I got slapped by a pt. at the med window. Pretty hard too I might add. She took a dislike to me for no particular reason she can articulate and I can't fathom. Her consequences were wing restriction. While on wing restriction, I brought her a PRN for agitation. Of course she was verbally abusive and told me she wanted another nurse. I told her I was her nurse today and that wasn't going to change. She could choose to take her meds or not take her meds. The choice and the right was hers. I was professional and kept my cool with her.
What do you think happened? The charge nurse told her she would assign another nurse to administer her meds. Every nurse that went in there to give her her meds listened to a tirade of how she hated me. I felt that she was rewarded for her bad behavior, and this set up a staff splitting situation. Now she thinks she can get what she wants by misbehaving and worst, physical aggression against staff.
There are two schools of thought here that came up. 1. The goal is to get the meds in the patient and stabilize so let's get another nurse. The other is 2. The patient was successful in her staff splitting and has learned that physical aggression works to her benefit.
Specializes in telemetry, med-surg, home health, psych.
good for you for getting out....we have had the same short staffing issues for a year now....very bad, one RN to 30 pts. at times....very unsafe....we were told that there are 14 new orientees coming so we all have bets on how many will stay.....the popular number is 3...that is pathetic, isn't it???? most are going to nights so I doubt that us on days will have it much better....
This is bad. Is seclusion not an option? From what I read in your initial post, this situation will probably continue to escalate. Your hospital must have policies around violent patients and how to deal with them.
Just to give you a snap shot of how we operate. If any patients assault staff they will be restrained and secluded. Refusing meds will lead to an IMI. (By the way we dont use seclusion that much)
It saddens me to read that this is happening to nursing staff with no consequence to the patient.
We don't use restraints or seclusion as consequences for behavior. If a patient can contract for safety, then the only thing done is filing criminal charges. We can also encourage a voluntary time out.
We don't use restraints or seclusion as consequences for behavior. If a patient can contract for safety, then the only thing done is filing criminal charges. We can also encourage a voluntary time out.
So you can get badly beaten up in your unit and the patient is allowed to just carry on what they were doing?
Specializes in telemetry, med-surg, home health, psych.
we do have restraints, but have only used them twice in last 2 yrs...a pt. threw a chair through a door glass once, then was calm as all get out...we medicated and put him on LOS (1 to 1) another time a pt. attacked another pt and the dr. was there and jumped him...we medicated to no avail then put on the restraints....after 2 hrs, still violent so we called police and sent him out.... usually after one escalates, meds and LOS will do the trick....if not, then restraints, if that doesn't do it, call police....
I still say we need stun guns on the unit, but no one seems to hear me !!!!
That would definately give a few of us some peace of mind.....
We don't use restraints or seclusion as consequences for behavior. If a patient can contract for safety, then the only thing done is filing criminal charges. We can also encourage a voluntary time out.
After thought.
There is a difference between bad behaviour and assault. You assault a nurse in my work place you will end up being secluded.
So you can get badly beaten up in your unit and the patient is allowed to just carry on what they were doing?
I haven't had to deal with this situation yet. But was told that if the pt is calm and can contract for safety and no longer is violent, we would just press charges as seclusion and restraint are not used as consequences. We are trying to greatly reduce use of seclusion and restraints, and are now expected to use de-escalation techniques to help agitated patients.
I haven't had to deal with this situation yet. But was told that if the pt is calm and can contract for safety and no longer is violent, we would just press charges as seclusion and restraint are not used as consequences. We are trying to greatly reduce use of seclusion and restraints, and are now expected to use de-escalation techniques to help agitated patients.
I've been punched in the face three times and kicked in the genitals once, de-ecalating someone after they did that was not an option. All of these cases were dealt with by restraint and seclusion.
It was not a consequence, it was process in safety. All cases the person continued to fight after we laid hands on them.
Laying charges is fine, but thats not going to protect you at the time.
I'm not having a go at you, I'm just saying its all very well and good for managers to sit behind a desk and say de-escalate/dont seclude/dont use PRN but they are not on the receiving end of a fist.
Oh, I agree. We are expected to notice signs that patients are starting to escalate and intervene before they become violent. (Like that never happens without warning!) Anyway, I don't think some of the MHWs are picking up on escalation signs, tho, to intervene or call in other staff to help with the patient. And it doesn't seem right to me that a patient can pretend to be calm and contract for safety, and then get to attack a second person before PRN/seclusion/restraint. Haven't seen anyone get dangerous there yet, but it's been close a couple of times.
I've been punched in the face three times and kicked in the genitals once, de-ecalating someone after they did that was not an option. All of these cases were dealt with by restraint and seclusion.
It was not a consequence, it was process in safety. All cases the person continued to fight after we laid hands on them.
Laying charges is fine, but thats not going to protect you at the time.
I'm not having a go at you, I'm just saying its all very well and good for managers to sit behind a desk and say de-escalate/dont seclude/dont use PRN but they are not on the receiving end of a fist.
different countries; different standards, maybe? medsurgrnco is pretty correct on this one in the US; you can't restrain or seclude an individual who can contract and is showing no escalation after the assault, which is likely to be the case with your Axis II folks; now if a schizophrenic or manic attacks, most likely they won't deescalate on their own so seclusions and/or restraints might be appropriate; but for an Axis II, they are most appropriately dealt with by law enforcement, which is another reason why, IMHO, Axis II folks are not best treated in an inpatient setting
Specializes in critical care; community health; psych.
Pt. in question is MR with a diagnosis of impulse control disorder. A behavior plan was drawn up for her which emphasized reward and contraindicated consequences. Of course most of us snickered at it but we complied. This is how it worked out. She would wait until she got her reward, then she would assault and threaten staff. She got her first taste of locked seclusion after she slapped the charge nurse. But it was the second locked seclusion the following night that put the behavior plan on ice. When she didn't like the reward she was being offered, her slap turned into a beating and I was the victim. I wasn't injured but quite shaken up over the attack. I want her off the unit. I would have pressed charges but because she is MR, I didnt think they would stick. Now most staff approaches her for care with a security officer. I really do not want to care for this patient at all even with security present. I'm just so done with her and get the willies getting close to her. Do I have a choice? Would it be unprofesional of me to pass her on to the other nurse?
usually after one escalates, meds and LOS will do the trick....if not, then restraints, if that doesn't do it, call police....
aloevera
861 Posts
good for you for getting out....we have had the same short staffing issues for a year now....very bad, one RN to 30 pts. at times....very unsafe....we were told that there are 14 new orientees coming so we all have bets on how many will stay.....the popular number is 3...that is pathetic, isn't it???? most are going to nights so I doubt that us on days will have it much better....