I have a huge problem with this... opinions please

[dawn30]

I work in an LTC that has 3 units. 2 units are connected and one is a locked unit. tonight while doing my med pass, i heard yelling coming from the other unit and see the nursing supervisor go flying by the opening between the 2 hallways w/ a resident on her heels. I heard her yelling " you assulted me" so i immediately went to the unit to see if she needed help. (we have very few men working in the facility so all available nurses respond when there is a problem) when i reach the nurses station, the unit nurse(agency) is sitting behind the desk looking like a scared cat and the super is on the phone w/ the police. the resident is standing at the desk holding a replacement trach tube package in his hand and gesturing wildly at the super. I asked the unit nurse what happened and she said he hit the super. the supervisor then yells GET HIM AWAY FROM ME so i escorted the resident to the lounge and got him to sit down. when i got him calm enough that he could talk to me he stated i can't breath and need my tube changed. (he's not on o2 just has the tube in his trach) i go to the unit nurse and tell her he needs his tube changed. she doesn't move. i check the resident and again go to the unit nurse and tell her he needs his tube changed NOW.... still, she doesn't move. I grab gloves off her cart, take the replacement tube from his hand and change it. The old tube was extremely dirty. he instantly calms down and begins to apologize saying he just couldn't breath. he explained that he had been asking to have the tube changed for hours and they kept ignoring him, walking past him etc.. the last time he stuck his arm out to stop the super and that's when she said he assulted her. the police arrived and so did the assistant administrator. i explained to the officer that the resident was not a threat to anyone and was completely calm now. the administrator said we still had to send him to the crisis center as per protocol. the super had to be sent home early because she was crying and SOO upset!! i gave the administrator a written statement of everything i saw heard said and did. there is now a strong possibility that this poor man will not be allowed to come back to our facility becuse the super says he assulted her. I am furious at the super and the unit nurse. why didn't anyone take the two seconds and change the poor mans tube??? any opinions?

[meownsmile, BSN, RN]

I agree the super maybe is out of her comfort zone. Noone should be there if they arent comfortable taking care of a trach and the facility is skilled enough to have them. The home should be careful, they may be walking on a slipper sloap if they ignored his need for stoma care and threatened his life by letting his airway become obstructed. If he has family around that is very attentive at all, they may be a long time hearing the end of this one.

[casi, ASN, RN]

It would seem to me that ignoring that someone is having trouble breathing and not doing something to correct the problem is neglect.

Just think of what could have happened if he couldn't advocate for himself.

[ebear, BSN, RN]

PLEASE let us know how this turns out!

ebear

[Noryn]

Just out of experience I would be careful before I made any final judgements. Did you actually see the situation occur? If not then how do you know he is telling the truth. Do you take care of the patient often to know his demeanor? Why was the agency nurse afraid? Was he actually having difficulty breathing?

Did you ask the agency nurse what had happened? Patients and nurses are both capable of lying. I dont know how many times patients have told me, I have been waiting 2 hours when actually it has been about 30 minutes. Again though it is really difficult because we dont know exactly what happened.

If someone is truly having difficult breathing related to their trach tube being occluded then I think it would be rather difficult to walk them away, sit them down and calm then down without first removing the obstruction. I also think it would be rather apparent without the patient having to tell you this. I am not saying agitation doesnt increase shortness of breath, of course it does but from the description it does not seem like he was in acute distress. What do you mean by extremely dirty, were there dried secretion in the tube or around it?

I guess my opinion is to not rush to judgement. Not being able to breathe is extremely scary (and has been used as a means of torture--depending on your definition of torture) but I would also be careful as well. Generally it is beyond our scope to say that a patient like that is not a harm to others. If the administration and police would have done nothing because you said that and 8 hours later he decked a staff member or another patient you could be held somewhat responsible.

[MzMouse]

Wow, thank you for being an advocate for your patient. Sounds like at the least there is definitely two sides to this story.

[SharonH, RN]

Just out of experience I would be careful before I made any final judgements. Did you actually see the situation occur? If not then how do you know he is telling the truth. Do you take care of the patient often to know his demeanor? Why was the agency nurse afraid? Was he actually having difficulty breathing?

Did you ask the agency nurse what had happened? Patients and nurses are both capable of lying. I dont know how many times patients have told me, I have been waiting 2 hours when actually it has been about 30 minutes. Again though it is really difficult because we dont know exactly what happened.

