AZ Ogre

Wow! That's great to hear. I definitely think this issue deserves some attention. A law on the books in my state would quickly bring to everyone's attention that it's not a safe practice. Would you be willing to help me find the law/statute in your state that defines it as a restraint? I would like to read how the law is written and find out who pushed for that change and how they passed that law. Thanks for bringing that to my attention and thanks in advance for your help.

I feel that as an NP you should set a standard for yourself and all other NP's by rejecting anything less than what you feel you are worth. You've worked hard to become a Nurse Practitioner and should show that by the choices you make. You should be starting out at a salary equal to the 20th percentile of the RN's in your area. Taking a job for the experience can be great for your career but only if it makes sense for what you want to do and only if it's a unique experience that you can't get somewhere else. Your first job will set your course and can confirm or invalidate your decision to become an NP. Also, if you take a job with a bad company, it may be harder to find a job in the future because it will reflect poorly on your resume. A company that is willing to pay so low will probably be cutting corners in a lot of other ways. I'd hold out if I were you.

I disagree because some people have such limited mobility that they cannot get out of a bed, chair or recliner (with our without a prop) at home without assistance. If the CMS definition is taken too literally, a flat bed with no guardrails would be considered a restraint for a quadriplegic. We do need to consider the actual patient, but to me it seems that common devices and equipment that people use at home for ADL's like beds, chairs and recliners should not be considered restraints unless they are modified in a way that would be unusual at home. This is where I agree with you because the prop is a modification. I can also see people doing the same thing at home, where guardrails on a bed are not an option at home and therefore worthy of more scrutiny. From the CMS definition: I think the key here is "attached to or adjacent to". A patient with limited mobility/ROM may not be able to touch their toes sitting in a chair or recliner at home. In this case, we are not restricting, their current state of health is restricting. We have not caused this situation their health is the causative factor. The problem I still see is that we are using the recliner in a way that the manufacturer didn't intend, putting ourselves and the institutions we work for at risk for being at fault if an injury were to occur. What I'm hearing from people who have posted, there are two real risks when using the recliner; the first is risk for entrapment and the second is risk for ejection. While their isn't any empirical data, I am seeing that the anecdotal evidence suggests that the safest course of action is to not use the recliner in an unsafe position. I'm okay with using deductive reasoning to create an evidence based practice statement. If the evidence is pointing to a particular practice creating a risk for injury, stop the practice. What if the solution is as simple as this: If a patient can demonstrate being able to move themselves in and out of a reclining position, then they can utilize the recliner and if not, they should remain in the seated position. The thing that I like about this solution is that it doesn't cost money to implement, it maintains patient safety by removing the risk for ejection injury and entrapment injury. I don't have to rock the boat on my unit and start bothering the managers and safety officers. At this point, there have been no reportable incidents and there is no way that an institution is going to make these chairs a budgetary priority at this time. I would appreciate if people would comment on the strengths and weaknesses of my proposed solution. Thanks! Ogre

Thank you all for your comments. I appreciate the input and can see the pro's and con's of using a trash can and not using a trash can. I can see that there is a tension between managing day to day patient injury risk and managing litigation/regulatory risk. I have reported the issues that I witnessed to my managers and over the last 10 years on our unit, there has never been an injury related to use of a trash can as a prop for the foot rest. Since starting this post, I've taken a new approach with the recliners. I have found that there are two reclining positions. The first position keeps the upper torso in an upright position where the second position reclined further allowing the patient to lay almost flat as if in bed. I've found that if I move the patient into the second position and then back to the first position, I don't need a prop under the footrest. In situations where this works, I will not need a trash can prop. If the footrest still does not stay up, I will inform the patient that we unfortunately cannot use the reclined position and will offer for them to sit up in bed if their bottom is getting tired or sore from sitting in the chair upright with feet down. Another option that I'm thinking about is giving them some way to elevate their feet without using the foot-rest of the chair. Something like an ottoman or footstool may be safer. Before I escalate reporting this concern within our hospital system, I want to find other options that don't require reporting. Of course, if I witness someone trapped or fallen, I will report but for now, I feel like I've done my job. One clarification I'd like to make is that the concept I was speaking about in legal terms is False or Wrongful Imprisonment. While four bed rails can be considered a restraint, I was thinking about the concept of wrongful imprisonment but I don't think that applies to our situation unless someone were to put a patient who had limited mobility alone in a room in the recliner with the foot-rest propped and the door closed for hours at a time. We are not a nursing home. I also don't see the chairs as a restraint from a legal or medical perspective with the foot propped up because a healthy person with full mobility and range of motion (ROM) would be able to safely get out of the chair. The problem is that our patients don't have full ROM because they are in a lot of pain after open heart surgery. Anyway... For those of you who have the recliner that has a second position, try adjusting to the second position before putting it back to the first position and see if that helps. Cheers!

I'm a new grad working on a cardiac progressive care unit and have identified an issue with the way our recliners are being used. When assisting patients into a reclining position, nurses and aids often put the garbage can under the foot of the recliner to prevent it from falling back into the sitting position because they don't stay in the reclining position for some reason. Our patients are older and our plan of care includes getting them out of bed and into the chair for breakfast lunch and dinner and walking four times a day among other things. We encourage them to only use the bed at night so reclining in the chair is a great way to make position changes and allow them to rest between meals, assessments, interventions, walks and physical therapy. The problem is that I've walked into rooms to see confused patients or patients who can't reach their call light trying to get out of the recliner with their foot/feet stuck in the garbage can and/or one or more legs caught in the space between leg-rest and the seat. I'm afraid that someone will end up falling and sustaining an injury. It seems to me that if using all four bed rails can is considered entrapment, then the same would be true if a patient can't get out of a recliner without assistance moving the object from under the let-rest. Does anyone else think that this situation seems dangerous or know of any facilities that have policies that prohibit the use of objects to hold up the leg-rest in a recliner chair? Thanks in advance for reading my post and sharing your input.