if poor leadership were not enough, majority of the other nursing assistants are just as bad and actually, even worse. The person I was training with said that they don't even take some of the vital signs but just write something down. I was like, "you do what?" And so I expressed my concern to the supervisor which in turn he said not to worry about it if I didn't know how to take them. #1, vital signs are VERY important when it comes to monitoring a patient's condition. How is the nurse supposed to catch on if something is wrong when he/she doesn't even have an accurate baseline to go by? Honestly, that puts the patient at risk and I feel that it also falls under neglect as well. #2, you are saying it is okay for them to make up something to write in the patient's chart which I am pretty sure falls under false documentation. Big no-no! So I did report this up through the chain of command, mentioned it to the nurses myself because I feel that it's important for them to know, and I haven't heard anything else about it.

But there was also some other issues which I reported to the supervisor as well. A pt made allegations of being threatened and emotionally abused. (Pt did not use these terms, but that's what it falls under.) The allegations were brushed off and I was informed that the pt "lies" all of the time. However, part of me was still suspicious because my gut was telling me differently. And as I just found out, another NA said she was present when this was actually said to the pt. So as it turns out, the pt was not lying to begin with just as I had thought. I mean, why else would the accused NA tell the pt to shut up and that I don't care about what goes on in her life? Actually, I do care. That is why I chose healthcare to begin with.

But back to the staff for a moment. We have pt's that are one-on-one and others who are supposed to be in visual contact at all times. But guess what? You'll find just about ALL of the NA's (except the few of us who do our job) sitting around beside each other talking, laughing, cutting up, playing on their phones, listening to inappropriate music and videos, and then not even acknowledging their pts. This upsets me. Just the other day, a pt who is elderly, immobile and requires complete care was lying back in a geri chair and began spitting up. No one acknowledged this happening except for me. Pt couldn't move to turn head to side and could have even aspirated. This same pt is one who tries pulling off bandages and pulling out tubes if unsupervised. Maybe immobile, but still has some arm strength. Pt is known for doing these things yet NA's leave pt in room alone and go do their own thing a lot of times. This makes me so mad though. Pt is 1:1 for a REASON.

Another pt struggled getting the wheelchair through the door and everyone sat there continuing to do their own thing until I got up and helped since it was clear that they were not. They are rough when transferring pts to bed. The nurses have told them to use a draw sheet for transferring pts, but they still refuse. I even recommended it because not only will it make life easier, but I feel like it is a lot safer when you're trying to move a larger pt who cannot help move themselves.

These people have made very inappropriate comments in FRONT of a pt concerning her genitals (and the pt said she was "use to it"). They wipe from orifice toward lady parts. They refuse to give pt a cup of ice or water (and no, there is no fluid restrictions on pt). They provoke some of the pts making them lash out in anger. They argue with the pts instead of redirecting that anger as we were taught to do. The chart that they have given pts a shower when the pt complains that they want one but NA refused to give them one. They do not provide oral hygiene as that was a concern expressed to me by numerous pts. When a pt asks a question or wants to do an activity, most of the time they are completely ignored until someone like myself says something or helps them if able.

And then this leads me to something else that I was just informed of. Apparently, we have one NA who yells, cusses, throws, and yanks pt's around. The fact that other NA's see this type of behavior and do not report it really pisses me off (and this is another part of what I am reporting tomorrow). When the upper-level supervisor(s) are not at work, NA's will come to work out of uniform dressed in everyday clothing, stay on their phone the ENTIRE shift and not even do their job. They take twice the amount of time given for their lunch breaks (in which they do not clock out). They will disappear from unit and are nowhere to be found. We have quite a few pts who are unable to communicate, so these NA's pretty much put them alone in a corner somewhere and don't even look their way until it's time for meals or to take them to bed. And of course, when I am spending time talking to the pts and actually acknowledging them, these same NA's sit there and run their mouth about me while giving me these awful go-to-hell looks. Even though that is irritating, I deal with it because I know that the pts appreciate what I do for them as they tell me so every single day.

If I didn't care about the pts though, I wouldn't stay. But I do care about them very much which is why I am seeking advice from others who might be able to give me some recommendations. As I said before, I have reported some of this (more which I will be reporting tomorrow). My only concern is that I feel like they are trying to get rid of me although I have done nothing wrong. I am constantly being eyeballed by everyone as if they are waiting for me to make a mistake so they can get me out of there. I mean, maybe I was a little out of line by telling one of the girls to move and let me provide perianal care since she was badmouthing the pt and upsetting her. And of course, recommending we use a draw sheet. And apparently speaking to the pts as if they are a person instead of ignoring them.

