"Someone tied a knot in that restraint"

[Alnitak7]

When I was new to healthcare I had to work with a girl who liked to tie knots in the restraints even though this is a safety issue.

Sometimes she and I were working the wing alone together so I knew no one else would have done this.

I had a time getting this out and I was overwhelmed with my workload. I felt like the higher-ups were not going to listen to me if I complained about her.

I was livid that she was tying tight knots in the restraints and this was only one of her tactics on a long list of abuses.

As I worked at getting this knot out, my hands were aching and I wanted to start screaming and it was late at night when most of our people were all sleeping.

I was violated by having to work with someone this ignorant about safety.

What if I had to get someone up in a hurry or in an emergency?

When I wrote a note to the DoN about her, it was ignored, either/or she never actually got it.

Several years later, I was working in a hospital that had very few CNAs and I went into someone's room and now for my second time, found a tight knot in someone's restraint.

This time, I came down the hallway and announced loudly that "Someone tied a knot in that restraint." No one really answered back.

Later I was cited for "talking accusingly at them."

I was wondering why this behavior is never written up. Why am I being denied the right to express anger over something that is a dangerous practice and is totally uncalled for?

Anyone can tie a half-bow in the restraint. Even a ten-year-old can learn this.

It comes out with one firm tug and it is safe. You can even double this and have it still be safe.

[Lovely_RN, MSN]

You can confront a co-worker without blowing up at them. It is wrong to tie knots in restraints but blowing up and expressing anger in a hostile manner isn't going to help the situation. Do you feel that confronting someone needs to lead to a hostile encounter? Why did you yell down the hallway? You could have approached them directly. Next time you see a knot in a restraint speak to the person directly and stay calm so you don't escalate the situation. Tell them what you found. Explain why it's dangerous and ask them not to do it again. If they get an attitude that's their problem. Just walk away and if they do it again then report them because you gave them a chance to stop doing it. If your facility does nothing about it or gives you a hard time find a new job and maybe report them as well.

[iluvivt, BSN, RN]

You would be amazed with the number of health care workers that do not know how to tie a single or double slip knot. If you find it happening a lot always make sure you carry scissors with you in case you need to urgently cut them. Sure you can get upset about it..but remember to approach others in an assertive manner and not in an agressive manner. Agression violates anothers rights ..the distinction can be a bit tricky to understand and then execute the proper assertive method. Use the opportunity to teach. I would tend to do something like this... "Hey I noticed that in 442 A the restraint was knotted improperly and I have an easy way to make a slip knot..can I show you now." If you express your anger..others will become immediately defensive and then shut you out and will not hear a word you say anyway. I think I would also do an inservice or make soem kind of poster to put the the staff lounge..demonsrating the proper way to apply restarints and the key points about why it is important to do it that way. You will also be perceived well that way..as helpful..part of the team..not rigid..willing to identify a problem and then come up with a solution.

[jadelpn, LPN, EMT-B]

This is all fine well and good until a patient or a family decides to sue the facility as continually restraining a patient, knotted so they are really not able to be released easily is against the rights of the patient, which should be the number one concern. And further, the nurse loses her license as presumably, a CNA tied the knot or the nurse would take the blame for tying the knot. There are some pretty strict laws in most states regarding restraints. This goes against the basic human rights of a patient. THAT would be what I would base education on, as apparently, there are a number of people who need it in your facility. I am outraged that people are being continually restrained at all. So I don't blame you for being upset. Your license for sure is on the line with this, and most importantly, the basic human rights of the patient.

[Esme12, ASN, BSN, RN]

While I believe that patients have a right to be restraint free. I have the same belief they need to be safe and cared for. Obviously the need for restraints in LTC can be vastly different to the need for restraints in acute care, ICU or the ED.

It is not the message that might be misinterpreted but how the message is delivered. I would say that I observed that the restraints were not tied properly and you would like to show how that can be done. I'd offer to hold an inservice to "teach" everyone the proper technique. If it continued I'd start writing it up as an incident report.

I personally carry trauma shears for this very reason. If they need to be freed.....cut them.

[jadelpn, LPN, EMT-B]

And you are correct Esme. There are needs for restraints for patient safety in some instances, however, I believe in each facility in most all states there's some pretty strict guidelines of same. And tying people down in bed with knotted rope is very barbaric. It is against the law to leave animals tied for hours--people go to jail and pay fines for that. And you bet your bippy I would be red hot to find that as the only licensed person on the floor and responsible for the actions of UAP's, to find my patients tied down to the bed in knots that had to be cut, or the knots worked on for hours. That is abusive and wrong. And it will take some education (that I am curious if the UAP's are long standing employees, they REALLY don't know how to tie a slip knot?????) In my state, only an RN can apply restraints with an MD order only. And then there's a whole procedure that needs to be followed and documented. A family member comes for an unexpected visit to find Mom tied to the bed in 4 points (or 2 points, or one point) then guess what? Saiderap is responsible for that. Period.

[That Guy, BSN, RN, EMT-B]

What if I had to get someone up in a hurry or in an emergency?

That is why every nurse should have a pair of shears/scissors on them all the time. I have cut someone out of IV tubing they were trying to hang themselves with.