Staff nurse role in reporting abuse? Insight, please!

[SweetErica]

This is going to be a long post, so bear with me! I am hoping for a bit of advice, perhaps some direction, personal experience, opinions, and will accept my role with out too much pouting if I'm told I was in the wrong!

I have been an LTC nurse (LVN) for 10 years, and a CNA for 11 prior to that. I had been at my most recent facility approx 5 months. Nearly a month ago now, I received a phone call from my DON at 930pm asking if I would go and "interview" as resident, and ask about her shower that day. He stated that depending on her answer, we may have to file a "self report" to the state for abuse. He did not tell me anything further, nor what kind of abuse I was to inquire about. The resident in question has dementia, but while making pleasantries, asking how she felt, did she get her shower, did anything happen during it... she tells me she was punched in her back. I return the call to my DON (on my cell phone) and notify him, he tells me to let the CNA know he is being suspended for an allegation of abuse pending investigation and have him clock out, and to complete a head-to-toe skin assessment, and that he and the Administrator will "take care of everything else". I ask if I need to write any kind of statement TWICE during this call, and he finally said "yes, you can do that". I immediately contacted the Administrator, as he is our Abuse Coordinator, and I had not spoken to him and wanted to be certain he was aware of the issue occurring, and left a message. He returned my call, assuring me he was aware (a CNA had heard of the incident and directly contacted him-- I was not aware of anything prior to the first call from the DON). I went to conduct the skin assessment shortly after 1015pm and texted him my findings (none). He texted back "Im sure the DON told you, but document, include her pain scale, call the physician and notify the family. I just did the state report." I responded that the DON had NOT told me any of this. I then refused to call the family and told him that I felt it was something either he or the DON should do considering the circumstances.. It was 1106pm and the situation was, in my honest opinion, something that the Administrator/ upper management should handle (for those who work night shifts in LTC, those late night phone calls are terrible to make, as families always answer with apprehension, fearing the worst. This situation, in my opinion, was delicate). The administrator did not reply back via text nor phone call, and I was under the impression that he was indeed contacting the family to notify, discuss, and answer any questions. The legalities of what I could tell them, what was being done, and how the investigation would proceed are not anything I am knowledgeable about. I have never contacted nor been asked to contact a family in regards to an employee deliberately and intentionally causing/ possibly causing harm, injury or pain to a resident -- that is something the Abuse Coordinator/ Administrator at facilitates I have worked always handled. I DID complete the skin assessment and document it, contacted the on-call physician, and documented a brief progress note (again, unsure as to what I could/ should state) and that she complained that both shoulders were "a little sore".

I completed the remaining 7 hours of my 12 hr shift. I returned the next night and even saw/ spoke to the administrator, tho nothing was mentioned regarding the previous night's incident, and worked the entirety of that 12 hour shift. I did see in the charting that the DON had contacted the family that following morning, and they were upset and had concerns. I was off the following 3 days (Friday, Sat, Sun). On Monday, my next scheduled day to work, I received a call from the Administrator, with the DON in the room as well on speaker, and I was terminated for refusing to do as instructed. He specifically said "due to the sensitivity of the issue revolving around the incident". Yet didn't deem it sensitive enough to personally interview the resident, nor suspend the accused employee himself, and filed the report with state after only exchanging a few brief texts and very short phone conversations with me. I have applied for unemployment benefits, which are likely to be denied, as the company told them that I was told by both the DON (never) and Administrator to contact the family and I didn't. I have all texts and calls that came thru my phone recorded (legal in Texas), yet have not been asked to submit these. I also have not been contacted by any State agency regarding the abuse allegation, and I question if it was properly reported, or if it may have been 'adjusted' to reflect that the administrator conducted the interview and employee suspension.

Former co-workers I have spoken to regarding the situation have relayed that they have never been tasked with notifying the family in these types of situations. I am curious if anyone else has. While I did in fact refuse to do as instructed, I don't feel I was insubordinate, as it was a situation in which I was not experienced or knowledgeable about regarding legalities and the process of investigation. Being that the administrator did not respond when I refused to make the call (even a "if you don't, you're fired" might have made me rethink things), I really would like some insight or experiences regarding this situation. What is the purpose of an Abuse Coordinator-- just to file the report itself?

[SoCalRN1976]

I have had to report many situations like this to family over the years regarding patients.

The ONE thing you need to be aware of is your license. If this situation had you finding the situation and claims you should call the family to protect your license.

