Threatened staff

  1. Help,
    we have a LTC resident, ETOH dementia w/severe behavioral disturbance. Sexually inappropriate (masturbates in hallway) threatens to kill staff, is verbally abusive, has hit 4 staff, or layed hands on staff, and of course, we can do no harm...follows CNAs n hovers over them, some other patients have expressed fear of this resident. Also has poor prognosis, cancer that will take them out prob in 5 years or so.
    What are staff rights? Some sups say, well the pt is weak, n can't really hurt you, we expect these behaviors. If you're just nice, resident won't hurt you (bs- resident splits staff, manipulates, lurks in resident doors, looks in resident rooms, comes to roommate side of room during care (when curtain closed for privacy) .
    Some staff really afraid, some just grossed out. How to protect self, n other staff? PRN meds have little effect.
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    About RNBSC, ADN, RN

    Joined: Sep '13; Posts: 7; Likes: 4
    RN supervisor; from CT , US
    Specialty: 2 year(s) of experience

    12 Comments

  3. by   Sour Lemon
    Quote from RNBSC
    PRN meds have little effect.
    ...then they need to be changed or adjusted. What did the MD say when these behaviors were communicated to him/her?
  4. by   dishes
    Sounds like he is a safety risk for the LTC residents and staff and should be placed in a locked geriatric psychiatric unit that is specifically staffed for high-risk dementia patients. Ask your department of labor what legal obligation your employer has to protect staff from workplace violence. Write incident reports every time he threatens or lays hands on anyone. Tell the supervisor and manager that he can do harm, the media is full of stories of dementia patients who have killed their nursing home roommates and/or beat up staff.
  5. by   cleback
    Agree with previous poster. Unfortunately, there are few facilities that take such patients. I know I took care of a TBI patient like that. Care management was looking for placement as far as Baltimore for him... and we were in the Midwest. Sad situation for everyone. Sorry!
  6. by   Sour Lemon
    Quote from cleback
    Agree with previous poster. Unfortunately, there are few facilities that take such patients. I know I took care of a TBI patient like that. Care management was looking for placement as far as Baltimore for him... and we were in the Midwest. Sad situation for everyone. Sorry!
    True ....if only it were that easy to just send them elsewhere!
  7. by   nutella
    Quote from RNBSC
    Help,
    we have a LTC resident, ETOH dementia w/severe behavioral disturbance. Sexually inappropriate (masturbates in hallway) threatens to kill staff, is verbally abusive, has hit 4 staff, or layed hands on staff, and of course, we can do no harm...follows CNAs n hovers over them, some other patients have expressed fear of this resident. Also has poor prognosis, cancer that will take them out prob in 5 years or so.
    What are staff rights? Some sups say, well the pt is weak, n can't really hurt you, we expect these behaviors. If you're just nice, resident won't hurt you (bs- resident splits staff, manipulates, lurks in resident doors, looks in resident rooms, comes to roommate side of room during care (when curtain closed for privacy) .
    Some staff really afraid, some just grossed out. How to protect self, n other staff? PRN meds have little effect.
    I would continue to talk to the MD, ask for psych consult/psych NP to evaluate for behavioral management with medications. And you guys should probably put your concerns in writing to management / DON and describe the behavior, how it affects staff and residents, concerns of safety and ask for support. There are strategies to deal with those issues - having said that - sometimes interventions do not work and the resident has to get moved. A common scenario in my area is that once the staff continues to call the MD and the DON and documents to leadership those residents get send out to the acute care facility with "mental status changes", which usually result in work up to rule out anything that can be corrected or find out what else is going on. Often enough those residents end up in restraints/ enclosed bed and so on - which means they can not go back to the facility asap. Once in the hospital, family can ask for an evaluation for geripsych or transfer to geripsych.

    A lot of residents with above or similar problems end up in the ED with "mental status changes" or "shortness of breath" or "chest pain" because they can not get help with them or transfer them to a different setting.
  8. by   carolinapooh
    "If you're just nice, residents won't hurt you."

