staff abuse

bargainhound, RN · Jan 18, 2005

It would be good to get a psych eval. He could be inpatient on a geripsych unit to evaluate/adjust his meds for behavior control.

CoffeeRTC, BSN, RN · Jan 18, 2005

without knowing his medical history I second the psych consult and also recomend doing a medical work up. Labs etc. Get the ID team involved especialy the behavior program. Yes resident sometimes hurt us,but it shouldn't be the norm. Once the facility admits him..its your problem. In our LTC it is very hard to get them out.

The lawsuit happy family is a concern too. They should be involved in all careplaning. You are right...getting agressive with a resident is abuse. Even if a family says to trasnfer them without a lift I would not. Make sure you are communicating to the nurse any family complaints or demands.

medpsychRN · Jan 18, 2005

We get patients all the time from LTC who have been aggressive. It's common practice for them to transfer a patient to psych if a resident hits someone. We have a young girl now who has CP and is MR. She bit once at the group home and was shipped to us. It seems your facility has to develop a standard and stick to it. It doesn't matter why someone is aggressive. Violent behavior is unacceptable.

Antikigirl, ASN, RN · Jan 18, 2005

Okay..this is a classic case of DOCUMENT DOCUMENT DOCUMENT!!!!!!! Until something is done to lower the aggression you must DOCUMENT it as much as possible to cover yourself in cases of potential lawsuits!

There is a trend going on that scares the devil out of me. Lawyers are telling their clients to wait 5-7 years before filling a lawsuit. WHY? Because they trust by that time you will not remember certain facts or days in questions and that helps their case! If things are not written down, they are considered as not happening at all...and that can certainly come back to haunt you!

Document what the situation was, quotes, discribe the physical as you see it...like don't say "slap" but state, "used open hand and made contact with CNA's face with audiable smacking sound, causing redness to the face and verbal mention of pain". (I have seen cases where staff has gotten in trouble because the lawyers have said 'slap' is subjective..and since it wasn't written like above were able to discount the slap all together!!!!), and most importantly document what was done to help the situation..your implementations are very important so you can be cleared of any neglect (if you don't put down what you did, they will assume you did NOTHING!).

I also add a plan...like "will speak to PCP about a geri psych eval" or "put on alert status and monitor/chart q-shift for behavioral concerns and parameters when to notify the RN" (we have one nurse per shift so CNA's must alert us to probelms..so I always have to write parameters to call an RN).

Even though I don't really do the old SOAP charting by the book...I do chart incidents like this in that type of format. That way I am not leaving anything out! Subjective, Objective, Action, Plan. Good to keep that in the back of you head for charting.

Good luck, and hope the resident gets to a facility more suited for him quickly...but my history shows that family tends to not approve of special 'homes' out of denial and cost...so good luck!

If he is a vet, why not a VA home??? Uhggggggggg! (most are shutting down around here even though the need is very high...so many times it is not an option...grrrrr!).

Antikigirl, ASN, RN · Jan 18, 2005

I also, as a nurse, have a habit of coping the chart notes and sending these into their PCP to REALLY show an MD that there is a real probelm! Sometimes the chart notes are the only way to prove that there is a probelm, vs say...the family saying nothing is wrong or blaming the staff (or an MD thinking...they just don't want to deal with them!)!

Every time I have sent in the chart notes, I have gotten results. See if this is possible in your facility (some have disclosure rules to contend with..even though an MD is allowed to see any documention about their patients!).

Also, don't forget some non-pharamlogical implementations to help quell behaviors. Like quiet dim room (not dark...just a little dimmer to quell overstimulation by too many lights). Music the resident likes...I find this one works wonders (avoid loud or fast paced music though). Offer a beverage or snack. Sit at a safe distance and try to have a nice conversation...make sure you sit, some people get aggressive because you are up above them in a dominient stance. Actively listen, sometimes they will say they are feeling overwhelmed and you can document that in quotes and either keep on trying alternative implementations to quell..or a prn medication for anxiety.

I have had residents that actually freak out more with quiet darker rooms, and like to keep themselves busy! We have soft squishy balls for residents to squeeze if they are anxious (and they don't hurt so much when they are hucked at you!), or we also had some envelopes that we had some residents help us sort away (all fake of course, but they feel productive and that helps!). Or we have had residents help with bed making, folding towels, things of that nature to help them feel helpful and productive!

Also, watch sleep times. Many residents don't know what time of day it is even if they look outside and see light/dark. So many oversleep during the day and are very anxious and awake at night. Trying to establish a good sleep pattern really can help! We also try really hard to keep residents busy doing activites so they are tired for bed at night! With the older residents we find BINGO really is a good game, and you can help assist them with playing..and it can be quite fun too!

We also have people come in or even CNA's that will read the paper to everyone in a nice room (we have one with a fireplace and lots of comfly recliners...this is a very popular routine in my residents daily life!). And we have this CNA that is an excellent story reader and reads a book to them twice a week! We also have bell choir and this can be done by just about anyone :).

Just some suggestions of things we do...

And yes, if you are injured by a resident you can press charges against them if you are physically harmed and you can prove it. When my staff gets injured I send them into an urgent care clinic or to their MD or even ER to have it documented for legal purposes, as well as for workers comp cases if needed. Nothing will get a admin going than a few workers comp potentials or documented cases of staff abuse!!!!! (again make sure before you go you charted EVERYTHING..that way they can't easily blame you for your injury!).