But your long post seems a bit overwhelming to read. My take away is this incident was found not by you and you were directed to call the family at an ungodly hour because of a claim that happened off your shift? If this is how I am reading it. Its not fair to be put in a place where you really had not obligation to report anything to the family as this should of been done so by the reporting staff. DON etc. My response to the DON or whoever is, I will call the family but its almost midnight.. is this something that you feel is urgent enough to make this call at this time? If so I will call, but I am concerned about the time of night, and the fact while we feel its important, is it urgent enough to call at midnight if it is I will call... and call the family and report that you are calling them under the direction of your your superior and no, you don't know what happened specifically, but you are alerting them at the request of your superior. Offer your superior contact information and let it go. You should of been done at with that.

[Closed Account 12345]

My biggest concern would be that you are a mandatory reporter of elder abuse, and mandatory reporting can't be delegated. I'd be concerned about whether the administrators truly made the report, or if they're skirting that and fired you to help conceal the incident since you were aware. Even though you are outside the required time window for reporting elder abuse, I'd still want to personally file a report with APS alerting them to the situation for my own peace of mind.

Otherwise, count your blessings for no longer being employed by such a place. I feel so sad for the resident - what a sick situation. I hope you're able to obtain unemployment in the meantime.

[SweetErica]

Thanks, ladies. The 'mandatory reporter' aspect concerns me as well. If I understand how it all played out, I was perhaps the 5th person to be made aware of the alleged abuse ( a CNA was told by someone, possibly the resident, who told a medication aid, who called the Administrator, who told the DON, who then called and instructed me to go and interview the resident). Here in Texas, the administrator in nursing homes is the Abuse Coordinator, and they make the report to the state agency with all of the information. At no time on the night the incident was reported did the Administrator nor the DON speak to the resident nor the CNA being accused. They spoke only to myself, and briefly to the medication aid when she made the call to report what she had heard about. Honestly, in the 10 years I have been a nurse in LTC, Ive never even been tasked with telling a co-worker they are suspended-- that is done by management, even if over the phone. As 'staff nurses' we can't even issue 'write-ups' to aides, only bring our concerns to management and allow them to determine if there is a problem.

[Golden_RN, MSN]

Since I am not familiar with TX laws my only advice is to read your facility's abuse policy, which should reflect your state laws and responsibilities. You are absolutely right that making phone calls to family/MD at night isn't great, but I'm sure there are circumstances that I'm unaware of. I totally agree that management should communicate with the accused CNA. I have never seen this delegated to a staff nurse.

[canoehead, BSN, RN]

It sounds important enough for an administrator to come in and do the interview of the resident themselves, make out paperwork, and make calls. If it wasn't important enough for them to come in, then I imagine the phone call to the family could wait til morning too.

Possibly... you could have called and said what happened, that the resident was uninjured, and the administrator would follow up in more depth with reports and a family conference later. A brief informative call, with all the weight on your boss for the next day? But I understand your initial reaction! They didn't even text you back when you said you weren't comfortable, it seems unfair to fire you.

[SweetErica]

Something that nobody else has touched upon, that really is eating at me, is that initial phone call, when the DON asked me to go and interview the resident, and the whole "depending on what she says, we might have to file a report." At that point, an allegation of abuse had already been reported by another staff member to the Administrator. If a resident/ patient cannot recall or is unable or unwilling to confirm abuse... it seems, at this facility at least, they don't deem it necessary to report/investigate.

[Crash_Cart]

So in other words they wanted to fire some staff so it looks like they did something about it.

The fact you were right, wrong, or indifferent doesn't matter.

[Orion81RN]

6 hours ago, Crash_Cart said:

So in other words they wanted to fire some staff so it looks like they did something about it.

The fact you were right, wrong, or indifferent doesn't matter.

This! OP, your facility knows it's in trouble and wants to make it look like they did something about it. I initially read this last night right before falling asleep and was so pissed for you. Bogus.

[JKL33]

What a mess. If you were the nurse on duty at the time the allegations ended up being reported, I don't think it is unreasonable for them to ask you to document a current patient assessment. All the rest of it seems slimy of them to have asked of you: The patient interview, the suspension of your coworker, and the notification of the family.

Some of these people play so fast and loose with rules and conventions that it becomes very difficult to decipher your own obligations. I don't know what more can be said about it.

On 8/16/2019 at 2:56 PM, SweetErica said:

[...]it was a situation in which I was not experienced or knowledgeable about regarding legalities and the process of investigation.

It really begs the question of whether that ^ very thing has something to do with why they try to stay out of it. Let other people mess it up and then those people can be blamed. Who knows. They certainly aren't giving anyone the impression that they care about patients/families or take this very seriously. This isn't proper handling of this for anyone involved/affected - - including the employee someday who is the subject of a mistaken allegation, etc.

[Crash_Cart]

On 8/16/2019 at 1:56 PM, SweetErica said:

I return the call to my DON (on my cell phone) and notify him, he tells me to let the CNA know he is being suspended for an allegation of abuse pending investigation and have him clock out,

Your DON needs to get off their lazy posterior and do that themselves.