Need Advice ASAP-have been suspended

dekatn · Jan 21, 2006

Wish I could be of more help, I do know that cell phones aren't allowed in our facility. We did have a resident one time that called 911 repeatedly and we unplugged her phone, but it was just a regular phone.

Nurse Ratched, RN · Jan 21, 2006

So was the patient demented, manipulative, or in pain? Assuming all attempts had been made to reason with the woman unsuccessfully...

Was she angry about being in the facility and calling everybody in the world to ask for pain meds to make them feel guilty about having her in there? On a psych ward, manipulative behavior like that would get your phone privlieges yanked. I'm not sure that a hardline approach like this works in rehab, altho if she was calling people at 3am, yeah, her phone is gone until morning if she wouldn't stop.

If she was in pain, not getting her usual regimen of meds (perhaps she was there because she had been overusing her meds resulting in decresed LOC, confusion) then she was likely doing whatever she had to do to get her meds. In that case, the expedient thing to do on a hectic night was to remove her phone, but it didn't address the reason for her behavior. If her pain asessment indicated she was having this amount of pain, the medical director needed to be called.

If she's just demented and someone else was in charge of her affairs, then IMO you remove the phone and call that person in the morning to advise of the problem and determine a solution.

I guess my question is, are the accusations of abuse stemming from the removal of the phone, or allegations that her pain was ignored? Please understand, I am not attacking you, but brainstorming.

Bird2 · Jan 21, 2006

So was the patient demented, manipulative, or in pain? Assuming all attempts had been made to reason with the woman unsuccessfully...
Was she angry about being in the facility and calling everybody in the world to ask for pain meds to make them feel guilty about having her in there? On a psych ward, manipulative behavior like that would get your phone privlieges yanked. I'm not sure that a hardline approach like this works in rehab, altho if she was calling people at 3am, yeah, her phone is gone until morning if she wouldn't stop.
If she was in pain, not getting her usual regimen of meds (perhaps she was there because she had been overusing her meds resulting in decresed LOC, confusion) then she was likely doing whatever she had to do to get her meds. In that case, the expedient thing to do on a hectic night was to remove her phone, but it didn't address the reason for her behavior. If her pain asessment indicated she was having this amount of pain, the medical director needed to be called.
If she's just demented and someone else was in charge of her affairs, then IMO you remove the phone and call that person in the morning to advise of the problem and determine a solution.
I guess my question is, are the accusations of abuse stemming from the removal of the phone, or allegations that her pain was ignored? Please understand, I am not attacking you, but brainstorming.

Excellent questions. We don't have enough info to get the true picture of what occurred. Was the MD notified of the complaints of pain and of the phone calls? Was everything documented? We often get the MD, Social Services and family involved when behaviors like this occur. Might the pt need a Psych consult. Sad situation, I hope all works out for you. Keep us posted.

NJLPN · Jan 21, 2006

We have had many situations like this in our facility. If the pt. is alert,oriented, then we can't remove the phone. They are paying for it. Did you call the MD? If she was in pain she needed adjustments in her medication. Could she have been anxious? Would she have taken a xanax?

robinregisterednut · Jan 23, 2006

O.K. - Let me explain a few more things with this situation. The patient had just recently been given her pain med, and it really hadn't had time to work. This had been explained to her, but she is confused, had just been admitted the previous day, and had repeatedly expressed to staff that she did not want to be there, she wanted to go home. She had also been shown numerous times how to use her call light. I don't know anymore than this. Like I mentioned in my first post, it was a very hectic night, she was new, and I didn't get much info. when I was called in for suspension, which is my fault, but at the time I had a migraine and could not even think to ask questions, and then it was the weekend when no one in authority was at work. I have written my letter, explained my actions, and read everything I can on patients' rights. In our facility statement of patients' rights regarding a phone it states - it is a residents right "obtaining regular access to the private use of a phone." She had her own cell phone, regular access, to me, does not mean in the middle of the night - harassing people, which is against the law. Thank you guys for raising these questions, which has helped me write the letter. I just hope I can keep this job. Robin

Chaya, ASN, RN · Jan 23, 2006

Still not sure where you as night supervisor fit into the picture unless they are suspending basically everyone who worked with the lady in question on that night?

Was there some action you took that they are contesting or is there something thay think you should have done?

