"Take down" in LTC?????

[NurseyTee]

I reported a situation to the Unit Manager that another nurse did what she referred to as a "take down" on a LTC resident. I am new to LTC and had no clue what she was talking about when she told me she was going to do this to the resident. I pleaded with her to allow me to take the resident back to her room and allow me to give her the IM inj. of ativan to her while in bed and that I thought she would allow me to give it to her because she trusted me. But this nurse had a head full of steam and didn't even want to discuss it. So she tripped her and knocked her to the floor and shot her with the ativan through her clothing. I don't even know how she could accurately hit her landmarks with the res. clothing still on. The unit manae ger told me this was abuse and should have been reported immediately, which I didn't do because the nurse was training me at the time and when I questioned her on it she told me it was policy, so how was I to know differently? My gut bothered me about this incident until I finally went to the unit manager about it. The nurse had left employment at our facility by this time (2-3 weeks later) (She walked out one day because she was riffed about something.)

Anyweveray.. last week I come into work to see her name on the schedule again. I was completely SHOCKED!! I went to the unit manager and asked her why given what I had reported to her and she didn't have much to say other than she didn't have control over it. I asked her if she had told the DON about it and she didn't reply. I told her to nevermind then because i had emailed the Admin. and the DON and explained everything in grand detail. She was later called into the Admin's office and asked if this had been reported to her, she said she had no recollection of it, even though we had just discussed it again that very morning. (LIAR!) I gave the CNA's names that witnessed the act and they were interviewed too. At this point I don't know what to do. If she comes back after I've reported this, she is going to make my life a living hell for ratting her out. She was already bullyish with everyone on staff and would scream and yell at everyone, bossing people around and telling them she was the new ADON (She's an LPN) etc. No one knew officially what her title was, but she acted as though she was the boss, so most of us believed she was.

My dilemma is that I don't know now if I did the right thing. My admin. was great and nice to me. The DON was not so nice and treated me like a nuisance. As though I had broken some unwritten rule to never rat out another nurse. I play by the rules and I don't want to see elderly people abused. In the nurse's defense, the res. was combative and she did bite her. I don't have this reaction from the resident at all. All I typically have to do is talk nice to her and she will follow me anywhere. This nurse has had run-ins with other residents as well. To me she is a loose cannon just waiting to go off again.

Please give me your insight. I am so new to LTC I'm not sure what I did was right or wrong now. I don't think the DON even believes me since the Unit manager has denied the report. Now I look like the bad guy, even though I wasn't the one who did this. What is the Admin. staff's responsibility to do with this information once it has been confirmed by the other witnesses? I don't wish to ruin this nurse's life, I just don't want her to come back to work at this LTC facility. She is always making life a living hell for the rest of us, not to mention the resident's too. Someone please tell me what I did was right or wrong?

[bigtex]

First off, I am an LVN who is an ADON, is there something wrong with that? Second off, your facility should have a abuse coordinator, but beings you were in training, and probably had no idea who this person was, you did the right thing. For future reference, especialy in ltc, always, always call your administror with anything you feel is abuse. If you had to ask yourself if this was abuse, then it is 99% of the time abuse. Last thing I have to say, you did no one a favor by not reporting this person to the state. Just because she is no longer abusing your Pt's, doesnt mean she not abusing someone elses!!! And if possible always follow up with what you report to anyone on abuse. They may not be able to tell you directly what is happening, but they will be able to tell you if they our investigating the complaint. :confused::confused::confused::confused::confused::confused:

[Midwest4me]

Hey Nascar-nurse---oh I was being facetious and I guess you're right--did some misinterpretation too--it's late!:) :chuckle

[BRANDY LPN]

I agree that you need to report this to the BON, this person will continue to abuse pts. and also you can always call your local ombudsman if you suspect abuse.

Doesn't the mandatory reporter laws cover elderly abuse? if so then if you dont report this to the BON yourself and they find out, YOU can also get in trouble with the BON.

[NurseyTee]

First off, I am an LVN who is an ADON, is there something wrong with that? Second off, your facility should have a abuse coordinator, but beings you were in training, and probably had no idea who this person was, you did the right thing. For future reference, especialy in ltc, always, always call your administror with anything you feel is abuse. If you had to ask yourself if this was abuse, then it is 99% of the time abuse. Last thing I have to say, you did no one a favor by not reporting this person to the state. Just because she is no longer abusing your Pt's, doesnt mean she not abusing someone elses!!! And if possible always follow up with what you report to anyone on abuse. They may not be able to tell you directly what is happening, but they will be able to tell you if they our investigating the complaint. :confused::confused::confused::confused::confused::confused:

Of course, there is nothing wrong with an LPN being an ADON. But at our facility they only hire RN's for administrative duties. Of course I have no objection to an LPN in this position. I'm an LPN and it is great to see that we can advance into administration without becoming an RN. That comment was mentioned to show her dishonesty, not that there was anything wrong with the position.