My concern is that I am still considered "on probation," and I was also told by the nurses that all of the supervisors through chain of command are just like this one. One of the nurses said that she tried reporting something and was reprimanded. I just don't see how this corruption has been going on for this long and no one has done anything about it. How did it even get this bad?

I am a firm believer that God places us somewhere for a reason though. I love every single one of our pts and I treat them just like I would treat anyone else rather than a "crazy" person who doesn't deserve to be respected. I am so heartbroken over these things. What kind of future-nurse would I be if I didn't care about the pts? I have been told to just do my job and let all of this go, but I can't do that. I believe in treating patients with the dignity and respect that they are promised to be given. Who are we to take that away from them and disregard them as being unworthy of our time? I love my job. I really do. And even though my coworkers are disrespectful to me and make working with them very difficult, I do it for the pts and because I love what I do.

Not once have I had a pt to act out toward me. If they are upset about something, they will talk to me about what is going on because they know that I care. Of course they are on medication and are on their way to healing, but these people don't even care about them. They say ugly things to them and it's discouraging to me. I can't possibly imagine how the pts must feel. Every day that I go to work, I take the time to say hello to every single patient and let them know that they are important to me and that I care. I encourage them and let them know that I want to see them succeed and get better. When they are crying and upset, I offer a listening ear when others just walk on by. These people are in a situation that we may never understand because everyone's journey in life is different. They didn't ask to have a mental illness. They didn't ask to come to that hospital. They were admitted against their will. We get to leave and go home, but that is their home right now. They don't get to leave. And there is absolutely no reason that we should make their life even more of a living hell than it already is.

I am scared that if I continue reporting these things that I will end up losing my job. I don't want them to see me as someone who is coming in and stirring up problems. That definitely is not my intention or else I would have already exchanged words with a LOT of ones who try provoking me as well. But that's not who I am. They can run me down in the ground all day long and hurt my feelings, but they will not sit there do that to these patients when I am there. I am a patient advocate. I am there to do my job which means caring for them and seeing that they get the best care possible. I am not there for my coworkers, to cut up, play on my phone, and get paid for sitting on my butt doing nothing. I really wish that we could all get along and they would at least show a little bit of respect and compassion to our patients, but that probably isn't going to happen.

My concern is that I am going to annoy the supervisor(s) by keeping on reporting these things to them. But that's my job to take care of the patients, so what other choice do I have? I don't want to lose my job because I love working with these people and they really need someone who actually cares about their well-being. But at the same time, something has to be done. I can't be there 24/7 to take care of these patients and even I could, I couldn't possibly take care of all of them at the same time. It hurts my heart so deeply to see what is going on and not be able to do much to change it.

If you were in my shoes, what would do? What are my other options? I'm obviously going through the chain of command first of all, and I can only hope and pray that something will be done. However, it seems like the problem has been going on for so long that it is going to take a lot to change this environment. Even if I report them to the proper authorities, what evidence do I have if no one else is willing to come forward and testify to the truth? It's going to be my word against everyone else employed at that hospital. But these people deserve so much better than what they are getting from us. We are failing to meet their basic needs when we don't provide adequate care. We are compromising their health and well-being in so many ways. We are neglecting them. And instead of promoting healing, these things are going to slow the process. I couldn't imagine being in their shoes when it's this hard being in mine given the situation. And sadly, it doesn't seem like too many others care.

But my question is this, what can I do to make this better and not worse? I am following the rules. I am biting my tongue even though it's hard. I am remaining professional (even though it may seem unprofessional of me asking for help like this, but I'm scared that seeking guidance from someone I know will end up biting me in the butt). I am trying so hard to be strong not just for myself but also for the patients who have to live with this every single day. I will not let my coworkers run me off by being hateful toward me. I can handle it even though it is hard. But I am not going to compromise in the way that I care for our patients just to "fit in" with the crowd. I am not going to turn the other way and pretend that I don't know what is going on. I can't, and I shouldn't have to. There has to be something that I can do though to make this situation better. And even if you guys don't have suggestions, please just say a prayer with me that I will be able to make a difference in their lives.

she_who_cares

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Make a detailed formal written complaint to the appropriate authority after you have found new employment and resigned from this job.

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Specializes in Psychiatric.

