Neglect question?

[druse]

During the time a patient is waking up from anesthesia and is disoriented, becomes combative.

If a nurse goes into the room and initially helps to restrain the patient, and then abandons to assist (because of risk of being hit), is this considered to be neglect if the patient is injured by a fall or otherwise due to his combativeness?

Also what is the expected legal role of the CRNA in this situation?

[ageless]

your question is confusing.........

Are you asking if you, as an RN, can exit the room leaving the CRNA alone with a combative patient, because during your attempt to help protect the patient from injury, you feared you might be hit?

[druse]

There was one RN in the room with the CRNA, and I & two others came in to help (I am an RN, another RN, and one scrub tech), when we noticed the patient waking up disoriented. The safety belt was on and the patient was trying to sit up, following a Septoplasty. The patient was coughing and blood was splattering everywhere, with each cough. I grabbed a towel and held it up to the patients mouth & nose with my right hand, left hand grabbed the patient behind the neck. An RN opposite side of the bed was assisting me in trying to calm the patient. The CRNA was at the head of the bed with a grin, and doing nothing. The patient became more combative and stated "let go of me, someone's gonna get hurt". The RN opposite me let go & backed away, I kept talking to the patient trying to orient him and shouted to the CRNA to give him something. The CRNA responded "don't tell me what to do, you're not my boss" and then proceeded to threaten me that he was going to hit me. I said "go ahead". I'm still holding the patient trying to keep him on the bed. The CRNA still focussed on me continues to threaten me and state that he's settle this later (implying something like we'll take care of this in the parking lot after work like he's gonna kick my *** or something). I said "anytime". Evidently there was a personality conflict that the CRNA was harboring and this event cause him to vent with personal threats. Afterwards after conferencing with the Anesthesiologist, Director and the others in the room I am painted the picture as the "bad guy". (All of the staff in the room were female exept for the CRNA, and I)

My question is concerning myself if after I touched the patient, if I were to let go, and the patient were to fall off the bed or sustain an injury in any way, is that considered to be neglect upon my part?

I am also concerned about the role of the CRNA in this scenerio. I am aware of ethics and the responsibility of the CRNA to assess the patient regarding status of airway, history,...etc, but during an episode like this shouldn't the CRNA have had some resposibility in assisting so that the patient doesn't follow through his disorientation and start swinging and hitting nurses, by maybe sedating the patient. Just curious.

[ageless]

Whew! Sounds like a bad situation for all involved.... especially for the patient.

This appears to be not a legal issue but a professional conduct question.

I think you were aware of a history between you and this CRNA long before this event. That being said, I would be looking at how my actions might have escalated this situation even if the CRNA is a total nut. I would also take time to discuss and resolve this conflict with the CRNA...away from the OR and with a neutral party present.

You did not say why witnesses painted you as the "bad guy"

PS: As you mentioned, how does the male/ female issue play into this ?

[druse]

Male/female doesn't play a role here.

[barefootlady, ADN, RN]

Ageless gave you good advice. ( I would not have allowed the patient to further place himself in harms way, you did right to maintain some contact with patient. ) The CRNA clearly has issues with you asking/telling him to give med to calm patient down. I would have a talk in a off facility space, with a neutral party to both present, and attempt to work issues out. If not, look for another place to work, the CRNA is going to have all of the chips if one is being considered for termination.

[druse]

Thanks for your replies.

Another question? Just curious, I'm not the legal guru, but what right do I have for any legal action against the CRNA for his threats?

[ageless]

legal definition:

An assault can be defined as the threat to use unlawful force to inflict bodily injury upon another. The threat, which must be believed to be imminent, must cause reasonable apprehension in the plaintiff. Therefore, where the defendant has threatened some use of force, creating an apprehension in the plaintiff, an assault has occurred. If the defendant threatens to use force against the plaintiff, but clearly states that the use of force will not be imminent, and will instead occur at some point in the future, then the plaintiff is unlikely to prevail on a claim of assault.

[druse]

Thanks!

I hate that this even occurred! The CRNA & I have talked following the event, and all seems fine, however this has occurred before(probably will again), he has threatened me, and others. I don't intend to pursue this further really because I'm just not that type of person(the sueing type). I didn't grow up that way.

I can go into further details if you're interested in hearing or reading about this situation as to why I've been painted as being the bad guy. It's probably entertaining to some, but not to me. I don't want to give a false impression of our facility.

[ageless]

This situation sound like it is just the tip of HIS iceberg...

Conflict is always unpleasant and your situation would make anyone feel awful just being part of it. Feel free to share. No one knows you or your facility. It may do you good to vent.

[elkpark]

I hate that this even occurred! The CRNA & I have talked following the event, and all seems fine, however this has occurred before(probably will again), he has threatened me, and others.

Are the hospital administration and the supervisor(s) of the CRNA aware that he has threatened you and others in the past? Are the others who have been threatened willing to come forward? The admininstration is responsible for protecting you and other staff from a hostile work environment. The hospital medical staff (I assume the CRNA is privileged as an allied health member of the medical staff) should have a process in place for dealing with complaints about inappropriate professional behavior by members.

There are ways of dealing with people making inappropriate threats at work other than taking the person to court. No one should have to put up with being threatened with physical violence by a colleague.

[barefootlady, ADN, RN]

No modern facility would ever allow a member of their staff to continue to make threats or bully other workers. This CRNA needs a verbal warning from the boss to say the least. Have the issues with his conduct been discussed with the boss?