Punched in face, kicked by resident

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A resident who clearly belongs in psych and new to our facility punched and kicked me. I was responding to an aide who called for assistance because they felt threatened. Later in the day, the doctor I'd notified was with a scheduled visit, and the resident attacked her. For this it was an emergency out to hospital. I'm often the only nurse on duty, with management nurses who are sometimes available. I'm finding more and more psych-related issues with residents, and with over 35 residents to pass meds for, I'm overwhelmed. How do other facilities handle residents who are a threat to staff and other residents? All I could do was beg my direct supervisor to please not let this particular resident back. I told her I can't handle all this, that I'll need help if this resident returns. The thing is, my time for the 60 or so residents I've got to consider is being sucked up by a couple of residents with their hallucinations, delusional thinking, etc. I'm in assisted living, by the way, and I love where I work, but I feel I need help with handling so many issues.

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Ugh, that's horrible. Are you injured?

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I believe this issue is a major problem, and more nurses within Long-care facilities are going to experience exactly what you are describing. It is due to the idea that new psycho-active drugs have come available. Mental health has moved from the hospital into the community. State "Mental Health" run hospitals are being closed in an increasing number. Those individuals are either being moved into the community, or they are being admitted to LCFs. It is those individuals who can not take care of themselves, or are a threat to self or others that will be admitted. A solution to the issue you have described has not been found. The state government is wiping their hands, saying "thank the lord it is not our problem". :crying2:

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Specializes in Hospice / Psych / RNAC.

As diligent-trooper stated about the state run psych facilities is true and many times they won't admit people who have Dx of dementia, Alzheimer's even though they have a history of psych Dx reserving the beds for the more serious cases.

So they all end up in the LTC facilities. I've worked in 2 LTC and both times about half the population had psych Dx and a few were aggressive like your resident. We handled them with meds because it was the only way but now days it might be near to impossible to do that (nothing really heavy, only prn stuff).

What to do.........bone up on your psych a bit. I know that sounds crass but it's the reality. Also do a med review for these people; they are constantly coming out with new meds for psych. The last place I worked where there were plenty of psych residents in LTC; those particular residents whom were on psych meds had a psychiatrist that monitored them.

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Specializes in ICU, Telemetry.

This is honestly one of the things that scares me about the next 50 years...we've got that huge "baby boomer" cohort that's going to be hitting the prime time for Alzheimers, dementia, etc. I spent my last shift trying desperately to keep one patient in bed, out of the floor and calm so he didn't have another episode and need to go back on the vent --- the family didn't want "pawpaw" sedated, but "pawpaw" was still physically strong and kept wanting to go home. Had he really put his mind to it, he'd have been able to really hurt us....I'm right at 6 feet, but the other 2 nurses with me were like 5'3" and petite, and this guy was bigger than me. We're about to have millions and millions more "pawpaws" and I'm not sure how the system is going to handle them.

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Specializes in neuro/ortho med surge 4.
This is honestly one of the things that scares me about the next 50 years...we've got that huge "baby boomer" cohort that's going to be hitting the prime time for Alzheimers, dementia, etc. I spent my last shift trying desperately to keep one patient in bed, out of the floor and calm so he didn't have another episode and need to go back on the vent --- the family didn't want "pawpaw" sedated, but "pawpaw" was still physically strong and kept wanting to go home. Had he really put his mind to it, he'd have been able to really hurt us....I'm right at 6 feet, but the other 2 nurses with me were like 5'3" and petite, and this guy was bigger than me. We're about to have millions and millions more "pawpaws" and I'm not sure how the system is going to handle them.

I work on a neuro/ortho floor and I see these types of patients all of the time. The family does not want them sedated which is understandable but then in in turn, the family needs to come in and stay with them and keep them under control. I think that would be one solution. The families don't understand that nurses do not have just that one patient and cannot be in the room all of the time. Even with one to ones it is dangerous. The CNA's can only do so much with a dementia/change in mental status patient to calm them down. When I was a CNA I was stuck in many one to ones where the patient became aggressive or threatening. Sometimes medication is the only way to keep the patient and staff safe. I think responsibility should be put back on the family if they do not allow us to do everything we can do to keep their family safe.

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This reminds me of hen I was a CNA and I worked on a locked Alzheimer's unit. A blind non am pt, grabbed me (with feces under her nails), and kicked me in my stomach. Did I mention I was 6 months pregnant at the time.

