Nursing Director removed my pts restraints

[remotefuse]

So I had a disagreement with my director recently. She was doing her rounding when she came into my pts room. He was in soft wrist restraints for being confused and super violent. The first time I saw him he nicely asked me to come over in a whisper. I came close to the head of the bed and he folded himself in half with remarkable speed and tried to kick me in the face. Among a lot of other things, he was just violent.

He had been in restraints for 2 days, I saw during my assessment that he was using a lot of accessory muscles in breathing. The acessory muscle usage had also been documented for about a week, but lungs were CTA and great sats. Also, multiple MDs had rounded on him.

Director saw the accessory muscle use and told me that we're not having a pt die in restraints. I told her I wouldn't go near him without restraints on.

I go go back in there and he was untied and slipping out of bed. There was no way I was going to help him into bed alone. So I got 2 other people and by the time we came back he was on the floor.

I was really upset about it because I told her all the things he had done, but she insisted that dying in restraints is a huge deal, and maybe a sitter would be a better alternative. I didnt get in any trouble or anything for the fall, I just think the whole thing was a bunch of nonsense that I really didn't need.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

The Director acted out of fear of getting in trouble and not out of concern for anyone else, including the patient.

^^^^Yes. A search of the CMS website regarding restraints will provide insight. A restrained individual such as the OP described is a danger to himself in and out of restraints. While in restraints, there are subjective risks to the patient: anxiety, panic, increased stress and strain on the heart, etc.

Being out of restraints, well, it's obvious what will happen. The director would prefer that her staff do the explaining instead of herself...even if it resulted in physical injuries that could have been avoided. What she fails to realize is that, as a director, she is still responsible for what happens in that case as well.

[cleback]

Dying in restraints is a big deal, but she still shouldn't have done what she did, putting you and the patient at risk for harm. Yikes. I hope that's a one off for her, and not a pattern for poor judgment.

Anyway, I am more inclined to go to the CNS and explain what happened. She can provide more education, and hopefully the director will see the error of her thinking. ...Unless you're aiming to get her fired, then go to higher up or bon.

[SouthpawRN]

Personally, I would have handled it by reporting the actions of your nursing director to the BON as they were pretty clearly negligent, but then again I'm a trouble maker.

It's her license on the line, not yours, If Pt had an order for soft restraints, which we have to have renewed q24h, didn't she violate a HCP order too? Then the patient suffered harm and a fall directly related to her actions which are Joint Commission sentinel events. Flip the tables. if you took the restraints off because of AMU and then left the combative patient alone so he/she fell, what would happen to you?

[NurseSpeedy, ADN, LPN, RN]

It is a big deal in my state. If someone dies in restraints, it becomes a ME case. There's a ton more

Paperwork even if we say the restraints were not the cause.

I get her concern, but I'm not getting kicked in the face for anything. The soft restraints were the only thing keeping him from making contact with me multiple times that day.

PChemical restraints didn't work for him and he was just incredibly violent. Also, his breathing was worth noting, but he wasn't declining. It had been his baseline since we had him. She just didn't care about us getting hurt and that's just what really bothered me. I'm telling her, he literally tired to kick me in the face, and that carried no weight. Her paperwork and protocols were the only thing she cared about.

** edit that's not really fair, she did go on and on about the lack of dignity in dying in restraints, but still... he was just an incredibly violent/confused pt.

Well, if she felt so strongly about getting him out of restraints to take them off herself and protecting his dignity (...whatever, protecting her paper trail and own rear. I highly doubt she gave two hoots about this patient's dignity), then I think she can open up her office in his room with the computer and be his nurse and sitter for the day. Once she gets punched out by Mr. Hadol and Geodon Can't Touch This maybe she will feel differently...or if it's still more important she can continue to let the patient play whack-a-mole with her head instead of her staff who she allows to be assigned to care for him

[ChrissyCasualty]

The part I'm stuck on is where you stated that you saw he was slipping out of bed, went and got two people, came back and he was on the floor.

Yea...your director made a dick move. But did you really leave a confused and combative patient with restraint orders by themselves?!

[Here.I.Stand, BSN, RN]

The part I'm stuck on is where you stated that you saw he was slipping out of bed, went and got two people, came back and he was on the floor.

Yea...your director made a dick move. But did you really leave a confused and combative patient with restraint orders by themselves?!

It sounds like it would have been difficult (if not impossible) to prevent the fall by herself, so would be wise to get help. And I don't know how it is where you work, but staffing doesn't always allow for every single confused/combative pt to have a sitter. So yeah...without a sitter, he will have to spend time by himself. She probably had half a dozen other pts besides this one...how would YOU have not left a "confused and combative pt with restraint orders" by himself? (?!)

[ChrissyCasualty]

Easy. Call out the door or, if the place is equipped, hit the button to call the charge desk. There is NO excuse to leave a patient who is already a fall risk ALONE in a room.

[MaryColleenRN, BSN, RN]

Which is why you aren't a manager... a patient dying in restraints IS a huge deal and there are many evidenced-based alternatives to restraints.

[morte, LPN, LVN]

Which is why you aren't a manager... a patient dying in restraints IS a huge deal and there are many evidenced-based alternatives to restraints.

it appears they have tried many of those. what else do you have to offer, besides platitudes?

[morte, LPN, LVN]

Easy. Call out the door or, if the place is equipped, hit the button to call the charge desk. There is NO excuse to leave a patient who is already a fall risk ALONE in a room.

patients who are fall risks are left alone all the time. or you would never get anything done.

[Kooky Korky, BSN, RN]

The part I'm stuck on is where you stated that you saw he was slipping out of bed, went and got two people, came back and he was on the floor.

Yea...your director made a dick move. But did you really leave a confused and combative patient with restraint orders by themselves?!

Read her reason why. She feared for her safety, which is why she got help.

[kconrad1712]

I am being taught to have a strict policy of reporting to the MD/HR/etc. anything that I deem is hazardous to myself or my patient, regardless of who I am reporting. I am being taught that patient and staff safety is my number one priority. If it is the Nursing Director I need to report, so be it. I've been told to always make my report in writing so that there is a written log detailing everyone's actions, my concerns, etc. Having a patient die in restraints is horrible, but having a patient die due to neglect is even worse. It may not be well-liked, but I'll be damned if I end up in a court room or in front of a license review board because my patient died from neglect.