Targeted by psychotic, manipulative patient

[HM7380]

I work in a LTC/Rehab facility. There is a patient there who does NOT belong (she is 65 and has absolutely nothing physically wrong with her). However, she is homeless, and because of the money grubbing higher ups, they won't discharge her. She is psychologically disturbed (though not diagnosed as such), and has targeted myself and one of my CNAs. She was able to have the CNA suspended pending an investigation due to a complete BS allegation of abuse, and she said shes coming for my job next. (She also stated to me that she knew what to say and what to do, to have me fired and my license taken.) On Sunday, she spit in my face, and trapped me in a bathroom and tried to punch me... Shes one of my patients, so I can't keep COMPLETELY away from her, though I do have another nurse take her her medication, etc. The patient hovers at her door and waits until I come down the hall, then jumps out in front of me and begins verbally abusing me, screaming, and threatening me. I really am at a loss as to what to do. I've made reports. I've filed grievences. I've had all the staff who witness her terrifying behavior write statements...

My question is... is there anything else I can do? I'm sure if it wasn't me she was targeting, it would be someone else, but to let this nutcase spit in my face and take a swing at my head is absurd. How would you handle it? It's getting to the point where I'm afraid to go to work. She really DOES know how to work the system and get the staff in trouble. She comes up with stories to try and pit the staff against each other, and because until shes targeted YOU, she seems like a somewhat off, but mostly together 65 year old woman.

This is the second time shes been at my facility... The first time they kicked her out for assaulting another resident. However, I'm sure they won't do anything if she assaults a nurse (I've been assaulted by another patient, and they told me that if I couldn't handle being attacked, to hit the door.)

Any suggestions as to what I can do?????? I've got to find a way to get this lady out of my facility before she attacks me or another resident again!!!!

[HM7380]

Oh and wondering....your title for the post refers to the resident as "psychotic"--but say she has no diagnosed psych dx. Not sure if you are just throwing that word around or if the resident actually is showing signs and symptoms of psychosis--an actual diagnosis, with treatment options.

Shes psychotic in MY opinion... she has NO dx of it... they're keeping her here for the $ and that is IT.

[HM7380]

SOOOO... She's BACK, after a week long stay at a psych facility. She ultimately DID come back with a dx of 'Psychosis' and a new order for Risperdal 0.5mg, bid, which she is refusing to take (she does take her 2 mg klonopin and 10 mg lortab, however). I've been relieved of my duties involving her (the mgmt told her 'I was not allowed to come near her or talk to her', which in my opinion, made me seem like the bad guy and the one who was at fault, but nonetheless, I don't have to interact with her ANYMORE.) I've been pretending like she doesn't exist... I refuse to make eye contact, never speak to her, and just generally act like I'm not aware that she's even in the building. She makes ugly statements to me when I pass, I don't change my expression. She comes in to a room I'm in, I continue smiling and whistling, etc. It's seeming to make her very irate, but hey, I'm not being assaulted or harassed nearly as much, and you can't 'fight' with someone who refuses to acknoledge your existance!! Now, shes having to target other nurses and pick on them. Shes' gone through at LEAST half the staff already, and shes only been there about 5 or 6 weeks.

One more question though... CAN facilities 'kick' people out for inappropriate behavior towards other patients and staff? If I wanted to 'help it along'... what should I do? I saw the comment that suggested to contact the Ombudsman, and thought that was a GREAT idea. I'm doing that Monday. Any other ideas? ANY would be helpful. I hate coming to work at this point and probably SHOULD start looking for another job, but they're sort of scarce here at the moment. The corp I work for is obviously keeping her for the money, as our census is not all that great right now, and any money is good. Particuarly since we were able to bring her in as a Skilled Medicare pt. A, and she really needs nothing FROM the facility.

Thank you all for all the help! You guys are GREAT!! :redpinkhe

[caliotter3]

Your employer has already told you what to do, hit the door. Can't get much clearer than that.

[Jonathank]

If she gets physical again, call the police and have her arrested.

That aside, get another job. Unless you are in the military and on a combat mission or a police officer, the occasional assault is not part of the job.

Thanks. You saved me some typing. [/end of thread]

[CapeCodMermaid, RN]

I've taken staff off certain assignments when they were targeted by a particular resident for one reason or another. And I've made it very clear to them that it was NOT punishment but a way to protect them and their reputation from false accusations of a resident.

Contrary to what you may think, you can't keep someone at a facility under MED A if they have no skilled need. Being in a psych facility for a week might get you 14 days but that's it...anything else sounds like Medicare fraud (not accusing anyone but given the information in the post....)

