i need some help -- DESPERATELY!!

Nurses General Nursing

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i need advice from all you nurses here with so much experience in so many areas. I've been a nurse for appox 10 years and went to LTC about 18 months ago. I work really hard and I'm not a regular call off person. I pick up shifts all the time to help out when we're short. All in all, i feel pretty much married to this facility. I lOVE my job though and adore the people I take care of. The families really like me too and seems like they are always coming to me to get things resolved. Okay, now that u have some background on how I work. -- A few weeks ago we had an issue with a res. that is in a w/c w/ a seat belt to hold her in to prevent falling. she is leaning forward to the point of her face touching her knees and was c/o back pain due to her positioning. we tried putting her back to bed, but she kept trying to come out of the bed head first so we got her back up to prevent the fall. the c/o back pain d/t positioning continued and res. was asking us to hold her up so she could see and be more comfortable. We just don't have the man power to devote someone to holding her up. Lap buddy was tried but didn't work either. I decided to try to hold her waist up with a sheet tied loosely around her waist, it worked, was soft and she was so grateful she could sit up again. she was in it less than an hour and was put back to bed and never used again. She's back to the same position and c/o all the time for someone to help her.

Now, we have a new position available for a night shift manager and there are a few girls in the running for it, myself included. Anyway, one of the girls also in the running for it picks up shifts from time to time but only with the stipulation that she work the same halls she typically does, which are also my usual halls too. If she comes in and I'm on my halls she throws a royal snit, as she did this past week. We exchanged some words on the topic and i heard her say something to her husband about getting rid of this problem. I wasn't sure what she meant and just went back to my duties. I saw her later that night meeting with all the aides down one hallway and thought that was strange, but just dismissed it. Anyway, to make this story somewhat shorter, some one called our corporate offices anonymously and complained that i was tying this resident up to her chair. NOT TRUE. from what I can accumulate from all this she wants me out of the way and is gathering up as much as she can to make sure it happens. I just don't function in this way, and I don't know how to combat this issue. i've told my side of the story, but I didn't tell about my suspicions with this other nurse and her motives. i honestly don't know how to fight this and I need some advice. there are other issues too but I didn't want to turn this post into a novel. I have seen this nurse do mean things to other nurses as well, writing them up for med errors that never happened, stuff like that. Please give me advice!

I have to agree with everyone that says you shouldn't have a problem. The intent of the sheet was not to be used as a restraint, but for patient comfort, to which the patient agreed. In my facility, for example, if we put someone in a recliner and recline them back with a chair or ottomon under the foot rest to prevent the patient from sitting up straight and maybe standing, potentially falling, THAT is a restraint. But, if the patient asks for it or agrees to it (our recliners something fall forward if the patient leans forward even slightly), then it's NOT a restraint. Same method for two different scenarios. Your intent was not to restrain the patient, she agreed with the method you used to keep her comfortable. Look at your policy...I know ours specifically mentions intent for certain things. Good luck! :)

Specializes in ER/Geriatrics.

Did you document? It sounds like you did right by the patient.....as far as the other nurse goes......she will crash and burn.......just keep doing good...the truth usually prevailsl...Liz

This patient all ready had an existing restraint that was ordered by the Doc and implemented, being the seat belt. I wasn't trying to restain her, I was trying to improve her quality of life and relieve her discomfort. Honestly, i wasn't aware at the time that back in the days some people used sheets as restraints and they were mis-applied just to keep the patient out of the nurses hair. this wasn't the case. i adore my patients and would never do anything to hurt them. i didn't document the use of the sheet since it wasn't an official item of use. I wasn't planning on implementing it for further use other than the 30 minutes we used it. I had tried to put her back into bed, but she kept trying to crawl out head first. I feel I've made a grave error here, and my job is on the line, just as the nurse who reported it was hoping for. She knows me very well and knows i would never do anything to harm anyone ever. I'm off work until the "investigation' is completed. Who knows what the outcome will be. I'm just emotionally ill over this. In my career i've never been fired and have always felt as a valued employee. I've also never encountered such back-stabbing and pure meanness to get a head.

Welcome to real life, my friend.

I think you need to consult an attorney right away because this thing is likely to snowball and it could come out smelling real bad, with criminal prosecution, firing you, even going after your license.

My first impression is that the evil individual :devil: you are up against is very skilled at setting people up, :argue: taking advantage of weaknesses, and destroying her competitors. You, on the other hand, sound like a loving, giving, genuinely nice person. Therefore, you do not comprehend her evilness. Result: you are disarmed. You must come to accept that there are some people in this world who will stop short of nothing to get what they want. They are called sociopaths. Lying, hitting below the belt, demanding assignment changes mid-shift, setting up colleagues - it's all part of their orificenal. The only thing this type of person respects or comprehends is probably another sociopath. Believe me, please. I've dealt with a few of these. She might also be paranoid and power mad, angry about whatever in her life. Whatever her problem, she is a monster and she is taking aim at YOU.

If she is truly the way you described, you are in the bush league and she is pitching for the majors. You are outmatched. :smiley_ab

I think you probably need to talk to your boss right away, before any final decision is made re: your disposition. You need to tell her the whole story - what you heard the enemy:angryfire :gandalf: :troll: say about getting rid of the problem, how there was already a restraint order so you thought substituting a sheet was ok -and PLEASE, in the future, always, always, and always get an order for every little thing - like substituting a sheet for a belt.

