I have a huge problem with this... opinions please

Nurses General Nursing

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I work in an LTC that has 3 units. 2 units are connected and one is a locked unit. tonight while doing my med pass, i heard yelling coming from the other unit and see the nursing supervisor go flying by the opening between the 2 hallways w/ a resident on her heels. I heard her yelling " you assulted me" so i immediately went to the unit to see if she needed help. (we have very few men working in the facility so all available nurses respond when there is a problem) when i reach the nurses station, the unit nurse(agency) is sitting behind the desk looking like a scared cat and the super is on the phone w/ the police. the resident is standing at the desk holding a replacement trach tube package in his hand and gesturing wildly at the super. I asked the unit nurse what happened and she said he hit the super. the supervisor then yells GET HIM AWAY FROM ME so i escorted the resident to the lounge and got him to sit down. when i got him calm enough that he could talk to me he stated i can't breath and need my tube changed. (he's not on o2 just has the tube in his trach) i go to the unit nurse and tell her he needs his tube changed. she doesn't move. i check the resident and again go to the unit nurse and tell her he needs his tube changed NOW.... still, she doesn't move. I grab gloves off her cart, take the replacement tube from his hand and change it. The old tube was extremely dirty. he instantly calms down and begins to apologize saying he just couldn't breath. he explained that he had been asking to have the tube changed for hours and they kept ignoring him, walking past him etc.. the last time he stuck his arm out to stop the super and that's when she said he assulted her. the police arrived and so did the assistant administrator. i explained to the officer that the resident was not a threat to anyone and was completely calm now. the administrator said we still had to send him to the crisis center as per protocol. the super had to be sent home early because she was crying and SOO upset!! i gave the administrator a written statement of everything i saw heard said and did. there is now a strong possibility that this poor man will not be allowed to come back to our facility becuse the super says he assulted her. I am furious at the super and the unit nurse. why didn't anyone take the two seconds and change the poor mans tube??? any opinions?

Specializes in Med-Surg/Peds/O.R./Legal/cardiology.

SharonH.,

While I can understand the super being upset, I would hope that she would be able to pull herself together before having to go home in such a state. IMHO, she displayed a certain amount of emotional instability. As a manager, she is expected to be in control of the situation.

Specializes in Long Term Facilitly.

when i reach the nurses station, the unit nurse(agency) is sitting behind the desk looking like a scared cat and the super is on the phone w/ the police. the resident is standing at the desk holding a replacement trach tube package in his hand and gesturing wildly at the super.

if the resident is standing at the desk, then he did not continue to pursue the supervisor as if he was totally irrational. i believe the supervisor and unit nurse are at fault. for goodness sakes, the man had a replacement trach tube in his hand, all he wanted was someone to change it, also, if a resident was pursueing me, i wouldn't go and sit behind the desk. i would be standing on my feet in case i needed to run again. as far as the supervisor going home, i think that is totally rediculous, she should be able to handle herself better than that.

granted, i don't think this pt was in resp failure, but clearly had dyspnea, which is purely subjective.

that alone, is frightening and disconcerting.

as nurses, don't we do everything we can in response to this type of distress?

no, we do not know what happened.

but if this pt was being ignored, and if he stuck his arm out to get the nurse's attn, i can understand why he'd be so upset.

yes, there are chunks missing from this story.

the supervisor sounds a bit too frail to be handling this position.

leslie

Specializes in LTC.

Just to clarify a few things... i was not the only witness to this. several aides saw what happened from begining to end and one even told me that the man had been at the nurses station most of the day asking for his tube to be changed. I guess what has me taking this residents side as opposed to the supers is that i have worked with her for more than a year and have seen her way over react in many situations. she gets extremely stressed over very mild situations (having more than one admission per shift, two call outs etc) when she is stressed she runs around the buliding yelling at everyone who gets in her path. I'm not saying that the man was not getting any air but if you've ever felt like your airway was obstructed you panic. this trach is also new for him. he was in a serious accident that damaged his throat. he's scared and nervous. i'm mostly angry with the unit nurse who didn't do anything after being told by me twice that the man needed his tube changed. the situation never should have gotten to that point. as for me telling the police officer that the man was no threat at that point... i guess you just had to be there. if the officer disagreed with me he would have taken action. as it was, i took the man to my unit and had him sit in a chair until his transportation arrived. i could see him at all times and our male behavior monitor stayed with him. i'm sorry if i didn't give enough info this morning when i first typed this but it was 1am and i had just finished the shift and was begining to see double

very helpful post, dawn.

thank you, sweetie.

it only confirms the overall negligence of this frightened pt.:madface:

leslie

Specializes in Med-Surg/Peds/O.R./Legal/cardiology.

