fired, and questioning reason

[tiroka03]

I recently got a job at a nursing home. There was a resident who was out of control, hitting, biting, kicking, howling, and unsteady on her feet. I gave her ativan IM, the correct dose. In order to give the shot safely, I had help holding her still for 10 seconds. The med worked and she was fine. But, I and everyone else involved were fired for physcial restraint. I have never heard of anything like that before. Was I really wrong?

[rehab nurse]

Sorry, but I don't understand this.

MJLRN...you say that it is against regs to hold down anyone to give an injection. It's basically considered restraint, I understand that. We would need an order to restrain said resident, etc.

But, in the "real world" I have gotten many an order for a psychotic, or demented resident who was acting out and hitting/kicking, etc, to give Zyprexa IM or Ativan IM. There is no WAY to give the injection without holding them down. I've seen nurses get hit and punched and get a needlestick from a Hiv+/HepC+ patient and got infected. I just don't understand.

So if a patient is unruly, and all other ways of de-escalating the situation have failed, and we have a dangerous situation happening, what do I do?? Even if I have already an order for a IM Zyprexa/Ativan, do I have to stop and call the doc and wait 20 minutes for him to call back and give me permission to restrain him for the injection, or am I not even able to get an order to do so?? Or do I just call the police and let them deal with it? Call 911??

I am not trying to be rude here at all, I am just reflecting on past experience in LTC and I can't count all the times help was called to hold down a resident to give a prescribed medication. I just don't understand what they want us to do. And I totally agree, the regs written for LTC are ridiculous (some of them). I understand they are there to protect the residents, but some of them are so archaic.

Take for instance, the recertifications that have to occur for those with mental illness. If they are on ANY type of psych med, whether for depression, anxiety, bipolar, schizophrenia, etc, we have to AUTOMATICALLY reduce and/or change their meds as proof we are not "chemically restraining" them. This causes distress for the resident, the nurses and aids who get hurt in the meantime, and the other residents who get hurt who have a right to live in peace.

I had to get out of LTC after many years there. It broke my heart. I love the elderly, but I hate the state and the regulations that cause so much paperwork and redundancy that cause nurses to spend more time writing than seeing our residents.

MLJRN, can you help me out with some of my questions? Or anyone else? I know there are some very knowledgeable nurses on here who are very smart and up-to-date on the laws of LTC. I would love to learn from you even though I am in inactive nurse due to cancer.

Thanks.

[TheCommuter, BSN, RN]

So if a patient is unruly, and all other ways of de-escalating the situation have failed, and we have a dangerous situation happening, what do I do?? Even if I have already an order for a IM Zyprexa/Ativan, do I have to stop and call the doc and wait 20 minutes for him to call back and give me permission to restrain him for the injection, or am I not even able to get an order to do so?? Or do I just call the police and let them deal with it? Call 911??

In the real world of nursing, we hold the combative patient down to give the injection, but we never document that we used physical restraint. We simply document that we gave the drug as ordered. Perhaps the OP made the mistake of either documenting that the patient was held down prior to giving the med, or (s)he told someone that the patient was held.

I worked in a small community psychiatric hospital, and we always had to hold violent patients down to give their IM drugs.