Shady S/R practices. . .

[BSNBritt]

Hello all,

I just accepted a job at a new psych facility, and so far it's pretty awful. Besides the nurses being completely rude and hostile to me all the time, there are some shady things going on with their seclusion and restraint practices.

For one, the documentation is terrible. They just write the total time spent in S/R but don't differentiate between the two. Another thing, is how long they allow patients to stay in seclusion. Average time spent in seclusion at this place is well over 10 hours!

Seems pretty long to me. . . .

The worst thing is that I think they aren't practicing 4 and 5 point correctly. First, I don't even agree with the use of 5 point anymore due to the risk of suffocation. Besides that, there was an incident that, at least to me, was TOTALLY illegal and unethical.

A patient had been in seclusion for over ten hours, just sitting there doing nothing. He got bored, I assumed, and decided to rip the mattress off a wood bed frame. That's when he was placed in 5 point. The thing is though, he wasn't trying to hurt himself with it. He wasn't hurting himself AT ALL, and so it's pretty much that they restrained him to punish him.

When I brought up this concern, I was basically told that I don't have as much experience as my orientation nurse and to mind my own business.

Am I right? This job sucks.

[Bklyn_RN]

You should leave. Remember that witnessing pt abuse and not reporting it makes you just as guilty.

[wish_me_luck, BSN, RN]

You need to report that. I agree with the other poster, you are just as guilty if you know and witness that and do nothing.

[Davey Do]

,

He wasn't hurting himself AT ALL, and so it's pretty much that they restrained him to punish him.

When I brought up this concern, I was basically told that I don't have as much experience as my orientation nurse and to mind my own business.

Am I right? This job sucks.

You are correct. Bklyn and luck are correct.

However, having experienced similar circumstances, if you decide to Fight the Good Fight, realize you are in for the Ride of Your Life. This Ride will be very very exciting, it won't be fun, and you could just end the Ride with being the Bad Guy.

I'd like to give you a little advice, if I may: Objectively Document everything. Make or keep copies of objectively documented facts. Follow the Chain of Command. Document meetings with Officials and supply them with a copy. Accept nothing that is conveyed only by mouth- if it isn't documented, it never happened. Do not take anything said about you personally. Always keep Principles above Personalities. Remember that you are a Nurse first. Utilize Outside Resources only if a Resolution cannot be reached by first utilizing Inside Resources. When you've done all that you can do, accept the Outcome. And, finally, do as a Wise Man once suggested, "If anyone will not listen to your words, shake the dust off your feet when you leave..."

The very best to you, Britt.

Dave

[newtinmpls, BSN, RN]

Maybe we aren't thinking of the same thing. With us, 5-point is limbs and a waist restraint.

Diane

[macfar28]

Have you considered reporting the hospital/agency to an outside authority? Investigate whether you can make an anonymous complaint to Joint Commission or DFS. They need to know and you need to protect your license and your patients.

[Orca, ADN, ASN, RN]

Practices like this are what led to the demise of Charter Behavioral Health Systems. I worked for Charter (fortunately not one of the facilities using improper restraint techniques) when the company essentially went under. CBS's 60 Minutes did an undercover expose of some of the practices of a Charter facility in North Carolina. These people could not have done much else wrong. They did not follow company policy in restraint situations, and a child died during one of these situations. Employees were fabricating documentation, and at least one doctor was charting patient encounters that did not happen. It's not a situation you want to be around.

[elkpark]

Run, don't walk, away from that place ... (And call and report to your state licensing/regulatory agency.)

[HolyPeas]

You need to report all of this in detail, and get out of there because by witnessing this and not doing much of anything you are also guilty. Not to say that there is anything you can really "DO" but you catch my drift....

You must protect your license.

[chevyv, BSN, RN]

I'm wondering why a pt is in seclusion for so long when they are sitting in there quiet and doing nothing? I wonder if the nurse was assessing the pt during that time?

If you stay, learn all that you can and be a better nurse. I see things daily that make me cringe inside. I'm still learning and it's been almost 2 yrs at part time. I try to be the best that I can be. I stay because I love behavioral health and I have a knack for it. I see many that have no therapeutic nature to them at all. My goal is to get everyone through the night safely and learn something new. If I can make just one thing better, I've won that night.

Stay if you can stomach it and make it better, run if it's just too much! Try to be aware of policy and follow it. Ours fill 3 big huge binders, which makes learning something new daily a breeze, lol. I do know that many people I work with are not concerned with pt rights so educating yourself is key. Good luck!

[newtinmpls, BSN, RN]

I've been thinking about this and while I do work in psych (inpatient & acute/emergent), and I have seen patients in a combination of restraint/seclusion/PADS (the latter is a kind of restraint a pt can walk around in, but they don't have enough freedom of movement [theoretically] to assault someone - although I've seen it happen so nothing's perfect) but our documentation is really detailed. You have to have an observer, and q 15 min documentation, and a face to face with the ordering provider at least every 8 hours and check for ROM/need 2 pee/restraint fit very often; jeez, I mean it's really really detailed.

I have seen really psychotic/violent/aggressive patients be in restraints and/or seclusion (and if you downgrade it to seclusion, then you have to get a new order to go back to restraints) for more than a day, and it was totally needed.

But you are right, something about what you are seeing in the lack of detail in your facility says ominous things about patient safety.

Diane

[algebra_demystified]

As a psych nurse, S/R is Code Blue. This is the most acute situation you can be in. Consider the crash team in the ED as the equivalent of the S/R situation on a psychiatric ward. There are many regulations in your state's Nurse Practice Act that deal with this situation. Every so many minutes a patient must be offered the opportunity to evacuate their bowel or bladder, to exercise a limb, circulation must be assessed, conditions for release must be communicated, opportunities for release must be documented, etc. All of your documentation will be reviewed by a board for abuse. S/R is extremely serious and every detail must be attended to without exception. It's a serious matter to take away a person's freedom of movement. Once you do so, your relationship with that patient is forever changed. How you implement your hospital's policies and your documentation of the same is vital to your continued employment and ability to therapeutically interact with the patient.

It's easy to lose your license over S/R issues. Learn your hospital's policies and procedures, and adhere to them strongly. If you feel your hospital's S/R policies are out of line, get out.

I know too many people who lost their livelihoods and their homes because of a serious interruption in their profession and credentials over S/R issues.

A compassionate and professional implementation of S/R policies and procedures can enhance your relationship with a patient, if you can believe that. If a patient is a frequent flyer, they know what is supposed to be done. Meet their expectations and it's likely that you will be able to retain a professional relationship with the patient. That means fewer problems down the road with them.