I agree with caliotter3. Also keep a detailed diary of what you see and hear (keep it purely objective - no emotions). I have been in your position although it was in community aged care; a 'carer' used to leave old folks in their own filth, no food provided, says they 'refused' to be showered (yet most folks looked forward to their showers and said the 'carer' refused claiming time restraints) and even after I lodged a written formal complaint outlining her neglect, it took ELEVEN months for her to be transferred off the team.

This place sounds like a psychiatric unit from Hell. I know you feel strongly for the patients on this unit, however be very careful with how you lodge the complaint. As I said, document every day what you see and hear re: neglect and abuse by other staff. If you know your immediate supervisors are likely to dismiss your concern, go higher. I never would usually suggest going over your line manager's head, but from what you've written about the abuse occurring, it seems an extreme case.

As for your nursing future, I'd recommend getting the hell out of there. Formalise the complaint, ensure you have included as much objective and factual documentation as you can but get the hell out of there.

And don't let this weigh you down. You are doing the right thing and you will make a difference to these patients if do the reporting process appropriately. Good luck and let us know how you go.

Make a detailed formal written complaint to the appropriate authority after you have found new employment and resigned from this job.

OP, you can complain to your state healthcare licensing agency, state mental health agency, and state ombudsman for the disabled in addition to the higher-ups at your current facility; but, as caliotter notes, I would find a new job first because you're not likely to survive that at your current job.

Unfortunately, there are a lot of psychiatric settings that provide v. poor quality care. Eventually, something really bad is going to happen there, either someone will get seriously hurt or the state will come in and investigate. You don't want to be hanging around to get caught up in the fallout when that happens.

Specializes in Dr of vet med, ER/ICU/Vet Anesthesia/Practice.

As a former patient in many hospitals, I am very sad to hear what this nurse is going through. It is obvous that she is very dedicated and cares about the patients. I will tell you that the patients follow eyes and can read people and learn who to trust and who not to. I have seen many acts of kindness made by p nurses and reported them positively to the apna but I doubt anyone cares.....the patients do believe me. People are either traumatized or smashed or kicked around by society and yes.....altered or imbalanced physiology etc........but in the main.......very very decent people treated by some exceptional nurses who care very much about them........and we could be just shacked to the wall. I am so sorry for what you are going through and it is upsetting and concerning......I do believe that many nurses get kicked around by doctors and admnistrators and the stress of the job.......and no one seems to come to their aid.........I don't appreciate this at all. I hope someone can assist this dedicated nurse.........the patients care and respect you greatly although we know we are not allowed to acknowledge it and its not personal personal.........but thank you on behalf of all patients. We owe the good ones more than we can ever say....

Specializes in Psychiatry, Community, Nurse Manager, hospice.

Praying for the OP.

Specializes in Psych (25 years), Medical (15 years).

My heart goes out to you, she who cares ​.

At times like this, my mantra is "My happiness is not a result of what others do or say or what happens around me. My happiness is a result of being at peace with myself." If we do the very best job we can do under any given circumstances, then we can be at peace, and subsequently happy, with ourselves.

"The world isn't changed by quitters" also comes to mind.

We can fight the Good Fight and attempt to divert the Mainstream into righteousness, but our endeavors often feel like we're shoveling sand against the tide- an exercise in futility.

You must decide the path you wish to take. If nothing else, your decision will be a learning experience which you will use in future endeavors.

I could relate similar circumstances that I, too, have experienced, but my recalling would be: "Except for the names and a few other changes, the story's the same one".

I am happy with who I am because I did what I felt was right, damn the torpedoes. I didn't make a lot of Friends, lost some jobs, helped a few People, and sleep very well with myself.

As Richard Bach wrote, "Your conscience is the measure of the honesty of your selfishness. Listen to it carefully."

The very best to you, she who cares!

Please, you are doing the right thing. You have a good heart.. and you're going to be a great nurse. Of course, you need to look for a new job. Hopefully that happens sooner than later for you. But that doesn't fix things for the patients in that horrible setting. Contact the local ombudsman - they are patient advocates. You might be able to send an anonymous letter, detailing the events you are aware of. If not, then yes, contact the state board or JACHO or someone! My great uncle with alzheimers, was beat by a nursing aid with his belt- I'm sure others knew that nursing aid was 'rough.' Maybe that wouldn't have happened if someone like you had the courage to escalate the issue! Also, talk with your instructors - they might be able to give you guidance and better contacts as well.