I've also tried to follow up with what is happening. I know for sure an investigation was performed. I just don't know the outcome. Last I heard from her one and only friend at our facility was that they had not decided whether she was coming back or not. What I heard from one person in admin. was that she was not coming back, from what he knows. I just know if she does come back there, she will make my life a living hell for turning her in. She made my life a living hell before I turned her in, so I can't even imagine how bad it would be now. :trout: We also live in a state that borders two other states, she can easily run over the line and get another state license and work there. I hope she is reported to the BON, does the facility have the responsibility to report this?

[vampiregirl, BSN, RN]

Tripping a resident??? I have worked in several settings that care for psych patients with a potential for violence. Not as a nurse, but I am guessing that some guidelines are the same for all staff working with psych patients. Staff was required to have training on specific techniques if a patient had to be assisted to the floor for safety and tripping a patient was never included. It was also a requirement to have detailed documentation of the entire incident if a "take down" occurred (including events prior to the escalation of behavior, what redirection/ deescalation techniques were attempted, etc). My question is, did the nurse document this incident (beyond the med administration)? Also, did this resident have a behavior/ care plan and was it followed to avoid getting to the point where a "take down" was needed? Although occasionally, a resident can escalate so quickly that it isn't an option to follow all the least restrictive steps due to safety issues.

Also, to the OP, your establishing a rapport with this patient was great. Sometimes, just a different person with a different personality is just what it takes to deescalate a situation. If you enjoy LTC, it sounds like you will be very successful with it. Good luck.

[NurseyTee]

We do have a behavior care plan on residents who have the potential for being combative. On this care plan I saw no notations as to what happened, but we have computer charting and I don't know what she wrote on that, if at all. Since no one seemed to know about the take down, I would venture to say that she didn't document it.

Thank you for your comments-- I do have a great rapport with a lot of the residents and I really LOVE my job. It's the first job I've ever had in nursing that I can't wait to get to work. I miss them when I'm not there and I worry about them when I know they are getting very ill. This particular resident will come to me for a hug every time she sees me. She knows I love her and will always do my best to protect her. There are so many of these people that need to know that they are not just a number to their nurses and to me they aren't. They're all special and I enjoy each and every one of them. The down side to me being so close to all of them is that it takes me forever to get through my med pass, because they wall want to talk, hug and catch up while I bring them their medicines. And they always get a hug goodnight when I tuck them in for the night. They know I really care about them and I know they need that. :icon_hug:

[CapeCodMermaid, RN]

In this state MASSACHUSETTS..we can NOT use IM ativan to subdue or otherwise calm an agitated patient down..it can only be used in the case of a seizure. It's considered a chemical restraint. Oh wait...in SNF's we can't do that...the local hospital used IM Haldol all the time!

And not to start an 'Initial War' but read the nurse practice act. In Massachusetts an LPN can not really supervise an RN so there is no way an LPN could legally be an ADON.

[BRANDY LPN]

I hope she is reported to the BON, does the facility have the responsibility to report this?

Check with your nurse practice act under mandatory reporting, but I believe it is also YOUR responsibility to report this. Of course it would also be the responsibilty of the facility, but YOU could be held accountable for not following the nurse practice act if you are required to report and you don't.

Someone jump in here and tell me if I am correct or not.....

[CapeCodMermaid, RN]

I think you're right....we are mandatory reporters.

[Renashia]

Check with your nurse practice act under mandatory reporting, but I believe it is also YOUR responsibility to report this. Of course it would also be the responsibilty of the facility, but YOU could be held accountable for not following the nurse practice act if you are required to report and you don't.

Someone jump in here and tell me if I am correct or not.....

YES! Nurses are manditory reporters and above all PATIENT ADVOCATES! I personally find it appauling that anyone is put in this situation as a new grad nurse. And that ANY resident is "taken down". It suggests to me that the facility cannot meet that resident's needs. I know it's different in SNFs and NH, but in an Assisted Living the resident must be stable and predictible to be a resident under the DON's care. You can make an anounomous tip to the State if you truly feel your job/standing is in jepordy, though it won't have as much of an impact. Also you can contact the local omsbudsman. Studies have shown the 70++% of the time problem behaviors in residents are directly related to the CAREGIVER approach. Personally I hope the nurse got a nice bacterial infection when the resident bit her.

Good on you to report it! It is very difficult to pluck up the courage in a new job and a new feild. PErsoanlly I think it is great haveing a mixed population of nurses in any nursing area. You have the new "book smarts" and the "teaching of lifetime" expereinces to help provide excellent nursing to our elders.

Good luck .. HHC LPN!!!

For you DON---> :trout:

[meownsmile, BSN, RN]

When i worked with DD/MR one of the first rules after you learned agression management was you have one right as a caretaker.

The right to run. So given that, and those who work in that environment know what im talking about. That nurse had no right to put her hands on that patient. PERIOD.

[Renashia]

I agree! One teaching method I like to do with my caregivers is "reality switch". They get to sit in a wheelchair, drink a full glass of water, and try to get someone to help them. Or they get to be a guinea pig in transfers, hoyer lift training, and feeding so they know how their residents feel. Too bad we couldn't return the favor to the nurse who assulted this resident!!