My nurse tied a resident in here wheelchair

[Chad_KY_SRNA]

Night before last I was alone on the Alzhiemers unit, my partner was on lunch and the housekeeper was cleaning on the unit. I was washing my hands in the medicine room when she came and got me and told me that one of the residents was in the floor. I went and checked the resident for injuries and deformities. I then called the front desk and had them send the nurse over to my unit. The Alzhiemers unit and ICF/PCF unit share a nurse, we have a CMA and two CNAs that work on the alzhiemers unit. The nurse, an agency nurse I don't know, came over in about a minute. She checked her and made sure that nothing was falling off, etc. We then helped the resident out of the floor. We put her in the wheelchair and I put her lapbuddy on and while I was putting the Lapbuddy on the nurse took the sheet that I had intended to use to cover her legs and tied her in the wheelchair. I was in shock, she said something about making sure that I untied her before the next shift showed up. She went back to the PCF/ICF unit and did the incident report. As she was leaving the unit my partner was returning from lunch. I showed her what the nurse had done. We took her and untied her and layed her down to sleep. I told my supervising nurse the next night what had happened and she said that she didn't want to know about it. Today however the DON and Social Work were running around asking questions about the night before last. Apparently the nurse had told the CNAs to do it to a resident on the skilled unit. The refused and went to the administrator who yelled at the nurse saying that she had better not ever hear of her doing it again. Since no one that I told told their supervisor it looks like I am lying and they may say that I never told them to cover their butts. If I could go back I would have called the administrator at home but whats done is done. Everyone is going to say that I should document to cover my a$s but we have no where to document. CNAs are not allowed to chart in the charts. The nurse that I told didn't report it to anyone. The Occupational Therapist is my witness that I told a nurse. The bad part is that it was almost 19 hours after the origional incident. Despite all of this when asked if she had tied a resident to a chair the nurse said that "she" had not tied anyone down. Well, lets see who does that leave.......oh yeah, me!:angryfire I am so angry right now and I am so sorry that I didn't report it sooner. I thought we had mentioned it to the CMA but I called tonight and asked and she said that we hadn't mentioned it to her. I told the DON what I had witnessed today and she sent me to the acting administrator who I told, she told me to write out a statement of what I had told her. I am terrified that my job is in jeopardy and that because of my stupidity the facility has been opened up to tons of liability. The company that is managing the facility has said that there are somethings that are making them consider pulling out of the sale. The facility was out of money when they took over, if they hadn't we wouldn't have gotten paid for the last month. They have told us that if at all possible that they would stay and close sale on the facility but that some issues have been coming up like a thing with an agency nurse that made them feel like we may not be the best investment. They are talking about what happened with me. I am worried that I have helped my 130 residents lose their home and my coworkers may lose their jobs. I am worried sick . I want my facility to stay open and I want the residents to feel safe in their facility. I want my job and I am afraid that if we don't close, that they may fire me. Any advice, remember I have no way to document. CNAs dont chart.

[Dixiedi]

Hmm. Well have ya'll been in a situation where you didn't HAVE a posey, chair restraint or wrist restraint immediately available? (Guess nobody here works for HCA or places like that...LOL)

Sometimes we improvise for a time. If someone is gonna fall or pull a line and hurt themselves and you'll be liable for something either way, we sometimes have to make choices. I don't know WHY this nurse did what she did...I just object to the whistle blowing and finger pointing before a reminder face to face. That may have been all it took...someone saying "You know, we really can't do this anymore...let me go find the proper equipment and we'll talk about it later".

I primarily do ICU where I WILL be liable if the patient hurts themselves so we sometimes make choices based on this knowledge. Its not a policy nor best practice to use sheet restraints, but I HAVE in extreme circumstances UNTIL I could find appropriate equipment.

I don't know the situation where the CNA is talking about. However, if I had to generalize a larage facility, short on help , her choice may well have been the best choice. After all, the pt was found on the floor!

I was talking about just the generalized use of retraints years ago when even little old ladies who would reach out and catch your hand or shirt tail as you walked by trying to get your attention were tied down. THAT I am glad is a thing of the past.

Retraints, properly used are, I believe a good thing. It's a nursing decision and any one who objects needs to find out what the nurses reasoning was before they speak poorly of her. I will note the nurse did tie the restraint herself, she did not instruct the CNA to do it.