If someone is truly having difficult breathing related to their trach tube being occluded then I think it would be rather difficult to walk them away, sit them down and calm then down without first removing the obstruction. I also think it would be rather apparent without the patient having to tell you this. I am not saying agitation doesnt increase shortness of breath, of course it does but from the description it does not seem like he was in acute distress. What do you mean by extremely dirty, were there dried secretion in the tube or around it?

I guess my opinion is to not rush to judgement. Not being able to breathe is extremely scary (and has been used as a means of torture--depending on your definition of torture) but I would also be careful as well. Generally it is beyond our scope to say that a patient like that is not a harm to others. If the administration and police would have done nothing because you said that and 8 hours later he decked a staff member or another patient you could be held somewhat responsible.

Thank you! I have a huge problem with this also: you walked in on the middle of a situation-no- you walked in after the alleged incident occurred and immediately took one side. In order to assault someone, chase after them and then tell a story you have to be able to breathe rather well so right away, his claim that he "couldn't breathe" sounds quite false to me. Clearly, he could breathe and well. He states that the other nurses were merely ignoring him; how do you know that they did not have other priorities that were higher at the moment than changing his trach tube especially as he was clearly not in respiratory distress? You were quite wrong to tell the policeman that the resident was no threat without knowing what really happened.

Beware of being manipulated! You were right to try to assist and descalate the situation but your other actions were wrong.

[Sabby_NC]

bless you for listening to him!!!! document it, turn it in to everyone in admin that you can think of. have the pt and his family also write in about it. even if he's allowed back, he has a legit complaint about the way a problem was ignored until it became life-threatening.

what an awful situation gone awry!

i pray that it is all sorted out but did anyone stop and think that this behaviour was totally out of character for this gentleman. that alone should have sent up a big red flag!

pts usually get very panicky when they cannot ummmm breathe!!:uhoh21:

[Dolce, RN]

One time when I was working in LTC I was punched really hard in the nose by a resident. The LAST thing on my mind was calling the police. What was this nurse's problem? Sounds like she has some major issues to deal with. If I called the police for every patient that "threatened" me I guess I would have to have them on speed dial.

[Sabby_NC]

If I called the police for every patient that "threatened" me I guess I would have to have them on speed dial.

Thanks for the giggle there Dolce... :lol2: Good point :)

[SharonH, RN]

One time when I was working in LTC I was punched really hard in the nose by a resident. The LAST thing on my mind was calling the police. What was this nurse's problem? Sounds like she has some major issues to deal with. If I called the police for every patient that "threatened" me I guess I would have to have them on speed dial.

What I am reading here is extremely disturbing. Just because you were willing to take a punch and let bygones be bygones does not mean that a nurse in a similar situation has a "problem" or "major issues" because she is concerned for her own health and safety.

Violence against nurses is a big problem. Just as big a problem is the pressure that nurses face from coworkers and administration when they refuse to care for people in this situation or are discouraged from pressing charges when they are assaulted. The OP seems to believe that the nurse in this case was at fault and thus had it coming since she (allegedly) ignored the patient's needs and apparently some of you agree with that. Sometimes we can be our own worst enemy.

[Dolce, RN]

No, my situation was a little different than you are describing. This gentlemen who punched me had advanced dementia. Calling the police would have accomplished nothing. I have heard of criminal situations when, of course, the police need to be involved. Assault of a nurse is a serious issue. This is especially a problem in the ER. The situation that the OP described does not sound at all like a criminal matter. In my personal opinion, from that facts that were established by the OP, it does sound like the nurse was the one with the problem.

[SharonH, RN]

No, my situation was a little different than you are describing. This gentlemen who punched me had advanced dementia. Calling the police would have accomplished nothing.

I thought you might come back and qualify that. Of course if the gentleman had advanced dementia you wouldn't call the police but it certainly doesn't sound like the person in this case had advanced dementia so it's not fair to compare your situation with hers.

The situation that the OP described does not sound at all like a criminal matter. In my personal opinion, from that facts that were established by the OP, it does sound like the nurse was the one with the problem.

What are you basing this on? The OP hasn't offered any facts other than the observation that the man's trach was dirty and I've never seen one that wasn't. All she gave us was the resident's side of the story and while it's possible it went down as he described, it really doesn't add up. I haven't read anything that suggests the super had some sort of problem. She was assaulted, she called the police, and she went home because she was upset at being assaulted. That sounds perfectly logical to me. If you were walking in the park and someone assaulted you, how would you have reacted? Why is this situation different?