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Discussion

sheets being used as restraints

On the Geri-psych unit I work on, the management took away velcro lap belts and now the nightshift techs insist on tying patients to geri chairs with sheets because we have too many who are at high risk for falls and not enough staff to constantly watch them. I KNOW this is wrong and dangerous but I need this job. How should I handle this situation?

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    You are asking an impossible question: how to force your administration to staff well with no risk to your own job. Not gonna happen.

    Are you a tech or a licensed nurse? If you're their peer, the answer's simple - don't do it. If you're their supervisor, direct the techs not to do it and if they don't comply, take it up the chain of command. Do not take the risk of being charged with failure to supervise them properly. If mgmt cannot address the situation, have a chat with risk management. Find a way to use the words "abuse" and "sentinel event" in the conversation.

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    Totally apart from the staffing question and the issue of restraining people without an order (I'm assuming no one's getting an order to tie people into geri chairs with sheets and completing all the required restraint documentation ...), using sheets as restraints is completely forbidden by every agency that has anything to do with licensing, accrediting, or regulating psychiatric settings. You can point out to your administration that this is a blatant violation of state and federal regs that could get them into serious trouble; or, you could just report your employer to your state ombudsman and licensing agency and let the chips fall where they may (of course, your employer will probably figure out that it was you who reported them, esp. if you had already said something to them about the sheets, and you'll likely lose your job).

    It really boils down to what kind of employer you're working for. If the management is trying to do a good job and just doesn't know this is going on, that's one thing. If you're working for the kind of organization that just doesn't give a crap, there is not likely to be a good outcome, either for the clients or for you. I know you said you need the job, but, if it's the latter, I would be looking for another job. If you're the responsible nurse on the shift when this is happening, you're the one who is going to take the fall when the doo-doo hits the fan one way or another (as it eventually, inevitably, will). If you're a tech, you have less to lose, but it would be hard to argue later on that everyone else was doing it but you weren't, and you might end up in some kind of trouble, either with your employer or with the state, at some point. As the old saying goes, "silence equals assent" (that is, if you don't speak up and object to the practice, you're basically going along with it).

    This is a difficult spot to be in. Best wishes.

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    I am so sorry you are in this position. Assuming you are a licensed person if this doesn't change immediately upon notifying management which I would do in a way that was documented I highly recommend resigning. Needing a job and needing a license are often in conflict and while it is a shame you are in this position I don't see any other option because this has the potential to get really ugly.

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    OP, I'm curious - why are your residents up in Geri chairs on night shift? Are these residents restrained in bed as well? Are bed/chair alarms available? (Alarms don't prevent falls, but they do let you know when the resident is on the move so that, even if they do fall, staff would be getting to them quickly.) Does your facility have a fall prevention program?

    It's hard to know how to advise you without more information. The bottom line is do not ever use sheets as restraints or allow anyone you supervise to do it either. Accept the fact that falls will occur and put your energy into strategies to minimize the number and severity. Elkpark's excellent advice should be taken to heart (thank you, elk).

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    I think I will resign effective immediately tomorrow. There are bed alarms and no patients are never tied to beds. They tie wanderers to chairs so they won't fall in chairs in view of staff or in their room with staff looking in on them. The other staff justify this by saying the number one priority is to prevent falls.

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    I think I will resign effective immediately tomorrow. There are bed alarms and no patients are never tied to beds. They tie wanderers to chairs so they won't fall in chairs in view of staff or in their room with staff looking in on them. The other staff justify this by saying the number one priority is to prevent falls.

    I would encourage you to resign in the usual fashion, give the expected amount of notice, and leave this employer on good terms.

    Actually, preventing falls is not the facility's number one priority. Most accrediting and licensing agencies will tell you that the number one priority is protecting the clients' rights. Wanting to prevent falls is not justification for restraining people illicitly, and restraining people (with or without appropriate orders and justification) doesn't necessarily keep them safe. Perhaps you could encourage your coworkers to look at the literature on restraint-related injuries and deaths. :)

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    I'm sorry you find yourself in this position, Misty. I think if you are not in a position to change things for the better for your patients and for yourself (as far as liability, being asked to participate in things that make you uncomfortable, and so on) you are doing the right thing to resign in whatever way you see fit. Elkpark is right that giving the required notice at your job will leave you with a better reference and an easier time getting another job but in the end it is up to you. And yes, as others have said, using a restraint without an MD order and using sheets as restraints are both never ok regardless of the reasoning. I know how much fall prevention is emphasized in geri psych so I understand the pressures your coworkers are under and why they may have gotten off track in their priorities, but in the end that does not make their actions right or make them ones you want to participate in.

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    Totally apart from the staffing question and the issue of restraining people without an order (I'm assuming no one's getting an order to tie people into geri chairs with sheets and completing all the required restraint documentation ...), using sheets as restraints is completely forbidden by every agency that has anything to do with licensing, accrediting, or regulating psychiatric settings.

    When my nursing class was getting ready to graduate, we were taken to a Board of Nursing meeting. One case I remember vividly was an LPN having her license suspended for six months for tying a patient's wheelchair to a rail with a bed sheet. It wasn't even touching the patient and the BON saw it as egregious enough to stop this nurse from practicing.

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