Any advice on how to handle being the charge nurse when you have a patient that is clearly not appropriate for LTC but there is nowhere else for her to go? The majority of your time is spent keeping 1 Resident safe, requiring 1 on 1, 100% of the time, unless she sleeping, which she does not sleep much. Behaviors include: punching, pinching, pulling hair, biting,standing up and attempting to walk which will result in a fall if you don't immediately assist. She takes the strongest psych med available for our use and the pcp will only prescribe tyl and Ibup for pain. She is clearly always in pain, c/o pain to back, and we believe that is why she constantly stands up, then sits, then stands, then tries to walk...etc. It is impossible to get through a med pass without being interrupted every couple seconds, taking her with you at times. He son said she has a hx of alcoholism and behaviors and is unable to come and visit her due to distance. Administration gaslight us saying she isn't that bad and there's nothing else we can do. She needs a sitter at the very least, but more appropriately, she needs a pschy unit. We do love her and she can be the sweetest person, but then mood flips sometimes out of nowhere and she becomes violent. Any helpful advice would be appreciated.
I understand your frustration. First I would ask the doctor for labs especially a urine culture. If she's in that much pain she can have a horrible UTI especially with back pain. That actually may be the reason for her behaviors as well. We have to make sure we clear patients medically before bringing psych into this. If she has one she'll more than likely need antibiotics. You'd be suprised in how bad UTI's can effect a patient. They can go septic and most times the signs starts with falls, increased agitation and becoming violent .It's very common on Dementia units. She probably won't let them catheterize her either so they may have to treat prophylactic. I urge you to always start there when dealing with behaviors. Seems like everybody's been focusing on her Alcoholism and not her pain. Not to mention her Kidneys could be experiencing changes due to the Alcoholism .Her pain is her pain. It definitely needs to be addressed. Keep us posted!
We had labs done and a UA that came back clear and her labs are unremarkable. UTI was the 1st thing we checked when her behaviors increased, so we were shocked to find out her urine was clear. She has history of mental health issues and behaviors.
When I was working LTC we had a similar situation with a volatile resident. Of course, with staffing in LTC being poor on the best of days there is simply no way to provide full-time 1:1 supervision to the difficult resident.
Sadly the 1:1 care was provided only after this resident hit another resident. Fortunately, nobody was injured. The resident-to-resident altercation was finally what convinced upper management to provide a sitter. They also initiated a transfer to another facility which took a few months to secure a bed in a facility more appropriate to his needs. So this guy had a full-time sitter for the duration and was much more manageable. I'm sure this was mostly because he had the type of total attention he needed, with that staff dedicated to just him he was no longer violent and never raised a hand to his assigned caregiver for the rest of his time with us.
Do you have access to social worker to look into what Medicare will actually cover and assist with possible transfer? Just keep charting your findings and cover your back. Good luck.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
It's incredibly distressing to see how poorly LTC residents' pain is treated. Advocate for pain management. Like can she have a pain management doc? We in hospice sometimes get referrals like these, and it's okay if the person truly has a prognosis of less than 6 months to live. But sometimes they do not, and then we can't treat them.
The patients have "the right to fall" and you have the right to not be assaulted at work. Continue to document your interventions, but when she starts striking out, step away from her, and allow her to exercise her right, as she is clearly refusing your help. RM will eventually get tired of her reports driving down their quality numbers, and make a move to relocate her to somewhere more appropriate. This is a common theme in LTC. They take psych patients that require drugs that they aren't willing to give because of (once again) their quality rating. It's a tough spot. I was once told I was violating a patients right for taking away her control for her recliner as she was weaponizing it. They saw it my way when THEY had to pay to replace the window she busted out with it.
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freddiegreer2003
1 Post
I understand your frustration. First I would ask the doctor for labs especially a urine culture. If she's in that much pain she can have a horrible UTI especially with back pain. That actually may be the reason for her behaviors as well. We have to make sure we clear patients medically before bringing psych into this. If she has one she'll more than likely need antibiotics. You'd be suprised in how bad UTI's can effect a patient. They can go septic and most times the signs starts with falls, increased agitation and becoming violent .It's very common on Dementia units. She probably won't let them catheterize her either so they may have to treat prophylactic. I urge you to always start there when dealing with behaviors. Seems like everybody's been focusing on her Alcoholism and not her pain. Not to mention her Kidneys could be experiencing changes due to the Alcoholism .Her pain is her pain. It definitely needs to be addressed. Keep us posted!