Oh boy, did I go off. That was it. It is not our job to be abused no matter the pysc status of a patient. This patient's first need the correct facility placement, and then we need to remember that is some cases restraints are necessary.

This patient was known for things like this, and I hadn't had her before. I went to the DON, and let her know, that while others just took the abuse as part of he job I wasn't going to. Let's just say I got laid off, due to a "low census", with a nice severance.

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Ugh, that's horrible. Are you injured?

No, not injured. It was just an awful feeling, more like being violated I suppose. Also, in danger and there with, excuse the simplicity, a "crazy" person.

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This reminds me of hen I was a CNA and I worked on a locked Alzheimer's unit. A blind non am pt, grabbed me (with feces under her nails), and kicked me in my stomach. Did I mention I was 6 months pregnant at the time.

Oh boy, did I go off. That was it. It is not our job to be abused no matter the pysc status of a patient. This patient's first need the correct facility placement, and then we need to remember that is some cases restraints are necessary.

This patient was known for things like this, and I hadn't had here before. I went to the DON, and let her know, that while others just took the abuse as part of he job I wasn't going to. Let's just say I got laid off (due to a low census), with a nice severance

Oh no! You were pregnant, and hit by a patient! How awful! The thing is, we do need to be honest, and go to management as you did. We are nurses, but just as the doctor in my case would not take the abuse, NURSES should not take the abuse either. If your co-workers had gone to the DON, you likely would not have had this experience, as you'd not have been let in to care for the patient while pregnant.

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Specializes in Trauma Surgical ICU.

We have a pt that has been on our floor for over 8 months now.. We are not LTC or a psych floor.. I work a 36 bed renal unit at a large hospital.. This pt was placed on our floor just because we had a bed. She refuses meds, vitals, unwrapped food, ADLs etc.. She is a psych pt with dementia..

Psych facilities wont take her because they say she is "not a psych pt she has dementia", LTC wont take her because they say she is does not fit their criteria she is "psych".. So for almost a year she has been on our floor.. I wonder if she will ever leave.

The sad thing is, many pts like her suffer and have no where to go. The family can't care for her, she refuses to even see them. So what will happen as many more become like her over the next few years?

Very sad situation....

I have been called ever name in the book, pts have tried to bite me, spit at me and some have tried to hit.. I just keep my eyes open and stay out of arms reach when at all possible. Those I just wrote were from little old ladies..

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Thank you all for the thoughtful replies! I see this is a problem that is only getting bigger!

As for dementia issues, in particular Alzheimer's disease, I have a passion for geriatrics partly due to caring for those with this horrible disease. As disturbing as the thought processes can be, generally there are tried-and-true methods that work in caring for this population. When you throw in the residents whom nobody else will take who have a long history of schizophophrenia, bipolar, etc., this is what I'm wondering, why us? And in my psych clinicals, we had plenty of staff (that would be ME who's called if a problem where I work!), we had the use of restraints (in AL restraints are not allowed), meds (already beaten up by the time connect all the dots get meds), and seclusion rooms if necessary (maybe the nursing office in AL!?). It just seems that we who are being dumped on with psych cases are the most vulnerable. While we do have psych services and meds (IF the family signs on and agrees to both), it's truly a far cry from the kind of intervention these poor residents need. Those I've tried sending to ER with psych-related issues almost always get sent back with dx dehydration or something, not even having been seen by psych. In the case of this resident who hit me, the DAY BEFORE, we sent her to the ER because she was out and about damaging items and required 3 staff members to keep her from hurting others. She returned to our facility a few hours later, with her family fuming mad that we'd sent her out, as if why??? That next morning, my incident, I did a prn med, she woke up a few hours later, saw Doc, and sent to a different ER the other side of town. I mean, the little old ladies and gentlemen looking for a retirement community, I didn't really have time to appropriately provide for them...that's what gets me too. And for the advice of brushing up on my psych, yes thanks doing that, and also sent a Christmas email to our psychologist, wished the Psych NP Merry Christmas by phone,...:) trying to keep warm relationship because we NEED their help. I'm also looking at my career goals, as I want to be a Geriatric NP, but I may want to lean more Psych NP for a secure job.

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Specializes in School Nursing.

I'm so sorry this happened to you. NOBODY should experience this type of abuse no matter what their field is. I hope they find a solution, as physical abuse is unacceptable.. not to mention a crime.. or does law not apply to LTC?

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