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

[dawn30]

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?

[Sunflowerinsc, ADN, RN]

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?

IF the pt even thought he was not breathing well, as a nurse I would change the trach tube or what ever it took for him to feel like he was ok way before I would even think about calling the police! I would be frightened, dyspeneic and problably angry if I felt like I couldn't breathe. I don't think it has anything to do about "being responded to in the manner in which he preferred"

[GilaRRT]

Police involvement, Statements, crisis intervention...sounds like a potential legal mess. Perhaps a public forum is not the best place to discuss the specifics of this scenario?

We have people on this site drawing battle-lines, I question what may occur at the facility.

[VivaLasViejas, ASN, RN]

I haven't read the entire thread, but it's clear to me that this event should be reported to Adult Protective Services. The fact that the resident allegedly assaulted the nursing supervisor is irrelevant. If this resident's trach had not been changed or cleaned in some time, it creates ample suspicion of neglect, and if I were an investigator for APS I'd be all over that facility like a bad smell.

From a surveyor's point of view (I spent two days this week in a CCMU training, so I learned a lot about how the state looks at these issues), this resident is not a perpetrator, he is a VICTIM, and the facility will fare very poorly if it tries to force him to move at this time. The facility will, at the very least, be asked what interventions were in place to prevent or manage assaultive behaviors.........all APS will need is evidence that his trach was not changed in a timely fashion, and not only can there be severe financial consequences for the facility, the involved staff could also face sanctions depending on whether a pattern of neglect is established.

The OP did well in documenting things, and I agree with her that this incident was handled very poorly by some of the other staff members. But it does need to be taken a few steps further, and both the OP and the facility's management should understand the seriousness of this incident, and that APS MUST be notified if they haven't been already.

[lantanaRN]

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.

Well said my friend!!!!

[SharonH, RN]

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.

That was meant for me.......I don't know why you didn't just direct your comments TO me. *sigh* For the record, it was not my intention to imply that she was "making things up" at all. As I plainly stated: "I don't know what happened". Therefore I am not drawing battle lines...oh no, not all......I don't know means just that. Most of my responses were meant to show another possible scenario to this discussion since almost everyone here was quite convinced that the super in question was wrong even before they had what are presumed to be the facts.

But mostly I was disturbed by the implications by some, that the super was emotionally unstable and had a problem because she was upset by this assault which we still don't know anything about. And that still bugs me. How many times have nurses complained that they were discouraged by management from filing a complaint after being assaulted by a patient and that they were made to feel guilty when they were victimized? I just read shades of the same thing here.

[luvmy3kids]

I was having trouble breathing myself just reading your story. I hope that this gets resolved and he doesn't have to leave. What a tragedy. It's very fortunate they have you working there. Take care and good job!

[CHATSDALE]

my opinion based on op post

agency nurse shuld have change/cleaned trach site if it needed it..patients ae usually not the best in deciding when procedures ae to be done

supervisor probably didn't know about the problem between nurse and patient, she was suddenly faced with an angry agressive patient and she was struck 'out of the blue'

glad that op was there to provide a calming influence but i think that removing patient from the scene at that time was probably for the best

charting is always a good good idea but always chart on facts that you have seen and don't make a decision

be factual with family but again don't give opinions that you can't get up on a witness stand and swear to

[MA Nurse]

That's AWFUL! If he was a relative of mine, I would have him transferred out of there in a heart beat! I would report everything you saw. That was abusive and should be documented as elder abuse IMO

[grace90, LPN, LVN]

I think the super would be better off elsewhere.

Yeah, like flipping burgers. Sounds like she doesn't belong in health care.

[pedsnurze1]

It would seem to me that ignoring that someone is having trouble breathing and not doing something to correct the problem is neglect.

Just think of what could have happened if he couldn't advocate for himself.

My thought exactly!

[pedsnurze1]

Just out of experience I would be careful before I made any final judgements. Did you actually see the situation occur? If not then how do you know he is telling the truth. Do you take care of the patient often to know his demeanor? Why was the agency nurse afraid? Was he actually having difficulty breathing?

Did you ask the agency nurse what had happened? Patients and nurses are both capable of lying. I dont know how many times patients have told me, I have been waiting 2 hours when actually it has been about 30 minutes. Again though it is really difficult because we dont know exactly what happened.

If someone is truly having difficult breathing related to their trach tube being occluded then I think it would be rather difficult to walk them away, sit them down and calm then down without first removing the obstruction. I also think it would be rather apparent without the patient having to tell you this. I am not saying agitation doesnt increase shortness of breath, of course it does but from the description it does not seem like he was in acute distress. What do you mean by extremely dirty, were there dried secretion in the tube or around it?

I guess my opinion is to not rush to judgement. Not being able to breathe is extremely scary (and has been used as a means of torture--depending on your definition of torture) but I would also be careful as well. Generally it is beyond our scope to say that a patient like that is not a harm to others. If the administration and police would have done nothing because you said that and 8 hours later he decked a staff member or another patient you could be held somewhat responsible.

There is always 2 sides and then there is ABC's

[MJA-47]

I have this to say: Many are called but few are chosen. I deeply regret the fact that this gentleman lack of care was percieved as a threat. I do know that it is impossible to practice with the hand that which is not in the heart. I thank God that you were there and honestly pray that we have more compassionate workers like yourself who I consider to be "nursing angels". For whatever reason the sup had for her actions I pray they are resolved and we can continue on as minister's of help and remember to "do no harm".

God always has a ram in the bush.

Carry on Little Ram, I can see the "Dawn" of a new day for you.