Is this abuse how do I report?!

[KMarieD]

Please be gentle maybe I am wrong in assuming this is abuse.

I am currently working at a SNF/Rehab. This is my first nursing job as an LPN.

I have a patient who has dementia and has recently starting mental declining according to other nurses. I haven't been the nurse in 1 month for them. I came in on sunday and was informed they due to have IM Geodon Q4H. When i got report the nurse said they had been refusing the med.

When I went in to the room and offered the med, I tried to convincing but patient stated "I have the right to refuse, i don't want those shots"

This patient recognized me, had conversation with me. Some confusion was evident, but this would be baseline for them.

I documented as refusal. Well supervisor came to me and said they received a text from the administrator (no medical background) stating this patient was "not allowed to refuse" and I HAD TO GIVE IT.

I told the nurse that this patient has the right to refuse, they are not a harm to themselves or others and I would not be holding them down and forcing them this is not a psych facility.

To which response I got "To bad, its a med error if you don't give it, and you can hold them down and give it"

I refused so the supervisor took my keys from me and administered the med while the patient yelled and stated "this is my right to refuse, this is illegal"

Please tell me I wasn't wrong in refusing to give this med. I was absolutely devastated that a fellow nurse would not advocate for this patient when they were doing NOTHING. They got the med and were so sedated they wouldn't even eat or wake up.

Is this not considered a restraint? Abuse? What do I do?

[Anna S, RN]

KMariD-

Congrats on your new job!

Reading your original post really made me sad. Poor woman.

[jadelpn, LPN, EMT-B]

OP, I am glad you accepted a new position. I would begin to question why it is this patient laid in bed all day, all night....no wonder there was yelling out!

To try and advocate further, is there a restorative aide that can help walk this patient? Can this patient be put in a wheelchair to "ambulate" the halls? Can you actually say to the patient "I know you are refusing this medication. But why are you yelling all up in here? Miss ________, they are all thinking you are as a mad as a hatter with all that racket!! Do you know how to get in touch with me if you need to? Can we get you out of the bed? It is such a nice evening, can we put in you in a chair to the living room to look outside?" What does their plan of treatment say? Has anyone actually attempted to follow it?

Yes, I would think 100% that you need to report this, as not only is medicating against someone's will ethically incorrect (and the administrator has no license to protect!) and I would do so to the omsbudsman, the state licensing authority, and the parent company compliance/ethics department.

And if anyone says anything to you about your reporting? "I have a license to protect".

And just as a side note, there are more than one person savvy enough that if they are touring a nursing home and there are "drugged out" people lying in beds in the middle of the day, that is NOT any better than someone yelling. And the someone yelling should be competent enough to be told to stop, and an alternate method of communication employed.

[Tenebrae, BSN, RN]

I live in NZ, however we would not be able to legally administer medications without patient consent unless they were either under the mental health act or deemed not to be capable and had a welfare guardian appointed

Ruas61: I work in LTC and I have been witness to some of the things caliotter3 has outlined. Including going in after an enrolled nurse had been doing a patients dressing to find out the wound had bone was exposed and no mention of this in the patients notes. I've had a CNA tell me to just let the patient defecate in their pull up and they would clean them up on the bed.

Not on my shift.

So, calm down. Caliotter3 was in no means making sweeping generalisations about LTC nurses.

[Sixtyseven]

Unbelievable! Of course you were right! Having worked with many severely dementia residents for 20 years, I can tell you that I would never have administered that injection. You were right to question it. Your supervisor should have been able to supply you with a valid reason that the med was ordered, and you should NOT have been "written up" as a med error, and certainly not fired. I am totally shocked at the treatment of your poor resident. She has always the right to refuse, unless she presents a clear immediate danger to herself or others.

[heron, ASN, RN]

OP - it might be worth your time at home to write down your memory of events. Pull up every detail you can while it's fresh. If the situation is as you've described, you may wind up being interviewed by an investigator. A clear memory of events will be helpful. Resist the temptation to make copies of patient records or incident reports - it's a whole other legal snake pit. Why complicate your life? If you decide you need to go there, get an attorney.

Meanwhile, this, too, shall pass. I hope the two weeks fly by for you. Two weeks pay is a good thing. Keep us posted, if you have time.

[meadow71]

After all of this reporting that you may be doing, I wouldn't want to remain working at this facility if I were you. Just to say, that a version of what you describe is not necessarily rare in LTC facilities. Most nurses either participate, or turn a blind eye, to what goes on. Just one reason why it is difficult to work in LTC.

Im not a nurse, but hope to be starting school next spring. Anyhow, back when I worked as a aid on a locked memory unit, I remember one patient was wheeling up and down the hall asking when will her mom pick her up. She wasnt really bothering anyone that I could tell. Anyhow, the lpn (looked to be about 20 yrs old at the time) said "Im not dealing with this ******** today" and proceeded to enlist the other aids into restraining her and proceeded to give her a tranquilizer.

I remember the whole thing looking pretty traumatic to me as I was new but the nurse and other aids on the unit seemed okay with it. I still hate to think about it...

