Restraint without order

Nurses Safety

Published

I had a combative patient who was fighting off 3+ staff with enormous strength. She was a schizophrenic who had not been taking her meds. I paged the Dr to see if he would order restraints. He never called back. Eventually we had 5 people, three nurses and two aides in the room attempting to get her back to bed. We put restraints on and I called the Dr again, at home, to update the status. He ordered a med to calm her down, but didn't confirm the restraints order. I got the order scanned, administered the med, meanwhile the patient was getting out of the restraints and trying to pull at her tubes and scratch at staff. I called the Dr back again and asked him pointedly about the restraints. He ordered a higher dose of the med and was angry that restraints were used. No order. I administered the med dose he ordered and removed the restraints.

The patient calmed down and was subdued once the med was in her system. Now I'm terrified I'm going to lose my job, maybe even license over this. I have no doubt that the situation was extremely unsafe. Every person in that room was in danger, including the patient to herself. I tried to call for more staff to help subdue her, but we no one else was available in that hall. In the end all I can keep thinking is "I restrained a patient without orders".

Feeling like my career is over...

Well i finally talked to my boss and she agreed with my actions. She said I did the right thing to keep the patient safe, but I should have tried lesser versions of restraints, like a belt. That wouldn't have worked with this thrashing patient, but I understand the need to start less invasively. I also should have called a manager right away so that they could have backed me up with what was going on as it was happening. In the end I still get to keep my job and live to nurse another day! Thank you all for your reassurance and opinions. As a new nurse I just didn't know what to expect. Your replies really helped as I waited to see what was going to come of this. :)

Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
She said I did the right thing to keep the patient safe but I should have tried lesser versions of restraints... I also should have called a manager right away so that they could have backed me up with what was going on as it was happening...:)[/quote']

I'm glad it all worked out. I wonder how a nurse actually covers her own orifice in a situation like this? Simply tell the pt to sit down and if they don't, just watch them hurt themselves while you call the manager and the police and check for orders? Is that the only way to be 100% "by the book"? In cases where the facility has no facility-wide protocol.

Specializes in Pedi.
That's weird that a resident can't write an order for restraints.

I don't think I've ever seen restraints ordered by anyone other than a resident. When I worked in the hospital, we had a patient who we routinely needed to put in 4 point leathers on the night shift. Said patient had a sitter at his bedside and security posted at the door. When he started acting out, we'd call for security reinforcements, wake up the resident and security would have him tied up pretty much by the time the resident came to the door. All the resident would do was basically nod or say ok and then put the order in the computer (as instructed by us, because they didn't know what needed to go in restraint orders). But it definitely wasn't an Attending or Fellow writing those orders.

Specializes in PCCN.

I bet that MD was an arrogant a whole who could care less if staff gets hurt or assaulted. Many MD's are this way. See nurses as disposable.

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