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?

[heron, ASN, RN]

Well, I haven't seen any "generalized dumping" in this thread. In fact, I think posters have been very careful to avoid that. I am personally highly impressed with the skills displayed by LTC nurses who deal with problematic behaviors without taking the easy way out. I'm also hopeful that administrators will become progressively more like mine, who declines to skimp on staffing to protect a bottom line. Read the LTC forums, especially members like CapeCodMermaid, to see what good care looks like.

But, don't yell at somebody who points out that problems still exist, because they do. It behooves us to acknowledge that and move on to trying to find a solution.

[slauren]

When some of my confused patients are disruptive, I just redirect them to an interesting TV show, give them a snack, or even sit them in the dining room with other confused patients which they enjoy talking to each other for the most part. I've never been the kind of nurse to just sedate someone. I've noticed that when some of the confused patients start acting up they usually need something and first thing I check is if they need their brief changed. I have worked with nurses that just jump to giving whatever PRNs they can give but I've noticed even the confused patients seem to be familar with the staff that truly care for them. I currently work in LTC/Rehab and I don't enjoy it anymore. It can be offending for someone to poorly speak of LTC but I understand.

[fakm]

KMarieD, you did the right thing. While those in authority may then take further steps if they judge it prudent, never do anything that your training or conscience tells you is wrong. God bless! Frannie, RN for 37 years and psych NP

[1jacque]

At our facility we were not allowed to force even with a POA demanding. Our doc looked into it and said it was against state law and I believe a federal offense. Many variables to this like, who failed to chart the actual occurrence that lead to this order. Obviously no good explanation in report. I've known of dementia patients who you could work with one day and never imagine! The next, they could be running around throwing fists and charging people. This order did seem excessive. I have called docs up to enquire if an order SHOULD HAVE been prn and usually the answer was yes! You were very right to be cautious, good instincts.

[nursingaround1]

Your manager handled this the wrong way. In cases like mandatory treatment, there should be a clear framework of what you are to do if the patient refuses. The plan should be approved, most likely, by a team - including consultant, nurses, and family.

Maybe this was all in place, and the manager didn't bother to tell you.

But you did the right thing.

If you're not comfortable with doing something, it is your right to refuse.

[Nurse Beth, MSN]

This is just so wrong.

I know you're leaving (yay!) but I would also consider asking the nurse who reprimanded you under what circumstances a patient can refuse a medication, or any medical treatment.

The purpose being to have them offer a rationale. I would also ask for a policy.

[kbrn2002, ADN, RN]

After reading through this thread I am glad you have already sought out other employment. Unfortunately doing the right thing and reporting this for further follow up could very well cost you your job there anyway. Sad but true.

I've worked in LTC for 20 years and have never witnessed anything like this. But then I'm lucky and work in a facility that would never allow such questionable practices to happen. I am shocked and appalled by some of the things other experienced LTC nurses have posted here on AN. Not all LTC is staffed well or with even decently skilled and experienced workers, but on the flip side not all LTC facilities are awful places to work that treat their staff and residents poorly.

[Jory, MSN, APRN, CNM]

The patient would have to be formally certified by the physician that the patient cannot give informed consent. Unless it is an emergent situation (which it sounds like this was not), the patient can still refuse treatment. If the patient has been rendered unable to consent, then the family should be called to make arrangements for a POA or if there is no family, APA should be called so the patient may have an advocate.

Unless "unable to consent". has been previously charted and the above procedures followed, you were correct in not giving the medication. I applaud you for advocating for the patient because if it blows back, it is not going to blow back on you.

I wouldn't have given it either and I would have told the administrator to kiss my grits.