No Restraint Policy

missmollie, ADN, BSN, RN · Oct 26, 2017

The only time I've demanded handcuffs come off is when a prisoner was in status verified by the EEG he was wearing for 24 hours. It was a tonic clonic seizure. Now, here's a question for you. Why would I do that?

AJJKRN · Oct 26, 2017

Handcuffs and shackles are not restraints...

KelRN215, BSN, RN · Oct 26, 2017

The hospital's "no restraint" policy is irrelevant in this situation. The patient is a prisoner. When I worked in the hospital, any time we had kids who came from juvie, they were shackled and handcuffed per DYS policy and had 2 guards with them at all times.

BSN16 · Oct 26, 2017

i was only once pretty pissed off about a patient having to be handcuffed. They were intubated and sedated on the vent and the officers STILL wouldnt take off the cuffs. It was pretty inconvenient, could only turn them to one side, etc. This patient was also VERY sick at the time and we were afraid they were going to arrest soon and coding while in restraints if not good.

basically after about a day of this we eventually did get the cuffs off because they were completely unnecessary at this point, and told them when the patient started to wake up they could be put back on

That Guy, BSN, RN, EMT-B · Oct 27, 2017

An ER with a no restraints policy. HAHAHAHA **** that place.

But as someone else pointed out LE handcuffs and shackles are not considered restraints so they could stay on in this fantasy land.

FolksBtrippin, BSN, RN · Oct 27, 2017

First, let me just say that no ED should ever have a no restraint policy. It would be okay for a nursing home or group home to have such a policy, because when their patients require restraints they can send them to.... you guessed it..... the ED. Sometimes teachers make up impossible scenarios to get you to look at all the ins and outs of a situation. That's what is going on here. Know that you will never encounter this in real life.

Putting that aside, how can you learn from this question? It is intended to get you to think about things. Why do we do what we do and where does policy come from?

One very important issue here is understanding who has custody of the patient. Do not be confused about whether or not the patient is restrained. The patient is definitely restrained. But is the hospital responsible for restraining this patient? Who is doing the restraining? Does it require a physician/apn order to continue to restrain this patient? That is what you need to think about when writing your answer.

EternalFeather · Oct 27, 2017

The gash is in his head. His hands are cuffed not his head.

Unlike other hospitals in bigger cities, local ERs do not have a really comprehensive security system like scanners at the entrance and private police officers, and outsiders cant just get in they needed to be IDed and verified or stopped and guided by properly trained special personnel; not just the regular security guards.

Anyone who has intentions to do harm with or without weapons, can just simply go in through the doors and commit violence. Guess what doors in hospitals are open 24/7 ???!! The ER.

Here.I.Stand, BSN, RN · Oct 27, 2017

You can post questions on this site; you really should share what you have first, to show that you are committed to doing your own homework.

This question is annoying me a bit though, so I'll bite.

A nurse can't dictate law enforcement policy any more than a LEO can dictate nursing practice. In this scenario, the LEO is acting according to policy -- DOC policy.

Clearly, that policy would prevail over a no-restraint policy. It is a safety issue -- an ED is just a tad lower level security than prison is. Also, when one commits a felony and is convicted, one gives up certain rights. One of those is the right to freedom, until his/her sentence is complete.

Prisoners where I work are shackled to the bed at all times, and two corrections officers are present at all times.

My nursing practice includes asking the COs to move the shackle to the other ankle q 2 hrs so the prisoner-pt can be repositioned. I also assess the skin under the shackle frequently. To prevent any pressure injuries, I will position an ABD or foam dressing between the pt's skin and the metal.

khrisrk · Oct 27, 2017

The only time I've demanded handcuffs come off is when a prisoner was in status verified by the EEG he was wearing for 24 hours. It was a tonic clonic seizure. Now, here's a question for you. Why would I do that?

Because if he starts to have a seizure then he will definitely injure himself.

akulahawkRN, ADN, RN, EMT-P · Oct 27, 2017

Handcuffs and shackles are not restraints...

Actually they are... just not medical restraints.

OP: I know this is/was basically a homework assignment. First of all, I wouldn't work in an ED that had a "no restraints" policy. Such a place would be dangerous because violent patients will either injure staff (or worse) if they're unrestrained OR they will require excessive staff to manually restrain all limbs to prevent injury to anyone.

Second, if law enforcement brings someone in that is handcuffed, I will find out why the handcuffs were placed. LE policy sometimes dictates that everyone that's in custody must be handcuffed. If the person is dangerous and LE needs the person to remain handcuffed, I'll require that an officer stay to monitor the handcuffs because they apply them, they can release them, and LE can be responsible for them. I will not accept responsibility for monitoring handcuffed people as I've not been officially trained (by my hospital) to apply, monitor, or release handcuffs.

DeeAngel · Oct 27, 2017

I'm going to notify my charge so she/he is aware. Despite that patient being in the hospital, he's in the officer's custody first. Otherwise someone who just did a mass shooting would come in and the handcuffs removed because "it's policy". The police are in charge of the prisoner here and the handcuffs are not my concern unless they appeared to used in an abusive way.

bgxyrnf, MSN, RN · Oct 27, 2017

What are your thoughts about this scenario?
You are working in the ER for a local hospital when police officers brought in a client with a large gash in his head. The police officers restrained him with handcuffs but you r facility has a "no restraint policy". You were able to assess and treat the client but the restraints make you feel uncomfortable. You asked the officers to remove the restraint but they refused. As the nurse on the unit, what will you do?

Handcuffs are neither treatment nor behavioral restraints and my hospital policy is irrelevant.

What do I do? Nothing at all. The patient is in custody and if the officers believe that the prisoner needs to be cuffed then s/he needs to be cuffed.