We are currently trying to discharge many of the not so nice residents the former owners of the building let in. It takes a long time to find suitable housing for some of these people. This is what I tell corporate: A high census is nice but not so nice if you take assaultive residents who are likely to assault another resident so we get tagged from DPH. If a resident who knows what they are doing hits me, I'm calling the police and pressing charges. If they are a demented person who thinks I am someone else, they will be sent out for an eval but I most likely wouldn't call the police. Just because you have a diagnosis of psychosis doesn't mean you can't be held responsible for your actions.

[Nascar nurse, ASN, RN]

I am being targeted by a resident as well. This resident was given a 30 day notice & I only have one week of torture left! If your facility will not back you, get a new job if at possible.

[clinicalteach]

wow! great insight! I am in the midst of a passive agressive resident's blame others and lets get them fired game. She has bullied another resident prior to my joining the team. She is always with this one gentleman whose family has asked (they have POA) that she be kept away from him, and she has been counseled by my ED and myself together. She pretends to be hard of hearing so when confronted she keeps yelling, "What?" She is a bad apple and spoiling the ALF with her instigation and lies. The staff told me she kept saying during lunch, "I know I'm not supposed to sit with him..what are they going to do , throw me out?" I finally had enough and I told her to stop, so she pulled out the I can't hear you card and so I yelled it directly in her ear in the dining room to which she started to try and deny she had any knowledge of what i was tlaking about. After I left the table and she was yelling how :fat: i have become, and unprofessional and the food sucked, and the staff doesn't do anything right, she proceeded to play passive agressive drama queen. A few hours later she came into my office, grabbed my arm, slapped me and started using words that i didn't even know existed (and I was formerly married to a sailor and have two older brothers) i kept my hands down by my side but rose up from my chair and moved us out the door of my office so that we were in sight of other staff. (dear lord, i could imagine the stories she'd come up with if i hadn't done that) The Activity Director witnessed her grab my arm yet again, put a rolled up magazine directly into my face poking my nose and threatening me with my job and calling me names. I finally just told her to go sit down and cool off to which she promptly yelled, "See they are telling me to go away" The activity director wrote down what she witnessed, I documented mine, called her son because this is not the first time she has caused a ruckus, just the first time she's assaulted anyone. As we were getting the paperwork together, she kept ranting at the top of her lungs, and i finally had to look at the other manager and yell at him to go stop it. i'm not about to have to be the only one to try and deal with her. I called my ED at home, told him..he said that that was not acceptable and I don't know if he's spoken to the son yet. needless, to say, I didn't go to work today, becaue it would have been me as the only manager on duty and i didn't want to be placed in that position. The supervisors kept me in the loop, but they are scared for their jobs if they deal with her. i'm at a loss to what to do. i hope my ED tosses her, and if nothing else i'll remind him that her apartment is one of the nicer ones and easy to sell :). I didn't even think to call the cops.

[JBudd, MSN]

It's not too late to call and make a police report.

[carolmaccas66, BSN, RN]

deleted

[chevyv, BSN, RN]

In Wisconsin, if a patient spits on you they will be issued a ticket to appear in court and pay a fine. If they cannot appear in court, a guardian will be told to appear. The ticket will stand and have to be paid.

Hopefully they are documenting her refusal of the risperdal and that may help eventually with walking papers. Management needs to let her know that the facility is a nonviolent facilty which includes verbal as well as physical violence. Spitting on staff is not acceptable. She will continue to target you and others. Document and call the police along with the supervisor and everyone else who holds a title including the MD. Let them know that you have contacted the police, who should arrive shortly.

Me thinks she needs a more involved psych assesment and different psych meds. Makes me happy I work in a psych hospital and can get an IM order if needed. Good luck!

[CoffeeRTC, BSN, RN]

Never, ever approach these residents alone. Even if you need to take the cleaning staff in the room (unless it is a clinical issue) with you...have a witness.

Document word for word what they say and do.

Call your ombudsman. It isn't a sneaky thing to do....they are here for us too!

Call the doc and let them know about the behaviors.

Incident report or what ever they call it in your building

Call the family and let them know about it too (should also be part of the IR)

Go the chain of command too.

Behavior plan.

[Rob72, ASN, RN]

Document in the chart. Talk to Risk management. Call PD & file a report. Then get a VPO. Legally, its no different, at that point, than if Mgmt hired an abusive ex-BF to work with you- its a no-go.

Yeah, it does get complicated, yes, it may cause problems for you. It depends on your ability to verbalize, and your ability to assess consequences. It is possible, tho'.