Recipient's right's complaint filed on me

Nurses General Nursing

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Specializes in Psychiatric Nursing.

I am a Registered Nurse case manager for community mental health. I was called into the med clinic last week to help out as they were short a nurse. I was performing an assessment on a patient after her appointment with Psychiatrist. This consumer is a middle aged woman with Borderline Personality Disorder with past SA history. When assessment was finished, I handed my consumer the Doctor's order for drug screen to be performed at lab across the street. This is a new policy and must be completed before hard copy script for benzo's can be given. I explained this to consumer very thoroughly and she became upset. She states, "I have never had to do this before," and her tone of voice became hard and loud with the use of many expletives. I remained professional and continued to explain the policy. Another RN who is a clinic veteran came into room and helped to explain the new policy, and was very sweet and sincere in her explanation. Consumer refused to do labs stating she "Has a volunteer driver who will leave me, I have my granddaughter with me," and, "I have people waiting for me at home." She also stated she will have this performed at her PCP's office. We continued to explain this will only take five minutes of her time and she can leave with scripts. Consumer left AMA without lab slip or her scripts.

Consumer was observed in the lobby 30 minutes later filing a Recipient's Rights violation on me stating "I touched her and I was very unprofessional toward her." She called her caseworker and left a message stating I touched her and tried to spread her legs. During assessment, I did ask consumer to uncross her legs and place feet flat on floor shoulder width apart. I asked that she not speak, close eyes and think pleasant thoughts while BP is being performed. I did touch her shoe when I asked her to place feet shoulder width apart. The only other touching was placing sphygmonameter and stethoscope on arm. I am very upset about this and my boss is aware of these allegations. I am reaching out for consultation from others who may have had similar incidents. Should I retain legal representation for protection and/or libel?

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I wouldn't bother with a lawyer for this. I would make sure the hard facts were recorded for future reference, though. You're probably not the first person she's made an unfounded complaint against.

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I wouldn't be concerned about defending yourself against libel at this point. In order to win in a libel action you would need to prove damages, or losses, which unless you lose your job is unlikely. Also it sounds like it would be hard to collect on a civil suit with this patient.

As to other needs for representation, I need to say that although I understand asking a patient to uncross their legs to get an accurate B/P, I have never seen a nurse ask someone to place their feet shoulder width apart. If someone asked me to do that to do a B/P check I would be uncomfortable due to the strangeness of the request, especially if the clinician reinforced the request with ANY touch, foot or otherwise. Given that this was a psych patient I would have been especially careful. I'm sorry, but I see a lapse in clinical judgment here. The feet apart stance is part of a standing exercise to lower blood pressure, and your assessment's objective should have been to get an accurate baseline.

Were I you I wouldn't go so far as to retain counsel until I saw what next steps were taken as a result of the complaint. But I'd be prepared by having researched representation options, and I'd be ready to engage at the first sign of any proceedings, employment or otherwise.

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Specializes in Psychiatric Nursing.

Thanks for the input, Sour Lemon, I have wondered if she has filed other complaints in the past.

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Specializes in Psych (25 years), Medical (15 years).

I can only echo what Sour Lemon and Kitallic said, nur5emarte, and reinforce the BP check and touching thing. If a patient is running a high BP, I'll encourage relaxation and the like to see if it isn't a transient situation.

I'm especially careful around those with an axis II diagnosis.

Having worked in psych on and off for nearly 35 years, I have been accused on numerous occasions of inappropriate behavior, e.g. having sex in the soiled utility room and another who accused me of rape. Nothing has ever come of these accusations after the initial investigation.

I hope this passes without incident, nur5emarte, and becomes merely a learning situation.

The very best to you.

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A problem with the patient with Borderline Personality Disorder is nothing to fool around with. I have seen nurses lose their jobs due to their "complaints".

You must have documentation from your supervisor regarding your report of the incident. I hope your documentation of the incident is spot on. You can go back and add an addendum.

I would notify my malpractice carrier... and be ready to lawyer up.

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Specializes in Critical Care; Cardiac; Professional Development.

My only concern would be whether you documented these interventions clearly in the chart. If you did, you have nothing to worry about.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

Do you have any witnesses?

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Specializes in ER.

I would not touch a borderline patient without asking their consent first, unless they were about to hurt themselves or others. It would be a great thing to do the same with everyone, but nursing is a touchy profession. But borderlines, or anyone a bit out of touch with reality...I try to get clear consent, and let them know what is happening and why.

Insisting someone be in a particular position for a blood pressure is a bit anal. Moving them without permission is pushy, though your intentions might be benign. So many choices are taken away from our patients, she may have had a "last straw" moment.

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Specializes in Adult and pediatric emergency and critical care.

As others have said, borderline patients are a risk management nightmare and I avoid them at all costs. I've been fired by several and have yet to shed a tear about it. That being said I would make sure that their medical record reflects the facts of your care, and I would be writing an email with the facts of the situation to your manager and risk management.

This patient clearly had ulterior motive in not wanting to provide a urine sample, and was looking for a reason for you to give her the script without her providing a urine sample.

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I would not touch a borderline patient without asking their consent first, unless they were about to hurt themselves or others. It would be a great thing to do the same with everyone, but nursing is a touchy profession. But borderlines, or anyone a bit out of touch with reality...I try to get clear consent, and let them know what is happening and why.

Insisting someone be in a particular position for a blood pressure is a bit anal. Moving them without permission is pushy, though your intentions might be benign. So many choices are taken away from our patients, she may have had a "last straw" moment.

You are blaming the victim. The nurse can obtain clear consent, the borderline will deny giving it.

The position requested for obtaining correct BP is good practice.

Borderlines are always at the last straw moment.

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