[nurse555]

I agree that the nurse that did that was very wrong even if she had the best of intentions for pt safety. I have been on both sides of the agency dilemma and knowing that the agency nurses are usually scapegoats that always made me more aware of my actions. I've also seen very poor excuses for staffing coverage in agency nurses. Its a good thing you did everything you did. Chances are if the buyers are thinking of pulling out its not a sudden decision so don't beat yourself up over it. One person can only do so much and you aren't in anyway responsible for anyone else's. Maybe your management will realize that there is an underlying problem and take actions to correct it. You did the right thing. Hopefully your management will dnr the nurse from your facility. On the plus side you've learned the most important aspects of documentation-covering yourself and protecting your patients. Keep us posted.

[CHATSDALE]

I don't know what the rules are from state to state...i would think though that a facility that hires agency nurses should have guide lines available for them to make decisions...what would you do with a pt who climbs over the bedrails and harms themselves...it the nurse responsibable for the injuries sustained...what did she write down on the incidient report...i know that the form that we use includes what happen and what steps were taken to prevent reoccurance...in any case cna should write down facts as they occured and let the don and adm make decisions...some problems don't have any solutions

[cnyrn]

Sounds like unlawful imprisonment to me, are there no standing orders for prn soft restraints on an emergency basis? Most facilities have these, requires an MD to sign in 24 hours.

[RN92]

I worked in a charity hospital emergency room...we had pts come in high on "something" (no telling what). It would take 4-6 firemen/paramedics to hold him down on the stretcher - they'd get them transferred to our stretcher and LEAVE!!! We werent allowed to use posey vests. We'd use 4pt leather restraints and the pts can still wiggle/fight and get out of them. Sometimes we'd have to use a sheet in addition to the restraints to keep them from raising their chest off of the bed. There is a FINE LINE between restraint safety and pt safety. Truth is - if someone wants to sue, they're going to do it anyway. Check out http://WWW.NURSINGLAW.COM One nursing home was sued for not restraining a pt who had fallen out of the bed in the middle of the night at least 3 times over the past several years. The nursing home and nurse was found at fault for not maintaining pt safety. Also, to CHAD - you could have also written an incident report that night - just to make sure they got your version of the story in writing. Anyone can write an incident report. There can be more than just one. Actually, the more versions of the incident the better.

GOOD LUCK

[Chad_KY_SRNA]

I talked to the social worker today. I have learned some very important things. They told me that she didn't pass the seven narcotics that were scheduled that night on the ICF/PCF unit. She didn't pass half of the meds the next night on the skilled unit. The administrator got her to admit that she had tied her down. The medication aide that was working with me that night said that she told her about it that night. Carole the CMA told me that when she told the nurse that she could not do that she said that she would as long as she worked there. One of the temporary administrators told me tonight that she was not to be allowed in the facility. She knew that it was wrong and the bad thing is she was going to do it again before two CNAs went and told the administrator. I told the new acting adminstrator today that we needed a shift report book like the CMAs and Nurses that we could document in. She said that she would look into it.

[stevierae]

I talked to the social worker today. I have learned some very important things. They told me that she didn't pass the seven narcotics that were scheduled that night on the ICF/PCF unit. She didn't pass half of the meds the next night on the skilled unit. The administrator got her to admit that she had tied her down. The medication aide that was working with me that night said that she told her about it that night. Carole the CMA told me that when she told the nurse that she could not do that she said that she would as long as she worked there. One of the temporary administrators told me tonight that she was not to be allowed in the facility. She knew that it was wrong and the bad thing is she was going to do it again before two CNAs went and told the administrator. I told the new acting adminstrator today that we needed a shift report book like the CMAs and Nurses that we could document in. She said that she would look into it.

You did good, Chad!!!!! You really are a true hero to your patients and a great role model to nurses everywhere who don't want to "get involved" or be "whistleblowers." I would be proud to work with you.

You know, makes me wonder why that patient was "down" in the first place. Wonder if she did not get meds that were due her and was disoriented?

Chad, I wnat you to type in "medicare fraud" and "whistleblowers" and "qi tam" on google and see if you run across anything that fits your situation. You may just qualify for a monetary award, or will, for following the appropriate steps to report this and improve care for your facility.

Do it, and feel free to p.m. me if I can be of help. I know some attorneys that handle medicare fraud and qi tam lawsuits.