There ya go, everyone. I stand by the opinions of my previous posts. Thanks for the additional clarification, Dawn. You're a peach!!

ebear

Specializes in Med/Surg, Geriatrics.
Just to clarify a few things... i was not the only witness to this. several aides saw what happened from begining to end and one even told me that the man had been at the nurses station most of the day asking for his tube to be changed. I guess what has me taking this residents side as opposed to the supers is that i have worked with her for more than a year and have seen her way over react in many situations. she gets extremely stressed over very mild situations (having more than one admission per shift, two call outs etc) when she is stressed she runs around the buliding yelling at everyone who gets in her path. I'm not saying that the man was not getting any air but if you've ever felt like your airway was obstructed you panic. this trach is also new for him. he was in a serious accident that damaged his throat. he's scared and nervous. i'm mostly angry with the unit nurse who didn't do anything after being told by me twice that the man needed his tube changed. the situation never should have gotten to that point. as for me telling the police officer that the man was no threat at that point... i guess you just had to be there. if the officer disagreed with me he would have taken action. as it was, i took the man to my unit and had him sit in a chair until his transportation arrived. i could see him at all times and our male behavior monitor stayed with him. i'm sorry if i didn't give enough info this morning when i first typed this but it was 1am and i had just finished the shift and was begining to see double

I'm not surprised that you came back to fill in the story with witnesses and a history of odd behavior by the supervisor. Did anyone witness the alleged assault? I don't know why you are mad at the agency nurse. If she is new there and doesn't know what is going on, why should she approach an angry, belligerent patient who was clearly not in respiratory distress and who she believes assaulted the supervisor? That's irrational.

You had mercy on the patient and that's admirable but you also had a problem with the supervisor which affected the way you reacted to this situation.

Why didn't they change the tube? Probably didn't know how or were afraid they'd do it wrong or feared mucus, infection, etc.

Specializes in Med-Surg/Peds/O.R./Legal/cardiology.

You had mercy on the patient and that's admirable but you also had a problem with the supervisor which affected the way you reacted to this situation.

How did you come to the conclusion that the patient was "angry and belligerent"? I believe I would be extremely ANXIOUS if I were having trouble breathing, had been asking to have someone change my trach tube, and was ignored most of the day!

WHERE YOU THERE???? The way she "reacted to the situation" was entirely appropriate, BTW.

Specializes in Med/Surg, Geriatrics.
There ya go, everyone. I stand by the opinions of my previous posts. Thanks for the additional clarification, Dawn. You're a peach!!

ebear

And I stand by mine. Dawn doesn't like the supervisor and I'm not sure she was an objective observer. Here are some pertinent facts that she still did not fill in(but I'm sure she will):

1. Did the patient actually assault the supervisor? Were there witnesses? What was the nature of the assault?

2. Why didn't anyone change his trach when asked? We already know they were short-staffed because they are using agency. What was going on that changing his trach was not done?

3. The supervisor went home because she was upset. According to you, this is proof of her emotional instability and as a manager she is supposed to be able to take an assault and keep on trucking. What other types of issues had she been dealing with prior to this incident? Staffing? Issues with administration? Angry families? Staff who undermines you at the first opportunity? Was this the final straw that sent her home for the day?

4. Was this patient truly frightened and dyspneic or just frustrated and angry that he wasn't being responded to in the manner in which he preferred? Is he manipulative? Playing staff against one another is a time-honored tradition and I have seen patients who are sweet as pie with one nurse or with an entire shift become belligerent and rude with other shifts and other nurses. It is especially effective if they know that staff don't like certain other members of the staff. In these cases, the staff become willing pawns against the other. Yup. It happens.

So what really happened? I don't know and you don't know either. Like Dawn said, you had to be there.

And I stand by mine. Dawn doesn't like the supervisor and I'm not sure she was an objective observer. Here are some pertinent facts that she still did not fill in(but I'm sure she will):

Where did she ever say that she didn't like the supervisor?

Specializes in LTC,Hospice/palliative care,acute care.

why is this thread becoming an argument? Generally in LTC we don't call the police on our residents-it is not the same as home health or acute care.The majority of our folks have some type of dementia.We also learn pretty quickly that sometimes it is better to just do what the resident asks (within reason) As this post illustrates- a simple procedure performed in minutes could have prevented this escalation. As far as the supervisor goes-if I have a resident going down the drain and call my supe she better arrive promptly and be able to handle what ever is going on-cry and leave? She should NOT be a supe.How many of us have made mistakes,written ourselves up and finished out the day? Or gotten half of our hair pulled out by an Alzheimer's patient and worked on..Obviously the man's airway was not occluded or he would not have been running around waving another cannula.Maybe he IS manipulative,controlling,frightened-He CLEARLY deserved a few minutes of someone's time and attention BEFORE the situation spun out of control.I think we can all agree on that.Anxiety exacerbates SOB-that's a no-brainer,too..The OP responded to the situation the way many nurses would have-advising her to avoid making judgements without all of the facts is sound,constructive advice-accusing her of "filling in"parts of the story-implying she is making things up-is NOT constructive. I'm sure it was an upsetting experience for all involved--as someone sles pointed out this resident may be better off in another facility...I've seen nurses put off doing trach care or not doing it at all because they either don't "like" to do it or are not comfortable with it.Maybe the agency nurse did not know HOW to provide the care. You are a GOOD nurse,Dawn-you clearly care about the well being of all of the residents.Many other nurses in your position would not have gone over to assist...Probably several of the responders on this thread would have just pretended not to hear any commotion.Better to NOT get involved-might make you late clocking out.

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