Psychiatric patients refusing to move rooms?

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Specializes in Psychiatric.

I started working nights on a 21 bed psychiatric unit about  7 months back and have recently been “promoted” to charge. We have 7 private rooms and 7 double rooms with 2 beds. The private rooms are ideally saved for the extremely sick  or those who absolutely cannot have a roommate for whatever reason (Transgender, some sort of contagious infections,etc). Now normally, we can shuffle patients around say if we have a male in the ER downstairs that needs placement  but only have a female bed available. (Obviously males and females cannot room together). But The other night I was in charge and we had a situation where we only had an empty female bed available, there was a male patient in the ER needing placement, and all of our private rooms except for 1 absolutely could not be moved due to their level of acuity. The 1 Patient who could be moved absolutely refused.  I tried  to talk to her for an hour and she was adamant she was not moving and the only way she was going out of the room was By going down kicking and screaming. I called my nursing supervisor (who had told us all how much she despises psychiatric patients, psychiatric nurses are lazy and basically just those who couldn’t make it in “real” nursing, etc) and she completely lost her cool on me and told me the patient did not have a choice on moving and I needed to force her. I told her that I agreed with her that the patient did not technically have the “right” to not move as this was a hospital not a hotel, but there was no way I could “force” her unless I literally put my hands on her which would 1. Be assault/battery and 2. Would be considered a restraint which would require all the proper paperwork, the doctor coming in at 3am for a (unnecessary in my opinion) restraint and in general would just be wrong for it to escalate to that point . She hung up on me. Fortunately, the patient in the ER labs came back abnormal and it had to be corrected so he ended up not coming up on my shift, but I honestly don’t know what I would have done Had they not and they expected a bed for that patient. My question is, while I know patients do not have the “right” to refuse to move rooms, but what should I do in situations like this When it comes up next time?   

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Specializes in Mental health, substance abuse, geriatrics, PCU.

So I've had this play out before. ER was slammed we had multiple incoming admissions. Had a patient that needs to be moved to make room, refusing to go saying he'd tear the place a part if we moved him. We talked to the supervisor who talked to the doctor who talked to the on call administrator and the executive decision was made to call security and have the patient removed from the room and escorted to his new room. Once security arrived on the floor to do this he luckily became more cooperative but we were getting ready for a full on fight.

In my personal opinion I would try the path of least resistance but in our case there were simply too many patients needing a bed to justify allowing one patient to monopolize the unit.

If this ever happens again I would highly recommend that you do as you did and get input from your supervisor and psychiatrist and let them direct you on what needs to be done.

Oh, and sorry your supervisor has such a nasty attitude.

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If they want to go down "kicking and screaming", then we give them what they want. Security may be called, and some IM medication may be given ...but if they need to move, then they're moving.

Setting limits is important. It's not therapeutic to allow the patient to run the entire hospital. I do try to gain cooperation in other ways first, but I wouldn't spend an hour begging for compliance.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I'm certainly not blaming you for the situation that arose, but would there have been a way to approach the whole thing so the patient knows it's not really a request. Sometimes we make things sound like a question out of courtesy, but there are times where a statement just needs to be made.  I also would let a patient know that while it's not the route that we would prefer, security will come to escort them to a new room. If it's a case of moving from a private to a semi-private that's generally easily explained as an insurance issue because there is no medical necessity for the private room so the patient will be moving. 

Sorry your manager was completely unsupportive, that sounds like the type of person that shouldn't be in charge of anything. 

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What would you do if the patient was in any other area of the floor/unit that was not conducive to the care of other patients?

I agree that this can't be presented as a choice, and even if it wasn't originally presented as choice, the hour that she was given to discuss it did not help matters (not meaning to criticize you or be harsh...just realistic).

In this situation I would consult the psychiatrist and the supervisor and hope to make a plan that follows whatever policies you would normally follow when a patient is physically not where you need them to be and their location is interfering with the care of another patient.

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Specializes in Psych (25 years), Medical (15 years).
3 hours ago, Ashleynurse101 said:

My question is, while I know patients do not have the “right” to refuse to move rooms, but what should I do in situations like this When it comes up next time?   

On geriatric psych, we had a rodent problem and some of those safe little mouse traps were used various places on the unit.

If I took an armload of them in a noncompliant patient's room and began placing them under the bed and in the corners with a comment of "This is the most infested room!",  they begged to be moved.

Just kidding. But I had nothing else to add to the others' advice.

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Specializes in Psych, Addictions, SOL (Student of Life).

