Patient abuse, difficult situation

[Joyfulnurse79]

Hi,

I am looking for guidance.

I am an lpn that works on a unit with complex behaviours. Essentially , to sum it up ,early onset dementias ( so they are still young and ambulatory enough that physical threats are real) and these patients have been sent to us after repeated incidents that regular interventions have not been succesful.

Safety is an issue, nurses are injured on a fairly regular basis. We currently have one out for a shattered pelvis, as an example.

I understand the extra stress can influence staff behaviours.

There is a HUGE problem though, where i can see sometimes staff have escalated behaviours.

I am relatively new to the unit. ( 5 months) but have extensive experience in dementia care. I also happen to love it, know it is my niche in nursing, and while i am not a perfect employee, at every job I have had, have received high praise for my ability to deal with said patients, and my willingness to try different approaches. I am not a new grad that is blind to how challenging some patients can be.

There is an intense bullying dynamic on the unit. I have heard staff say " we will make sure they leave" and witnessed the fall out. They lose good nurses all the time due to this.

We currently have one lpn suspended for that reason.

I went to management two months ago to express my concern over some patient care ( being held down by four staff face down to do care) faces being covered with blankets, and other things. I refused to give staff names because of fear of co workers.

My co workers mistakenly thought it was someone else who brought it up, and bullied her off the unit. Thankfully, she was casual and has full time work full elsewhere, but i still feel awful.

Nursing jobs are scarce here, and i am a single parent. I need to work full time.

This weekend at work was awful. They placed a woman in a pinel restraint after she became aggressive while doing care . Hitting, kicking, spitting. Five staff doing her care ( she regularly refuses) and talking about how disgusting she smells, how tbey arent allowed to hold her face down anymore...etc. I would want to spit as well, had i been her. This is regular treatment.

She was not my patient, and remained in the pinel for the remainder 6 hours of my shift. I came back 12 hours later and she was in same restraint, same chair, same spot. The night rn said while signing off to us " i didnt chart it and if anyone reports it i know it was one of you guys" no idea if it was supposed to be a joke. She did pass it along in taped report, and i noticed the night lpn had done appropiate charting.

I received her as a patient that morning. As soon as report was done, i immediately went to release her. My co workers could tell i was upset. When asked where i was going i said " she has been in there for 18 hours, this is wrong".

I also expressed that i was upset with myself for letting it happen for the six hours yesterday, despite her not being my patient. As an lpn though, i take direction from the rn's.

I went for morning break and when i came back she was in restraints. After the two hours was up ( which is the policy but still in ghis situation unnecessary) i said " ok, she's coming out". She slept most of the afternoon.

Come suppertime i was charting and heard a loud thunk that we all know is a fall. Said patient was on floor as another patient had pushed her down. The psw told me she had hit him ( no doubt) and then he retaliated. I immediately redirected him, and then came back to assist the staff with her.

The charge rn said to put her in the pinel restraint. While doing so, the charge nurse said " if you dont stop i will f ***ing punch you " and told us to put her chair " over there and let the sun burn her". Amongst other niceties.

This all makes me sick to my stomach. Along with sll the charting that happens on the unit that is false.

This is regular treatment of her, and other patients, although she gets the brunt of it, being so challenging.

I can't report this and go back to work, because of how staff would treat me.

I can't let it keep happening.

There is also the false documentation that if an investigation happened we would all be guilty of ( even though it comes from direction) and i fear losing my license.

I dont know what to do.

I apologize for the length of this post.

[FolksBtrippin, BSN, RN]

You are in a hellish situation. Being broke and unemployed is not worse than the moral distress you are experiencing in keeping quiet about the abuse. I've been broke and unemployed as a mother. It is an uncomfortable but temporary situation.

You know what you need to do. I am praying for you, for strength, for a better job opportunity, for justice.

[Been there,done that, ASN, RN]

"I can't report this and go back to work, because of how staff would treat me.

I can't let it keep happening.

There is also the false documentation."

Know when to say when. Resign now. Report the abuse to the proper board.

Best wishes, the truth will come out.

[dream'n, BSN, RN]

Do the right thing by your patient's and your license. Who cares if other employees get pissed off? Jobs come and go, but you won't get any work as a nurse if you lose your license. Do your work so that you can always defend yourself with the BON and continue to look yourself in the mirror.

[Emeraldsight]

YOU NEED TO REPORT THIS TO THE BOARD OF NURSING AND INCLUDE YOUR NAME!!

If you report the illegal actions that you are forced to do & the abuse you are forced to ignore because your job is in jeopardy you will not get into trouble with the board.

Your job as a nurse is to be a a patient advocate. Which you are not doing. You are allowing patients to be abused. Your inactions is also a form of abuse.

Call the board right now. Do what is right.

[Joyfulnurse79]

I did go to my manager. She has asked me to submit it in writing. She plans to forward it.

I spoke to my regulating body as well. They are going to back me .

I do have genuine concern that the witnesses will not tell the truth.

I am fully aware that this is abuse, and i am a mandatory reporter. So i did. I would have, anyhow.

I am also fully aware of how people can adapt to their surroundings, learn from nurses who are burnt out. This particular population of patients is extremely difficult. I am not making excuses, but i am aware that getting punched, kicked, bit , called names, having feces flung on you etc day in day out can do something to a psyche.

I feel as though there needs to be self awareness as to if this type of nursing is a good fit or not, and unfortunately, not everyone has that.

This will truly be a problem though. My licensing board has told me if need be they can help me find a new job. The hospital will have to accomodate me as well if need be.

There is no doubt in my mind the fall out from sone of my co workers will be huge and i will have to move on.

I live pay cheque to pay cheque and both of those could potentially take a long time. In an ideal world, i could do something else in the meantime, but where i live, jobs are scarce.

My manager told me in our meeting that she tells all the new grads to " model themselves " after me when questioning how to interact with these patients. I am fully aware i am good at what i do, and truly love it.

I think this situation is not only horrible for that patient ( and others) but reflects on what a toxic profession nursing can be , when you consider all the contributing factors in this situation.

I am really heartbroken over all of this.

[ChryssyD]

I'm so sorry you're in this position. I work in a setting much like yours and I know what your staff is going through, but there is simply no excuse for the scenes you have described. Your manager should not "forward" your complaint--s/he should have a mandatory meeting IMMEDIATELY and lay down the law: Anyone found to be engaging in abusive behavior will be in a world of %#@&. Period.

By the way, does your facility use cameras? They can really cramp an abuser's style.

I hope it works out well for you and your patients. You're doing the right thing--thank you. :)