Threatened staff

[RNBSC]

Help,

we have a LTC resident, ETOH dementia w/severe behavioral disturbance. Sexually inappropriate (masturbates in hallway) threatens to kill staff, is verbally abusive, has hit 4 staff, or layed hands on staff, and of course, we can do no harm...follows CNAs n hovers over them, some other patients have expressed fear of this resident. Also has poor prognosis, cancer that will take them out prob in 5 years or so.

What are staff rights? Some sups say, well the pt is weak, n can't really hurt you, we expect these behaviors. If you're just nice, resident won't hurt you (bs- resident splits staff, manipulates, lurks in resident doors, looks in resident rooms, comes to roommate side of room during care (when curtain closed for privacy) .

Some staff really afraid, some just grossed out. How to protect self, n other staff? PRN meds have little effect.

[hppygr8ful, ASN, RN, EMT-I]

I would continue to talk to the MD, ask for psych consult/psych NP to evaluate for behavioral management with medications. And you guys should probably put your concerns in writing to management / DON and describe the behavior, how it affects staff and residents, concerns of safety and ask for support. There are strategies to deal with those issues - having said that - sometimes interventions do not work and the resident has to get moved. A common scenario in my area is that once the staff continues to call the MD and the DON and documents to leadership those residents get send out to the acute care facility with "mental status changes", which usually result in work up to rule out anything that can be corrected or find out what else is going on. Often enough those residents end up in restraints/ enclosed bed and so on - which means they can not go back to the facility asap. Once in the hospital, family can ask for an evaluation for geripsych or transfer to geripsych.

A lot of residents with above or similar problems end up in the ED with "mental status changes" or "shortness of breath" or "chest pain" because they can not get help with them or transfer them to a different setting.

Easier said than done . I have worked LTC and also have a mother with dementia who was diagnosed by her well meaning GP with "Psychotic Aggression" after she cornered her memory care staff and some patient's in a corner while she attempted to assault them with her walker. It was quite a scene involving police, paramedics etc..... She went to acute Hospital which kept her 3 days for a UTI then shipped off to a gero-psych where she spent 22 days. We were able to move her to a new facility with nurses and aids trained in behavioral interventions as psych meds had little or no effect. She is happy a cooperative now on only 25mg of Seroquel TID, but such care is costly and not covered by Medicare as it is custodial care, We are currently paying $6000.00 a month out of a family trust set up by my father before he died. Sadly many families do not have such resources. There are actual federal laws that prevent a patient being medicated with more than two antipsychotics or being chemically restrained by medications. Such patients need to be in facilities where staff is trained in redirection techniques. When I worked in LTC I was the only nurse there with any psych experience, it was appalling to see that nurses there had no interest in learning how to work with these patients and only wanted to medicate them.

hppy