Would like some advice on assaultive client

DDRN4me · Jan 31, 2009

WoW and what are the reasons that they need to put him back on your unit? Seems to me that if he is a direct threat to you it creates a hostile work environment and they should not put him there it is against labor laws. I would tell the administration directly that working with him will increase your stress level and may cause you to need to go out on disablitly . they wont like that one bit! maybe it will help them reconsider. (((hugs to you)))

Whispera, MSN, RN · Jan 31, 2009

Since there's another team available, and YOU have been seriously assaulted, you win--they need to take him into their care. Is there a third team that might take him?

I see an assault waiting to happen--please ask them to move him from your team!

leslie :-D · Jan 31, 2009

this is totally nuts!

what am i not understanding??

why is he on your team???

why aren't your employers being more proactive in protecting you???

i'm so not getting this.

leslie

2batty2care · Jan 31, 2009

We're the only all male team and he started having problems with a female on the other team. I was out for awhile before with appointments and tests as well as eye movement therapy and I'm not sure it bothered the administration much although they're having budget problems this year. I don't know if I could go out again on workman's comp unless he hits me again. I was thinking about telling them I just wanted to stay in the office and do meds but that doesn't seem fair to the other nurses on my team. Maybe a 10 foot restriction from me? I'm not sure that's workable though as there's not much room on our team with a couple of narrow halls , a dining room, and a small dayroom. Thanks for your reply and caring though. It just feels good to talk to someone who isn't involved.

Kayartea · Feb 1, 2009

This person is creating a hostile work situation for you and your employer is required by federal law to protect you from it. Whether it means finding other placement for that patient or paying you to stay off while he's there, they must respond to a complaint of hostile work environment. Report it to Human Resources, immediately. Document every comment he makes, has made, etc, date and time and give those the HR as well. With the fact that he has already injured you there is a good case for relocating him to a different facility (yes, there is one somewhere, all patients like this in the state/country are not in your facility). If you do not get an acceptable (to you) response rapidly, report your employer to the Labor Relations Board and file suit. Do not mess around and get hurt again, take care of this now. Yes, in your job there is always a possibility of being hurt, but this man has already done so and is threatening again. He must be stopped. If putting him in 24 hour lockdown is the only way to maintain your safety, then insist that it be done until another arrangement can be made to transfer him elsewhere.

I know that your employer is not responsible for this person's behavior (and I'm sure you don't want to cause trouble for them), but they are responsible for protecting their employees from such people, and they have no excuse for not doing something, he has done it once and is giving plenty of warning of a repeat.

eriksoln, BSN, RN · Feb 1, 2009

I worked on a lock down unit once, traumatic brain injury LTC. The patients attacked people on a regular basis. I spend entire 12 hr shifts going from one room to another restraining people. It got old, but sometimes I couldnt help but laugh, I felt like a television pro wrestler. I'd spend my day restraining people, the other nurses would pass my meds and I'd get my head to toe assessments done between physical crisis events.

I can say this, although its not good advice..........those pts knew who was coming in their room to restrain them. They'd start intimidating the staff. If the 135lb female CNA came to answer the call for help, it escalated. If I walked in (only male nurse on day shift, pushing 300lbs), they'd curse and sit down. They.......understood who could handle them and who couldnt and acted accordingly.

Guess my point is, dont be intimidated. When he makes "veiled threats", off to seclusion that very second, no questions asked. Do the proper documentation and its done. Eventually he will get the point that you wont be bullied.

I dont think administration will have your/our best interest in mind when it comes to being assaulted. Their primary/only concern is that the hospital doesnt lose out in any way (lawsuits from you or pt., fines for improper procedure, loss of money from workman's comp. if you are out again). They will avoid trouble for themselves in any fashion they need to, including throwing you under the bus after placing you in an unsafe environment. You have to take your own safety into you own hands. Use restraints and seclusion to keep yourself safe. If the "threats" are real and you document well, no one can finger you for any problems.

Mr Ian · Feb 1, 2009

I've been in similar.