You must understand that keeping your license comes before everything else - including your residents' comfort. That is, the resident could have waited another few minutes while you called for an order. It sounds like she has horrible osteoporosis and is all bent over as a result. She must suffer from horrible muscle spasms and cramps. Maybe cold cloths, Vicks (it numbs the area to which it's applied), maybe heat, maybe massage, perhaps a TENS unit would help her, maybe gentle stretches of legs, arms, back, shoulders, neck would aid her.

Understand that it is easy and probably true to say that you adore your patients, :heartbeat you love your job - but investigators are looking only at hard facts. They should take your intent into account, they should look at the whole picture. But they aren't. That's just the hard, cold truth.

I think you should probably secure a different job with a different employer before there are any marks against you publicly. Do NOT answer "yes" if asked if you ever were forced to resign because, as of now, you have not been. Do not mention anything about this to the new prospective employer. It is none of their business.

I wish I had better news for you but I am speaking from experience. I hope I'm wrong and that all ends well. :kiss

Did you document? It sounds like you did right by the patient.....as far as the other nurse goes......she will crash and burn.......just keep doing good...the truth usually prevailsl...Liz

I must respectfully disagree. Even if she does C&B, she will probably take a few people down with her. Truth does not always prevail, innocents do suffer all the time.

The Bible tells us to be harmless as doves but wise as serpents. Or walk softly and carry a big stick. :lol2:

Search the internet or find an article that professionally justifies this above position: patient functioning is NOT the equivalent of restraints.

Use it.

Try THIS article, which explains things along the same lines, from Federal Law:

http://www.usd.edu/elderlaw/student_papers_f2004/nursing_homes.htm

Or, this:

Medicare Law, Facility Operations Manual Page A-182:

http://216.109.125.130/search/cache?p=interventions+that+improve+positioning+versus+restraints&btn=Search&tab=Web&ei=UTF-8&fr=my-vert-web-top&u=www.cms.hhs.gov/transmittals/downloads/R17SOM.pdf&w=interventions+improve+positioning+versus+restraints+restraint&d=LCcZovmdOeuf&icp=1&.intl=us

"A positioning or securing device used to maintain the position, limit mobility, or temporarily immobilize during medical, dental, diagnostic, or surgical procedures is not considered a restraint."

I would challenge any use of the word, 'restraint'. I would maintain that you used a 'positioning device', not a 'restraint'.

~faith,

Timothy.

Tim, I think you have hit the nail on the head! Positioning vs. restraining; add it to the pt's gratitude, relief, and willingness and maybe our friend here is ok, not guilty of restraining w/o an order. The above link (the 2nd one didn't work for me but I get your drift. Let's hope it helps our friend.:idea: :lol2: ;) :balloons:

Specializes in ub-Acute/LTC, Home Health, L&D, Peds.

Have you thought about getting an order for a geri-chair? It can be reclined and she wouldn't be bent over like that. I have had residents with the same problem and this is what we tried and it really helped alot. Good Luck!

Thank so much to all of you for your support. I am supposed to meet with adminisration tomorrow for final disposition. If any of you can find laws or codes that could apply to this situation. I would greatly appreciate it. I plan to copy them off and take it all with me to the meeting.

I forgot to anwer the gerry chair question. we only have one and it's being used by another pt. at the moment. You would think the place would spring for another one or two, but noooo.

any one scouring the internet on this, please let me know if you find anything I can use to support my decisions.

Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.
Is the pt with it? Can she testify on your behalf?

As for her positioning, maybe she needs to have a reclining w/c ordered for her, so that she can't tilt forward.

The trubblemaking nurse: not much you can do about her except hope that management knows how she operates. What about the rest of the staff? Will anyone stand up for you?

Excellent idea Tazzi! If the patient can testify that should take care of the situation, for the most part. But you probably still need to figure out why what you did is considered wrong, and find out the difference between positioning and restraining. Sometimes the line between the two is very thin.;)

To all my great friends here who tried to help me -- Thanks for all your efforts. I was canned anyway, even with the supporting evidence. I had hoped my history with this facility would bear some weight with their decision as well, but it didn't. I had poured my heart and soul into this place for almost a year and half. I would always come in when we were short or other nurses called off, I would come in early and stay late and most importantly of all, I adored my patients and their families knew it.

The only thing on my side at the moment is there is an uprising from the families about me being gone. Two are threatening to pull their family member out of the facility because of this. I honestly hope they don't do that, moving to another facility and getting used to new staff is always so hard on the resident. It does make me feel a little better that they care that much though. I'm really going to miss all my people terribly. ive spent the last 4 days crying my heart out. Sigh! i'm on the look out for a new job now. Yuck! i hope I'm able to get another one

I'm so sorry, Tee.

Thanks so much to everyone.

I am moving on and have two interviews on Monday. (I went in to pick up my pay check.) and i did over hear someone in the office state to the Admin. that he had started a crap storm by "firing that girl". Some of the residents have gone to the local newspapers to complain that the company fired a "good worker that cared about all of the people". They didn't mention my name but as far as I know, I was the only one let go. I'm a little confused by this.

Any thoughts?

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