I hope that this is a message for all CNAs everywhere: YOU ARE NOT POWERLESS. YOU ARE SOMEBODY. YOU HAVE A VOICE. DON'T BE AFRAID TO SPEAK UP.

I also encourage you to call the board of nursing and report her. Don't assume somebody else will, as they most likely will not. She will end up in another LTC facility, doing the same thing, if a formal board of nursing investigation is not launched.

Here is their contact info. According to their website, you can report a nurse anonymously.

Kentucky Board of Nursing

312 Whittington Parkway, Suite 300

Louisville, KY 40222-5172

Phone: [phone] or 800-305-2042

[lifeisbeautiful]

Working in a Nursing home can be very tough work physically and emotionally. I worked in one for 4 years, then decided to work in a hospital. Many of the people that I graduated with also started in Nursing homes. We use to share stories all of the time. Some of these stories would blow your mind. The State turns a blind eye to Nursing Homes though. Nurses and CNAs have way to many residents to care for. I feel this is what makes staff frustrated. I would like to see the state inspector get up 15 patients in an hour and a half, give each res. a bed bath/ proper peri-care with warm water, oral care, hair brushed. clothes matching, etc....no short cuts. I would like them to deal with the combative patients. The topic of restraints? I think I saw more broken hips because of the big fight against the use of restraints. Anyway, it is a tough and frustrating issue. I do miss the challenge geriatric nursing though.

[CoffeeRTC, BSN, RN]

Sounds like unlawful imprisonment to me, are there no standing orders for prn soft restraints on an emergency basis? Most facilities have these, requires an MD to sign in 24 hours.

There is not one restraint to be found in our facility...no posey wrist or waist restaints are kept in supply. Now we do have "positioners" for wheel chairs like a lap buddy or self releasing seat belt, but has been quite a few years since I've seen anything that ties. BTW, we have a mixed pop of demetia residents and it does get pretty crazy at times One of my current residents loves to lowere them self on the floor and climb all over the place (yuk)..he also spits everywhere :uhoh21:

[Dixiedi]

There is not one restraint to be found in our facility...no posey wrist or waist restaints are kept in supply. Now we do have "positioners" for wheel chairs like a lap buddy or self releasing seat belt, but has been quite a few years since I've seen anything that ties. BTW, we have a mixed pop of demetia residents and it does get pretty crazy at times :crying2: One of my current residents loves to lowere them self on the floor and climb all over the place (yuk)..he also spits everywhere :uhoh21:

This reminds me of one of the kids I have in home care. We couldn't get him any kind of bed that would keep him in it (Traumatic Brain Injury) after he became too big for a crib. We just had to keep watching him very closely as he would wriggle himself over/around siderails and end up on the floor. He was a shaken baby and does have a seizure disorder though it is well controlled. A couple of nurses have seen seizure activity but I personally have witnessed none. However, because a seizure is always possible we were able to get him a very nice net bed. He is safe from falling on the floor now. Just seems so silly we couldn't get it for his TBI safety but could get it under the guise of "seizure safety." Seems a person who simply doesn't know any better can not be restrained but a person who has a seizure disorder can. Let me say though these beds do not actually restrain a person, they are simply netted on 4 sides and top from the mattress to well over 6 ft height to prevent falling out.

[CoffeeRTC, BSN, RN]

This reminds me of one of the kids I have in home care. We couldn't get him any kind of bed that would keep him in it (Traumatic Brain Injury) after he became too big for a crib. We just had to keep watching him very closely as he would wriggle himself over/around siderails and end up on the floor. He was a shaken baby and does have a seizure disorder though it is well controlled. A couple of nurses have seen seizure activity but I personally have witnessed none. However, because a seizure is always possible we were able to get him a very nice net bed. He is safe from falling on the floor now. Just seems so silly we couldn't get it for his TBI safety but could get it under the guise of "seizure safety." Seems a person who simply doesn't know any better can not be restrained but a person who has a seizure disorder can. Let me say though these beds do not actually restrain a person, they are simply netted on 4 sides and top from the mattress to well over 6 ft height to prevent falling out.

I cant picture the netted bed, but it sounds dangerous for the dementia residents... for the constant faller-getting out of bed resident, we sometimes use low beds or even beds on the floor. Hey if thats where they like to be...

[mandykal, ADN, RN]