It sounds like your management are openly aware and supportive - at least they're not just springing it on you as often happens. Of course, they will be preserving their own positions so that they don't violate any HR / OH&S practices - but perhaps they also have your genuine interest at heart?

We were the only facility in our area so we took everyone - and re-took them after a stint in jail for assault or whatever. It's not easy but I find the best way - if you simply have to deal with it - is upfront and unabashed.

1st option - can he go somewhere else?

I'd guess they've looked at this already and since he's got himself a move from one team (as they can't leave him there and 'let' any threats be carried out) they've exhausted most other options. (Balancing potential sexual assault against physical assault - I'm sure you can see their line of thinking, even tho that doesn't help you at all).

2nd option - can a risk management strategy be put in place?

It depends on what the threat potential is and what practices you have there. We know you can never 100% remove risk - and you've as much chance of getting assaulted by another pt anyhow.

In times like this, we have assured staff safety by operating a "buddy" system - staff go in twos - or identified targets are never unaccompanied. But that can only work for so long as usually the threat disappears before the buddy system gets forgotten.

3rd option - and this is what HR/Admin are hoping to avoid -

They want YOU to come up with the plan. They've kinda put the onus on you to take reponsibility for this guy and how YOU are going to manage his threats. I'm not altogether happy about that.

However, it gives you carte blanch. Don't be nice to the employer. They're getting themselves out of a fix and potential claims - if it goes tits up - it was YOUR idea. As pointed out - they have a duty of care to you. Not you to them.

I would consider reverting the matter back to HR/Admin and simply giving them your expectations.

eg:

- I do not want to be in a position where I might be alone with this individual

- I do not want this individual to have opportunity to assault me

- I do not want this individual to have access to weapons

- I do not want my workplace compromised by any actions to militate risk

- I do not want to change my work environment

Now, the HOW becomes their problem.

If I was clinical manager and he absolutely had to come to your unit -

- I'd have him on a 3:1 staff special (2:1 if staff are confident and competent - never a 1:1) with restricted environment. He's been moved around for threats to staff and has a history of serious assault so they are well justified clinically - but they wouldn't want to spend the money if they didn't have to. That's their 'too bad'.

- I'd have him on a DASA every shift (tick sheet for dynamic presence of aggression)

- I'd have a "tight as a duck's orifice" care plan around his aggression and management of all his deviant behaviours; including threats, manipulation, staff compliance, farting to loudly, looking at me funny, looking at me at all and talking with his mouth open.

- He probably smokes - this would be a part of his management routine (leverage) - access to smoking areas is based on appropriate behaviour (caveat being - if he's 'acting risky then you cannot expose others in smoking area to that known risk of assault).

- I'd have psychiatrist on-side to state that any assaults would be reported and dealt with via the police.

- I'd slip a pack of smokes to the biggest patient on the unit and tell him the new guy said his mum was a ho

- I'd make sure all his activities and possessions were on a reward basis

- And I'd check in regularly with you to see how you were going with the whole deal.

Yes, it's all restrictive and it's all 'custody' not 'care' - but he's passed the threshhold and a line has to be drawn.

I've had patients on management plans due to (nasty) assaultative behaviour - they were approached by 3 staff - given a reasonable direction once - if they did not immediately comply they were 'taken down' and placed in manual restraint whilst instructions were repeated in regard immediate coimpliance.

Totally for the protection of staff.

Nothing therapeutic at all.

And I don't care.

Ps - the one about giving the smokes to the biggest pt.... purely optional. I've never ever done that. :smokin:

Melinurse · Feb 1, 2009

Is there another facility this person could be sent to? I agree with the others, this is just crazy. They have a duty to provide a safe working environment, I'd be talking to them and coming to some sort of resolution. Good luck.