AlixCoastRN · Jan 19, 2005

Also keep in mind that a resident who is physically abusive to staff is one step away from being abusive to another resident - and then the crap will hit the fan. I agree witht he documentation and the facts - incident reports should be completed on every instance. In the meantime rule out a medical cause and go from there. I don't like shipping res off to geri-psych but sometimes if everything else is ruled out then that is the only choice. We had one lady who went to geripsych from an ALF and was diagnosed with new onset A-fib and new onset hypothyroid - these were the root of the delirium.

virmm1, LPN · Jan 25, 2005

HE will be getting a psyche consult very soon. Thanks for all the execellent advice. For the last couple of days I haven't heard of him hitting anyone.

As for the dtr, our administrator had a little chat with her. She is much quieter when she comes in now.

virmm1, LPN · Jan 25, 2005

HE will be getting a psyche consult very soon. Thanks for all the execellent advice. For the last couple of days I haven't heard of him hitting anyone.

As for the dtr, our administrator had a little chat with her. She is much quieter when she comes in now.

lindymarie · Jan 25, 2005

Whats up with LTC management allowing staff to be abused by rsds. We recently got a new admit. What legal recourse do nurses and CNA's have when management keeps making excuses for agressive rsds? Man w/ dementia, WWII vet. He has been here less than 3 weeks and so far has smacked me in the face, punched an aide in the stomach, busted another aide's lip, and yesterday grabbed the LPN who was trying to feed him by the throat. Fortunately, his roomate has a sitter who had to pry the man's fingers from her throat. Our administrator thinks that maybe he is like this because someone hurt him in the past and hes afraid of being hurt again. This man also has a sue happy POA. Who bragged that she has filed a suit w/ another LTC facility in the area. Rsd is supposed to be transferred via lift. The other place didn't and dropped him and thats why she is suing them.
Yesterday she wanted the two aides who were getting him out of bed to manually lift him instead of using the hoyer. Didn't happen. She the dtr slapped his arm hard enough to make a slapping sound and told our aides that they needed to get agressive w/ him. But yet wanted to know why they were holding his hands so he couldn't hit them. Told them to let go to see what happened. She also told them that they were bringing the abuse on themselves and that he wasn't like this at the last facility, Funny , thats not what the notes from that facility say. One of the aides told her that she wasn't going to get agressive w/ him ,that it is abuse. I had the aides write the incident up and turned it into the DON. I think this POA is trying to set us up for a lawsuit. I was also told she told her mother to "shut up" when they were in visiting dad. This person is a CNA. If this is how she treats her parents I wonder how she treats other rsds.
We are a small facility and he is the only one we have like this so far. Our administrator and Don are trying to make concessons so this rsd will maybe settle down. I would hate to see him removed from the facility because we have some of the BEST CNAs I have ever worked with. and they take good care of the rsds and treat them with respect. He would possiabily be abused somewhere else.
I didn't mean to ramble on but I needed to get this off my chest.

Sounds like a tough situation. We had a couple of residents at one time that exhibited these behaviors. They had family members responding in the same manner as this man's dtr. We made it a policy to never enter these rooms alone. Two staff members always went together. By doing that we always had a wittness to any exchanges or care that had taken place. :uhoh3:

lindymarie · Jan 25, 2005

Whats up with LTC management allowing staff to be abused by rsds. We recently got a new admit. What legal recourse do nurses and CNA's have when management keeps making excuses for agressive rsds? Man w/ dementia, WWII vet. He has been here less than 3 weeks and so far has smacked me in the face, punched an aide in the stomach, busted another aide's lip, and yesterday grabbed the LPN who was trying to feed him by the throat. Fortunately, his roomate has a sitter who had to pry the man's fingers from her throat. Our administrator thinks that maybe he is like this because someone hurt him in the past and hes afraid of being hurt again. This man also has a sue happy POA. Who bragged that she has filed a suit w/ another LTC facility in the area. Rsd is supposed to be transferred via lift. The other place didn't and dropped him and thats why she is suing them.
Yesterday she wanted the two aides who were getting him out of bed to manually lift him instead of using the hoyer. Didn't happen. She the dtr slapped his arm hard enough to make a slapping sound and told our aides that they needed to get agressive w/ him. But yet wanted to know why they were holding his hands so he couldn't hit them. Told them to let go to see what happened. She also told them that they were bringing the abuse on themselves and that he wasn't like this at the last facility, Funny , thats not what the notes from that facility say. One of the aides told her that she wasn't going to get agressive w/ him ,that it is abuse. I had the aides write the incident up and turned it into the DON. I think this POA is trying to set us up for a lawsuit. I was also told she told her mother to "shut up" when they were in visiting dad. This person is a CNA. If this is how she treats her parents I wonder how she treats other rsds.
We are a small facility and he is the only one we have like this so far. Our administrator and Don are trying to make concessons so this rsd will maybe settle down. I would hate to see him removed from the facility because we have some of the BEST CNAs I have ever worked with. and they take good care of the rsds and treat them with respect. He would possiabily be abused somewhere else.
I didn't mean to ramble on but I needed to get this off my chest.

Sounds like a tough situation. We had a couple of residents at one time that exhibited these behaviors. They had family members responding in the same manner as this man's dtr. We made it a policy to never enter these rooms alone. Two staff members always went together. By doing that we always had a wittness to any exchanges or care that had taken place. :uhoh3: