Failure to report abuse and relied the supervisor

TheMoonisMyLantern, ADN, LPN, RN · Jan 30, 2021

Did you document that you interviewed both residents, assessed for injuries, and notified the supervisor? What is causing the facility to investigate this further, did an injury surface or did another assault happen?

Sour Lemon · Jan 30, 2021

I'm also a little confused as to how this became a "serious issue". What you describe doesn't sound like something that would cause a license to be revoked, but we don't know all the fine details.

It might make you feel a bit better to look up disciplinary actions on your state's BON website (if they're available).

Ariana30 · Jan 30, 2021

15 hours ago, TheMoonisMyLantern said:

Did you document that you interviewed both residents, assessed for injuries, and notified the supervisor? What is causing the facility to investigate this further, did an injury surface or did another assault happen?

Yes, I did. I know that I have to report directly if my supervisor is not doing anything but I wasn't aware that it should be within 2hrs. I waited until after I'm done with my 48 patients. I thought within 24 hrs. That is my mistake there.

JKL33 · Jan 30, 2021

16 hours ago, Ariana30 said:

Now, the facility is investigating because this is a serious issue and I got all the blame everything is my fault and all that.

My guess is that the full reporting procedure wasn't followed. This would be something like a written incident report or another form that your facility uses to document incidents such as this.

Some may disagree with me but I believe that at the point you communicated with your supervisor about this and about your findings, etc., that person then shared some responsibility (along with you) to make sure that the handling and reporting of the incident was completed according to your facility's policies and/or normal procedures. I say this because no new nurse can know every detail of things such as this. Although it's a good lesson to remember to consult written policies if possible.

Now - I think they are messing with you. It's okay to stand up for yourself. In your post you have called yourself "dumb" twice, stupid, and said that you are not deserving of being a nurse. Now you do know these things are not true. Kindly I must say: Stop carrying yourself this way; stop giving off this vibe (likely to everyone around you). You were not trying to hide anything or cover anything up, you are not guilty of any kind of patient negligence or any malfeasance. The worst (it seems) that you could be "guilty" of is not following a house policy related to reporting things like this, and this may have caused your facility to not handle this in the exact way they are required to by law.

So, let's say that in that regard you may have made a mistake. It can be handled on their end, and on your end you will not make that mistake again.

Everything else is just them bullying you.

In a neutral and professional way, stand up for yourself.

??

JBMmom, MSN, NP · Jan 30, 2021

100% agree with JKL33, don't give them any reason to pin more on you than you should own. You did the right thing by interviewing and assessing the patients. You also appropriately reported to your supervisor. You may have lacked knowledge about the correct procedure. If you attended a mandatory training that covered the issue, there's the possibility of some sort of repercussions. Most facilities do cover abuse policies in mandatory trainings for this reason. However, I would be surprised if it became too big of an issue unless they need a scapegoat for the investigating organization. Good luck and try not to beat yourself up.

Ariana30 · Jan 31, 2021

20 hours ago, JKL33 said:

My guess is that the full reporting procedure wasn't followed. This would be something like a written incident report or another form that your facility uses to document incidents such as this.

Some may disagree with me but I believe that at the point you communicated with your supervisor about this and about your findings, etc., that person then shared some responsibility (along with you) to make sure that the handling and reporting of the incident was completed according to your facility's policies and/or normal procedures. I say this because no new nurse can know every detail of things such as this. Although it's a good lesson to remember to consult written policies if possible.

Now - I think they are messing with you. It's okay to stand up for yourself. In your post you have called yourself "dumb" twice, stupid, and said that you are not deserving of being a nurse. Now you do know these things are not true. Kindly I must say: Stop carrying yourself this way; stop giving off this vibe (likely to everyone around you). You were not trying to hide anything or cover anything up, you are not guilty of any kind of patient negligence or any malfeasance. The worst (it seems) that you could be "guilty" of is not following a house policy related to reporting things like this, and this may have caused your facility to not handle this in the exact way they are required to by law.

So, let's say that in that regard you may have made a mistake. It can be handled on their end, and on your end you will not make that mistake again.

Everything else is just them bullying you.

In a neutral and professional way, stand up for yourself.

??

Thank you so much for the uplifting words. I appreciate it so much.

amoLucia · Jan 31, 2021

Any report of inappropriate pt-to-pt contact (like one hitting another) is considered a serious issue. It must be investigated in-house and a report to the state DOH may be made. Sorry, this is considered serious stuff because it could represent a further threat to other residents and may have been occurring (unbeknownst) to others in the past. I know NJ used to be very strict about this.

I would make sure that Pt A's family was notified of the 'unwitnessed' episode. I would emphasize that Pt A denied it and no injuries were obviously present. There will be NOTHING worse than if Pt A's family were to hear about it thru the grapevine. Pt B's family may need to be alerted also that this behavior may be occurring; again, this was 'unwitnessed'. PMPs should also be notified. You prob should have been required to complete your house Incident Report. Also the CNA may have had to make a statement.

I know lots of BS, for something that prob didn't happen. But given today's very legal sue-sue-sue mindset, it is self-protective.

I STRONGLY believe that the supervisor should also be held responsible. The ball was dropped here. Supervisor SHOULD HAVE KNOWN the proper P&P. And that P&P prob includes timely notification of the DON/Admin and the DOH within some time frame.

In an investigation, it is likely that "the 'episode of abuse' could not be substantiated" (official state jargon). But it is likely that there may be an issue in that there was a 'failure to notify the DOH in the prescribed timely manner'. The DON most prob knew the routine to follow, but if she wasn't informed by her staff, then she just didn't know. And that's another issue for for following mandated training.

Where this can get really sticky is that adverse behaviors should be being tracked and care-planned as nec. Was this NEW behavior vs OLD behavior as documented in the med records for both residents?

Hopefully, this will just resolve without much ado. But for OP, this very upsetting. As another PP has said, please stop calling yourself dumb & stupid. Others will jump on this to dump more blame on you unnecessarily.

As a newbie nurse, you did do a pretty much decent approach to the episode. But just not far enough, but that should have been the supervisor's responsibility. Hang in there.

NurseSince2014 · Feb 1, 2021

On 1/30/2021 at 12:25 PM, Ariana30 said:

Yes, I did. I know that I have to report directly if my supervisor is not doing anything but I wasn't aware that it should be within 2hrs. I waited until after I'm done with my 48 patients. I thought within 24 hrs. That is my mistake there.

I would almost think that if an investigation is being completed that it would fall more on the supervisor's inaction, not yourself, especially if you weren't aware of the notification policy. Hopefully, they just use this as a reminder of what the facility protocol is, and it doesn't go anywhere else from there, at least not with you. Based on what you are saying, their focus should be on the supervisor.

JBMmom, MSN, NP · Feb 1, 2021

20 hours ago, amoLucia said:

I STRONGLY believe that the supervisor should also be held responsible.

This is absolutely true. However, for ALL employees at long-term care facilities in my state there is an annual abuse training that everyone in the building has to be signed off on. At that point it makes each person as responsible as anyone else for following the appropriate reporting process.

I completely understand how busy the floor nurses are. This happened to me in the dementia unit where I worked. It took me over an hour to stop everything else that I was trying to get done for the patients and follow all of the steps to report appropriately. The supervisor did not help in any way, despite having been informed. There are posted signs throughout care facilities with information related to reporting abuse. While I certainly hope that this goes no further for the OP and her job or career, it would unfortunately be considered appropriate for action to be taken against her as well IF she did receive the appropriate mandatory training but failed to follow up as instructed.

FlorentineRN · Feb 7, 2021

I think the most appropriate outcome would be for the employee and supervisor to be required to complete the training again on reporting of suspected abuse. The facility needs to hold itself accountable for supervisory employees also not having a clear understanding of the policy.

OP handled the situation reasonably well. BON should not be contacted.