DusktilDawn · Jan 23, 2006

Years ago I was the recipient of phone calls from a confused patient that resided in a nursing home. At first this occured once in a while, no big deal. The more confused this person became over time, the more frequent the calls. This person even called the police stating I was in her home, the police called me. I was not the only person this patient called, she also kept calling her neighbour in regards to a cat she never had. I called this neighbour after being given the number from the confused patient, she was also upset about receiving these calls from this patient. I also spoke to whomever was in charge of the facility and explained the situation including the fact that her neighbour was also receiving calls, initially they took her phone away, than staff on the W/E would return it to her, no doubt because she complained and it was done to shut her up. Long story short, I changed my phone number.

I'm not sure why you were suspended Robin, I agree that calling people in the middle of the night infringes on the rights of those receiving those calls. You left her with her own cell phone, so she had access to a phone. Another question, was it the family or the patient that initiated the complaint?

southern_rn_brat · Jan 23, 2006

I work as the night shift supervisor at a nursing home/rehab. combo. facility owned by one of the hospitals in my city. It was an extremely hectic night, and we had a new resident on the rehab. unit that I was told by the LPN on the unit, that she was repeatedly calling people outside the facility asking for pain medicine (she had already been given her pain med.), and the LPN told me she had taken her phone out of the room, and that she still had a cell phone. One of the people she kept calling, called the facility and told them to stop her from calling. Now I'm under investigation for patient abuse. I was told all this on Friday afternoon, and have to have a letter submitted to the head of human resources by Monday 12 noon explaining my position. I have never seen a policy or patients rights statement saying they are entitled to a phone in the room, and the other nursing homes I have worked in did not even have phones in the patients rooms. The Florida Patients Bill of Rights that I found on the internet doesn't give me ANY kind of information about this. Can anyone give me some help, advice, suggestions for this letter I have to write.

I'm a nursing supervisor in a nursing home too. If the patient is alert and oriented, then you violated her rights. Whether you have a policy stating they are entitled to have a phone doesnt matter. You cant prevent a patient from calling anyone. If she wants a phone, she can have a phone. I am sure that it annoyed the family member she was calling but that was their problem, not yours. Your responsibility was for the patient. We cant do something for the convienience of a family member, even though they think we can.

did you call the doctor and report her unrelieved pain? did you call the family and ask them to come and sit with her?

I am sorry this happened to you. I have had families scream and cuss at me to make mom stop calling them. I have even had them call 911 every time they need something and all I can do is tell dispatch "thanks for calling, I'll go take care of them".

Good luck to you!

southern_rn_brat · Jan 23, 2006

If she is confused, then was it her POA that told you to take the phone away? If it was, then I would think that would not be abuse.

Nurse Ratched, RN · Jan 23, 2006

O.K. - Let me explain a few more things with this situation. The patient had just recently been given her pain med, and it really hadn't had time to work. This had been explained to her, but she is confused, had just been admitted the previous day, and had repeatedly expressed to staff that she did not want to be there, she wanted to go home. She had also been shown numerous times how to use her call light. I don't know anymore than this. Like I mentioned in my first post, it was a very hectic night, she was new, and I didn't get much info. when I was called in for suspension, which is my fault, but at the time I had a migraine and could not even think to ask questions, and then it was the weekend when no one in authority was at work. I have written my letter, explained my actions, and read everything I can on patients' rights. In our facility statement of patients' rights regarding a phone it states - it is a residents right "obtaining regular access to the private use of a phone." She had her own cell phone, regular access, to me, does not mean in the middle of the night - harassing people, which is against the law. Thank you guys for raising these questions, which has helped me write the letter. I just hope I can keep this job. Robin

It sounds like this is a case of poo rolling uphill. I'm sorry you got caught in this. I agree that my definition of "regular" access wouldn't include calling whomever she chose in the dead of night, particularly if a recipient of said call wasn't happy about it.

If you haven't already turned in your letter, I might suggest adding something about the least traumatic/least restrictive stopgap measure given the hour was to remove the phone until the situation could be cleared up in the morning via the interdisciplinary team, while continuing to monitor the patient for response to pain med and adjusting accordingly.

LoriAlabamaRN · Jan 24, 2006

I just wanted to thank you for alerting me to this. I'm also the night shift supervisor in a nursing home, and if I had a resident causing this type of situation, my reaction would have been to unplug the phone or remove it entirely. I'm so sorry that you've gotten stuck in this. Hopefully the letter will just be for a CYA folder and you'll be back at work soon.