[heron, ASN, RN]

@meadow71: that certainly sounds traumatic. The misuse of restraints is one of the reasons that long term care is one of the most heavily regulated industries in health care.

Restraints, including sedation, can be life-saving, and not just in critical care. Timely medication can also be a way to provide some peace and comfort to a person suffering unnecessary and painful/frightening symptoms.

Knowing when and how to use them is the difference between an amateur and a pro. The OP, while inexperienced, was thinking like a pro.

The problems ensue when restraint is used as a short-cut, a punishment or to compensate for lack of skilled staff to do the job right.

[Ruas61, BSN, RN]

How dare you yell at me on a public forum with your histrionic accusations. I have worked in more than one LTC facility and only stated what I saw in each and every facility where I worked. How noble of you that this shoe does not fit you!

How dare you imply such slanderous behavior on a group of nurses.

You presented it as the NORM for LTC people.

How noble is that?

I rarely call anyone out but your words really shocked me.

Frankly I am befuddled that no one else called you out.

I usually let this sort of thing go but I find your statements horribly offensive.

Yeah, I capitalized because I was calling your post out.

Fell free to report my post if you are slighted if you want.

I will say the same last words I used before.

Your words speak volumes but they are saying something you can't hear.

[heron, ASN, RN]

How dare you imply such slanderous behavior on a group of nurses.

You presented it as the NORM for LTC people.

How noble is that?

I rarely call anyone out but your words really shocked me.

Frankly I am befuddled that no one else called you out.

I usually let this sort of thing go but I find your statements horribly offensive.

Yeah, I capitalized because I was calling your post out.

Fell free to report my post if you are slighted if you want.

I will say the same last words I used before.

Your words speak volumes but they are saying something you can't hear.

Well, I think it ill behooves us to pretend that inappropriate or abusive restraint never happens in LTC and didn't happen even more in the recent past ... the regulators didn't write all those rules just 'cause they got bored one Sunday and decided to write a few regs just to keep themselves busy.

There is ongoing pressure in the industry to save money and minimize staffing ... and restraints are a quick way to promote both, at least in the short term, if you don't care about the ethics of the situation. And we have our fair share of both nurses and administrators who don't care about the ethics, and just go with what they can get away with that day.

[Ruas61, BSN, RN]

I never said it didn't happen.

However, not every nurse and administrator in LTC are participating, promoting or turning a blind eye to those types of things.

What's the number that constitutes a fair share? I guess the reader gets to decide that for themselves.

It's really easy to make a generalized dump on any group of nurses in a specialty because of some bad experiences either professionally or personally.

My spouse has been hospitalized three times for some serious health issues new to him these past few months.

I have seen some nurses in both the ER and on the floor that were less than stellar, inept and borderline on dangerous this year caring for him.

If they could see their actions or hear themselves as someone else views them they may well be appalled.

However, I haven't and don't plan on ever making such sweeping judgments about ER or floor nurses (all or most) being inept or practicing in such a way that they are causing harm and distress to patients.

That is what I take issue with.

Degrading, marginalizing, devaluing ALL nurses within a specialty because you have a belief or perception or experience(s) that they are like that isn't fair play.

The sad thing is that this seems to be the norm.

Well, it is the internet and you get what you get.

I've said my opinion, ain't dying on this hill.

Peace out.

[hppygr8ful, ASN, RN, EMT-I]

Patient refuses because they state 'I am not doing anything wrong. Its my right to refuse'

It was ordered because they had been stating 'I don't want help, please just leave me alone, no one in this place cares' dementia is worsening, they categorized it as 'behaviors'

Confused about what day it is, what month, meal times.

But isn't everyone else?

They lay in bed all day. They have no family to advocate, they have been alone for 10 years.

I'm confused - They are using an antipsychotic for above described behavior? Geodon in contraindicated in older dementia patients - often make dementia worse. Have they tried anything else - who is the POA? There must be a signed consent for all psychotropic medications.

Hppy

[hppygr8ful, ASN, RN, EMT-I]

EXCUSE YOU!

REALLY???

MOST NURSES EITHER PARTICIPATE, OR TURN A BLIND EYE, TO WHAT GOES ON.

How dare you make a sweeping derogatory generalization of us LTC nurses.

I have never done such a thing nor have I knowingly let something go on or turned a blind eye to something unethical. immoral or illegal.

I have always done my best for those under my care.

The majority of nurses I have worked with over years do not reflect your opinion.

Your words speak volumes but they are saying something you can't hear.

What she said:

I mostly see younger nurses advocating to sedate troubling patients that wander the halls and talk or yell. Still one or two ols stalwart types have been doing it to. I have 6 years of acute psych experience and it always my first question to ask what's causing the behavior. There are many non-pharm modalities to try before forced medication. I have a lady on my unit who thinks she's on a cruise ship and is constantly calling for the deck steward. It's annoying but not really a problem. Still there's one newer nurse who always says "Can't we give her something?"

It is not the norm to medicate patients in LTC setting at least not in California. If we want to medicate because someone yells we have to figure out what they are yelling about.

this is abuse plain and simple

hppy