    I have no words....
  9. by   Double Dunker
    Quote from nutella
    A common scenario in my area is that once the staff continues to call the MD and the DON and documents to leadership those residents get send out to the acute care facility with "mental status changes", which usually result in work up to rule out anything that can be corrected or find out what else is going on. Often enough those residents end up in restraints/ enclosed bed and so on - which means they can not go back to the facility asap. Once in the hospital, family can ask for an evaluation for geripsych or transfer to geripsych.

    A lot of residents with above or similar problems end up in the ED with "mental status changes" or "shortness of breath" or "chest pain" because they can not get help with them or transfer them to a different setting.
    Yep, and then the acute care facility is stuck with those patients for weeks on end because then we can't get placement for them. We certainly aren't equipped to deal with all of that either. The system is so messed up.
  10. by   nutella
    Quote from Double Dunker
    Yep, and then the acute care facility is stuck with those patients for weeks on end because then we can't get placement for them. We certainly aren't equipped to deal with all of that either. The system is so messed up.

    Yes - but the system will only change if it is financially motivating. And longterm care residents in acute care - because there is not longterm care strategy in place to accommodate the aging population with increasing number of dementia and related problems in a way that makes sense - is expensive. Acute care is very expensive and I guess that will lead to other care models in the future that are targeting that population more.
  11. by   dishes
    Nurses can make changes in these type of situations, they can band together and speak up in order to hold employers accountable for the residents', patients' and employees' safety. Nurses can write to their elected officials and describe the problems with violent dementia patients, the threats to residents and staff, explain that the current solution of dumping residents in acute care is ineffective. They can ask elected officials to create and enact legislation that requires that LTCs that accept violent residents, have adequate numbers of locked geriatric psychiatric units with safe staffing levels.
    Nurses can group together through their state nursing associations and unions and help create, sign and distribute petitions to lobby for change at state and national levels.
    If nurses do not know how to create change, they can learn how by reading Suzanne Gordon's book "From Silence to Voice What Nurses Know and Must Communicate to the Public".
    Last edit by dishes on Sep 5, '16
  12. by   RNBSC
    Thanks for that, seems like you've been in my situation.
  13. by   dishes
    Quote from RNBSC
    Thanks for that, seems like you've been in my situation.
    Not exactly, but I am someone who is inclined to advocate and petition for change. I'm familiar with the process because it is part of our nursing education where I am located.
  14. by   hppygr8ful
    Quote from nutella
    I would continue to talk to the MD, ask for psych consult/psych NP to evaluate for behavioral management with medications. And you guys should probably put your concerns in writing to management / DON and describe the behavior, how it affects staff and residents, concerns of safety and ask for support. There are strategies to deal with those issues - having said that - sometimes interventions do not work and the resident has to get moved. A common scenario in my area is that once the staff continues to call the MD and the DON and documents to leadership those residents get send out to the acute care facility with "mental status changes", which usually result in work up to rule out anything that can be corrected or find out what else is going on. Often enough those residents end up in restraints/ enclosed bed and so on - which means they can not go back to the facility asap. Once in the hospital, family can ask for an evaluation for geripsych or transfer to geripsych.

    A lot of residents with above or similar problems end up in the ED with "mental status changes" or "shortness of breath" or "chest pain" because they can not get help with them or transfer them to a different setting.

    Easier said than done . I have worked LTC and also have a mother with dementia who was diagnosed by her well meaning GP with "Psychotic Aggression" after she cornered her memory care staff and some patient's in a corner while she attempted to assault them with her walker. It was quite a scene involving police, paramedics etc..... She went to acute Hospital which kept her 3 days for a UTI then shipped off to a gero-psych where she spent 22 days. We were able to move her to a new facility with nurses and aids trained in behavioral interventions as psych meds had little or no effect. She is happy a cooperative now on only 25mg of Seroquel TID, but such care is costly and not covered by Medicare as it is custodial care, We are currently paying $6000.00 a month out of a family trust set up by my father before he died. Sadly many families do not have such resources. There are actual federal laws that prevent a patient being medicated with more than two antipsychotics or being chemically restrained by medications. Such patients need to be in facilities where staff is trained in redirection techniques. When I worked in LTC I was the only nurse there with any psych experience, it was appalling to see that nurses there had no interest in learning how to work with these patients and only wanted to medicate them.

    hppy

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