I had a patient refuse to change rooms on a prvious shift. They (The Noc shift) left it to AM (me and my team) as they didn't want a code green on noc that would wake everyone up. So after report I went and talked to the patient. He began gesturing and posturing aggressively stating that we couldn't force him to move. I calmly explained the next steps which would include possibly putting hands on the patient and physically removing him from the room, which might or might not include medication and time in observation. He continued with his posturing stating "I'll tear this whole hallway apart." to which I calmly stated " You do what you feel you have to do and I'll what I have to do."

Within 10 minutes he had quietly and calmly changrd roo with the help of floor staff. 

Where I work patients do not dictate their treatment.

Hppy

 

 

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Specializes in Psych, Addictions, SOL (Student of Life).
8 hours ago, Ashleynurse101 said:

"The private rooms are ideally saved for the extremely sick  or those who absolutely cannot have a roommate for whatever reason (Transgender, some sort of contagious infections,etc). ......

I don't think you meant what this statement implies which is that being transgender is/should be lumped in with those who have a contagious medical condition. As fas a I know you can't catch transgenderism. On our unit a patient is roomed with another patient of the same biolgical sex unless either party shows difficulty with appropriate boundaries, one or the other has a history of making false claims with regard to bing placed in the room with either a transgender patient. We have adolescents 13-17 who are perfectly capable of setting and maintaining boundaries. Some times we hear from family members who don't want their child roomed with that kind of person" I have had to explain to several parents that being LGBTQ is not contagious.

I remember once when I was discharging a patient the parent asked if his child would every be normal? My heart did break just a little for that child.

Hppy

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46 minutes ago, hppygr8ful said:

I don't think you meant what this statement implies which is that being transgender is/should be lumped in with those who have a contagious medical condition. As fas a I know you can't catch transgenderism.

I didn't take it that way, at all. Every hospital I've worked at has put transgender individuals in private rooms. No one thinks it's contagious. At least I've never heard that from anyone.

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Specializes in Psychiatric.
Quote

I don't think you meant what this statement implies which is that being transgender is/should be lumped in with those who have a contagious medical condition. As fas a I know you can't catch transgenderism

On our unit, it is policy that all transgender individuals, no matter where they are in their transition journey, have to have a private room, no exceptions. That is hospital policy throughout the entire organization. And I did not mean for it to sound like being transgender is lumped in with contagious diseases by any means. I obviously know you cannot “catch” transgenderism. I was just giving examples on situations and circumstances  that would Require a Patient having to have a private room according to our polices for example being transgender, having an open wound that is infected with MRSA, being extremely violent/manic/psychotic, the HIV+ patient who likes to pick their scabs and rub their blood on people,etc

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Specializes in Mental health, substance abuse, geriatrics, PCU.
4 hours ago, Ashleynurse101 said:

On our unit, it is policy that all transgender individuals, no matter where they are in their transition journey, have to have a private room, no exceptions. That is hospital policy throughout the entire organization. And I did not mean for it to sound like being transgender is lumped in with contagious diseases by any means. I obviously know you cannot “catch” transgenderism. I was just giving examples on situations and circumstances  that would Require a Patient having to have a private room according to our polices for example being transgender, having an open wound that is infected with MRSA, being extremely violent/manic/psychotic, the HIV+ patient who likes to pick their scabs and rub their blood on people,etc

That's probably the best policy, transphobia is just too alive and well and the last person a trans person needs during a psych patient is for a roommate to be ignorant. The problem we ran into on our adolescent unit is that there are more people out as trans at a younger age so you can run out of private rooms. It's definitely a complicated issue, balancing equality with safety with preference with legalities, I really think all hospitals need to go to private rooms for everyone, that would solve so much drama.

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Specializes in Mental Health, Gerontology, Palliative.

Your supervisor sounds like an ***. 

With those nurses I have to fight the urge not to bang heads together (metaphorically of course) and remind people that we are here for the best care of the patient.

The way our ward is set up, we have thirteen general beds, another 3 beds that can be locked off for a high care area, and 3 seclusion beds. Usually patients are happy to be moved out of the high care area. As others have said, we would frame it as 'we need you to move, I get that you don't want to, however moving to the open ward is a good thing, its getting you closer to going home. This move is going to happen and I would much rather help you with it. I don't want to see things going backwards for you"

If the patient was to kick off, we would need to assess whether the patient could be managed on the open ward or needed to go back to the low stimulus/seclusion area and if need be gather a large team. It's amazing how often the presence of lots of burly security and pysch nurses helps encourage compliance. That sounds wrong like I'm out to intimidate, the best comparison I can offer is when a patient hasn't been able to pass urine and we start to gather the supplies to insert an IDC and all of a sudden the patient manages to pee

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