Targeted by psychotic, manipulative patient

[HM7380]

I work in a LTC/Rehab facility. There is a patient there who does NOT belong (she is 65 and has absolutely nothing physically wrong with her). However, she is homeless, and because of the money grubbing higher ups, they won't discharge her. She is psychologically disturbed (though not diagnosed as such), and has targeted myself and one of my CNAs. She was able to have the CNA suspended pending an investigation due to a complete BS allegation of abuse, and she said shes coming for my job next. (She also stated to me that she knew what to say and what to do, to have me fired and my license taken.) On Sunday, she spit in my face, and trapped me in a bathroom and tried to punch me... Shes one of my patients, so I can't keep COMPLETELY away from her, though I do have another nurse take her her medication, etc. The patient hovers at her door and waits until I come down the hall, then jumps out in front of me and begins verbally abusing me, screaming, and threatening me. I really am at a loss as to what to do. I've made reports. I've filed grievences. I've had all the staff who witness her terrifying behavior write statements...

My question is... is there anything else I can do? I'm sure if it wasn't me she was targeting, it would be someone else, but to let this nutcase spit in my face and take a swing at my head is absurd. How would you handle it? It's getting to the point where I'm afraid to go to work. She really DOES know how to work the system and get the staff in trouble. She comes up with stories to try and pit the staff against each other, and because until shes targeted YOU, she seems like a somewhat off, but mostly together 65 year old woman.

This is the second time shes been at my facility... The first time they kicked her out for assaulting another resident. However, I'm sure they won't do anything if she assaults a nurse (I've been assaulted by another patient, and they told me that if I couldn't handle being attacked, to hit the door.)

Any suggestions as to what I can do?????? I've got to find a way to get this lady out of my facility before she attacks me or another resident again!!!!

[Christen, ANP]

This is a toughy. You need to be taken away from this situation and she needs to be given to another nurse, even if she is in your group. I wouldn't tolerate anything less from your management. If they are insane and refuse, I'd start looking for another job where my team cares about my well being. Being assaulted by a patient is NEVER something you should tolerate, and it is let go too much IMO. The job of your bosses is to protect you from things like this, not shove it under the rug and enable the patient. Crazy!

[canesdukegirl, BSN, RN]

Is there a Risk Management department at your LTC? I would think that if your managers are not looking out for your well being, I would write a letter to the RM dept. If you don't have one, write a letter to your BON asking about how to deal with the above situation. This shows in writing that you are concerned for your well being. Attach letters of those who have witnessed this lady's behavior. You should never have to endure this type of treatment.

[NurseyBaby'05, BSN, RN]

If she gets physical again, call the police and have her arrested.

That aside, get another job. Unless you are in the military and on a combat mission or a police officer, the occasional assault is not part of the job.

[roser13, ASN, RN]

Totally agree about calling the police. Call and report her for verbal threats, "taking a swing" at you and for spitting in your face. If you have exhausted your facility's remedies and have not received action, then it is time for both the facility and the patient to receive a wake-up call.

[Bella'sMyBaby]

Document, Document, Document.

Immediately notify Management.

Consult an Attorney to begin Legal Action.

[mentalhealthRN]

I would say you should be speaking to the facility doc about getting a psych eval done. There should be someplace you can send her to get one or your facility may have one they use that comes in. Once you have that, if there are any findings, the psychiatrist may be able to reccomend to the doc some meds that could help. If a situation is acute and the resident is unable to be de-escalated and you feel there is a safety risk have the resident MHA'd (Mental Hygiene Arrested) she will be held until an eval is done and if unsafe they could keep her and try to stabilize her, maybe start meds. If her behaviors are new and not just how she has always been be sure you aren't missing an infection or an acute delerium--which can cause paranoia and hallucinations that can present in resident being violent. When the psychiatrist does the eval be sure he/she has a current med list as some meds can trigger deleruim.

If she had absolutely no physical problems, no diagnosed psych issues--curious as to how the MDS nurse is getting any money for her......what is she scoring with!?!?!?

[mentalhealthRN]

Oh and wondering....your title for the post refers to the resident as "psychotic"--but say she has no diagnosed psych dx. Not sure if you are just throwing that word around or if the resident actually is showing signs and symptoms of psychosis--an actual diagnosis, with treatment options.

[carolmaccas66, BSN, RN]

Can't believe your management told you to walk out the door after being assualted!!

I would refuse to look after this lady and demand she go to someone else. This is why I refuse to work LTC anymore - hate it, hate it, hate the fat managers that get the residents money, then sit back and expect the nurses to sort all and every problem out.

You can refuse to look after certain patients and assaults come under that.

I'd be telling them what I think after I'd sent out my CV and got another job. I think ur fighting a losing battle to be honest.

Did you not learn self defense techniques? We do training courses in this as part of our job, and if she hit me I would be defending myself and hitting back. And yes document EVERYTHING. When it happens, write down times, take photos and yes I would call the police. That is ur right as a citizen.

I think you are kind of letting this woman do this to you and enabling her a little. If you don't stand up to her and management this will go on and on.

[whiskeygirl, LPN]

I totally agree with Bella's "Document, Document, Document" but would like to add, keep a copy for your records.

This sounds very much like a ALF resident I had briefly. While not totally appropriate in every circumstance I would treat her like a toddler acting out. I would give her choices that all had the end result of whatever I needed to get done. "Would you like to sit over here, or would you like to sit over there to take your medications?" I did have an instance where she grabbed my arm (in anger) and dug her nails into my skin. I was livid afterwards but other than charting it, did not call the authorities. I should have.

I will tell you this however, if you were my employee and you came to me with this, THE VERY FIRST TIME I would have confronted her with the consequences (in front of the Executive Director) which would start with the police being called and her being discharged. Do what you can to me but DO NOT mess with my people.

[gymnut]

Stories like this make my blood boil.

I love how it's pounded into our heads about what constitutes abuse towards a patient and we can get suspended or worse have our licenses revoked over so much as an awkward glance yet when a patient or resident decides to morph into a MMA fighter and assault us it's met with deaf ears and blind eyes.

I would call the cops the next time she assaults you. Maybe she'll flip out on them and something can finally be done.

[dishes, BSN, RN]

I agree with mentalhealthrn, talk to the team, doctor, sw, psych, the patient needs to be diagnosed. Have seen similar behaviour with patients who had borderline personality disorder.

dihes