eriksoln, BSN, RN · Feb 1, 2009

I've been in similar.
It sounds like your management are openly aware and supportive - at least they're not just springing it on you as often happens. Of course, they will be preserving their own positions so that they don't violate any HR / OH&S practices - but perhaps they also have your genuine interest at heart?
We were the only facility in our area so we took everyone - and re-took them after a stint in jail for assault or whatever. It's not easy but I find the best way - if you simply have to deal with it - is upfront and unabashed.
1st option - can he go somewhere else?
I'd guess they've looked at this already and since he's got himself a move from one team (as they can't leave him there and 'let' any threats be carried out) they've exhausted most other options. (Balancing potential sexual assault against physical assault - I'm sure you can see their line of thinking, even tho that doesn't help you at all).
2nd option - can a risk management strategy be put in place?
It depends on what the threat potential is and what practices you have there. We know you can never 100% remove risk - and you've as much chance of getting assaulted by another pt anyhow.
In times like this, we have assured staff safety by operating a "buddy" system - staff go in twos - or identified targets are never unaccompanied. But that can only work for so long as usually the threat disappears before the buddy system gets forgotten.
3rd option - and this is what HR/Admin are hoping to avoid -
They want YOU to come up with the plan. They've kinda put the onus on you to take reponsibility for this guy and how YOU are going to manage his threats. I'm not altogether happy about that.
However, it gives you carte blanch. Don't be nice to the employer. They're getting themselves out of a fix and potential claims - if it goes tits up - it was YOUR idea. As pointed out - they have a duty of care to you. Not you to them.
I would consider reverting the matter back to HR/Admin and simply giving them your expectations.
eg:
- I do not want to be in a position where I might be alone with this individual
- I do not want this individual to have opportunity to assault me
- I do not want this individual to have access to weapons
- I do not want my workplace compromised by any actions to militate risk
- I do not want to change my work environment
Now, the HOW becomes their problem.
If I was clinical manager and he absolutely had to come to your unit -
- I'd have him on a 3:1 staff special (2:1 if staff are confident and competent - never a 1:1) with restricted environment. He's been moved around for threats to staff and has a history of serious assault so they are well justified clinically - but they wouldn't want to spend the money if they didn't have to. That's their 'too bad'.
- I'd have him on a DASA every shift (tick sheet for dynamic presence of aggression)
- I'd have a "tight as a duck's orifice" care plan around his aggression and management of all his deviant behaviours; including threats, manipulation, staff compliance, farting to loudly, looking at me funny, looking at me at all and talking with his mouth open.
- He probably smokes - this would be a part of his management routine (leverage) - access to smoking areas is based on appropriate behaviour (caveat being - if he's 'acting risky then you cannot expose others in smoking area to that known risk of assault).
- I'd have psychiatrist on-side to state that any assaults would be reported and dealt with via the police.
- I'd slip a pack of smokes to the biggest patient on the unit and tell him the new guy said his mum was a ho
- I'd make sure all his activities and possessions were on a reward basis
- And I'd check in regularly with you to see how you were going with the whole deal.
Yes, it's all restrictive and it's all 'custody' not 'care' - but he's passed the threshhold and a line has to be drawn.
I've had patients on management plans due to (nasty) assaultative behaviour - they were approached by 3 staff - given a reasonable direction once - if they did not immediately comply they were 'taken down' and placed in manual restraint whilst instructions were repeated in regard immediate coimpliance.
Totally for the protection of staff.
Nothing therapeutic at all.
And I don't care.
Ps - the one about giving the smokes to the biggest pt.... purely optional. I've never ever done that.

Much better advice than mine. My way of dealing with it was a bit on the confrontational side but didnt really leave room for "care planning".

We do agree though, management will throw you under the bus to save themselves. I love how these people get paid so much to handle the "big decisions" and their only way of dealing with them is to.......ignore it and leave the nurse to figure it out. Gotta love hospital leadership.

Mr Ian · Feb 1, 2009

Gotta love hospital leadership.

:bowingpur

2batty2care · Feb 1, 2009

Really appreciate the feedback!:rckn: You seem to really understand where I'm coming from and I really liked your advice; it also gave me a chuckle which I really needed! :chuckle:chuckle:chuckle It's also something practical that it will be easy to put to use. Thanks again. I'll let you know how things turn out. Don't feel so much like:banghead: now.