I have this letter in another forum...but thought the general discussion group might be able to help.
Was doing home visits, hospice, and was told that a significant other was psychotic, and showing violent behavior. I called my administrator for backup prior to the visit, and was denied, x 3!
Got through the visit but have bruises to show for it...and an attorney...now that I have been terminated, wants me to find policies other agencies have re: DANGEROUS HOME VISITS. So far no luck, nothing written. We had been told to take a second nurse if we felt threatened, yet I was denied. Attorney wants to see other policies....and have witnesses, which ain't gonna happen. Appreciate any input. Oxymorons don't belong in healthcare! Especially hospice! and Administrative!
I'd like to believe that cops in my town would grab anybody that grabbbed me and remove that person. Why was this guy allowed to hang around? I dont understand this!
Don't take my remark personally. I UNDERSTAND why you did what you did.
I'm just saying, that from a totally objective persons' viewpoint, they might expect the nurse to consider the
risk, especially if she was forewarned.
they might say,
"maybe the nurse could have been/should have been a little more assertive
in protecting her own safety."
The police, and soldiers,are trained to get into
the middle of a potentially combative and violent situation,
and, they wear the gear for it.
Nurses aren't.
I understand your position. I'm just not sure a judge or jury would.
I understand and thank you. I begged for help, literally. I don't know how I even drove my car I was so scared, then to have the exe. dir. YELLING at me on my cell phone, I knew if I didn't go in, it would be instant abandonment. Instant termination. I felt if I gave it a go...at least I would have tried, and always figured I could kick and run...maybe. Never expected it to come flying back in my face.
I think the fact that you were informed prior to going in that there was a potentially hostile, aggressive, combative, violent, - - - not responsible for his own behavior - - - psychotic in the house,..........................and you decided to go in alone anyway,
.......I think that you are up against the wall.
If you polled 100 nurses, I'd be interested to know the % that
would decide to go in.
A judge or jury might think that it was your responsibility to look
out for your own safety. The psychotic would not be held responsible.
Possible, but my guess is, unlikely. First, there's a good chance that a lawyer will get this settled out of court. Second, even if it did go b4 a judge or jury, I think either one would possibly have an unconscious bias in your favor. The public may not like us when they interact with us in overcrowded ER's after long waits, but, in general, I still think they have alot of respect for the work we do. Third, your suit may be against the agency, not the person who injured you, even if you also press charges against that person. So, don't sweat it.
Our agency says if a pt or family person is aggressive we need to 1) put space between ourselves and the aggressor
2) if dangerous dial 911
3) last, notify office
I cared for a very combative Alz pateint for quite some time, and the policy was to mamnge the agitation so it wouldnt be taken out on the caregiver. We almost never sent new staff in, and if new staff was sent in, the company always made sure they were expereinced with combative patients and knew that the lady could get violent at times. I never got hurt. The family and MD were supportive,
Laura
If you don't mind, could you just tell me the name and address of your agency???? Just for the attorney. Don't have to give your name, we wouldn't contact. I just have to show it's legitimate. Thanks so much, this is exactly what I need!!!
Here is a link to a home care agency I worked for. They had an excellent safety protocol, including:
1) At intake, all referrals were assessed, and assigned to one of 4 risk grades. I can't remember them exactly, but it went something like unrestricted visits, ok for nurse to make visit without escort in daytime, requires single escort, requires transportation by company van with 2 escorts and walkie-talkies, one escort goes with nurse, one stays in van. Walkie-talkies are used so if nurse has to be alone in a room with a potentially violent pt for pt privacy, she can walkie-talkie to the escort in the next room, if needed. Assignments were made by managers, based on a variety of factors, including neighborhoods and known family dynamics/issues, and could be changed as new info became available.
2) Orientation included explanation that nurse should assess the situation upon arriving. If we felt unsafe before even starting the visit - ie, due to unsafe neighborhood - we were to drive to a safe place, phone the manager, and plans - such as for an escorted visit - would be made from there.
If you pm me your fax number, I'll fax our policy to you right now.
This is not a criticism, but at both of the agencies I work for, if I called my manager and described what you did, I would have been directed to drive right on by. Why did you have to visit when the police were already there?? That I really do not get. But it's neither here not there, what happened has already happened. If your agency does not have a policy, they don't have much to stand on, and I hope you documented each call to your director.
Good luck with your case. Both of my agencies have escorts, and I would not hesitate to use them, in fact, we had a situation not long ago where the son of a pt was know to be abusive, the supervisor made the nurse take escort, good thing she did, when the pt did not answer the door, knowing she could not go anywhere, the nurse called the police and they found the pt tied to her bed and gagged. Thank God that visit was made, the pt was finally able to get out of the situation.
Link to interesting discussion on impact of workplace violence on maintaining adequate staffing in ED's. Argues that in light of nursing shortage, employers cannot afford to ignore this problem.
I've been "Googling", trying to find applicable links and standards. I tried JCAHO. Not sure if I interpreted their standard correctly, but it appears as if "sentinel event" doesn't even apply to serious injury or death of staff. Which made me think, why not? I don't think your bruises should be a sentinel event, but that nurse who was stabbed in the BRonx ED - that should be.
Having a hard time finding JCAHO standards addressing staff safety from violence. Maybe nurses need to petition JCAHO to address this? However, this is the first time I've ever searched their site, and I may just have typed in the wrong keyword and missed something.
If you pm me your fax number, I'll fax our policy to you right now.
This is not a criticism, but at both of the agencies I work for, if I called my manager and described what you did, I would have been directed to drive right on by. Why did you have to visit when the police were already there?? That I really do not get. But it's neither here not there, what happened has already happened. If your agency does not have a policy, they don't have much to stand on, and I hope you documented each call to your director.
Good luck with your case. Both of my agencies have escorts, and I would not hesitate to use them, in fact, we had a situation not long ago where the son of a pt was know to be abusive, the supervisor made the nurse take escort, good thing she did, when the pt did not answer the door, knowing she could not go anywhere, the nurse called the police and they found the pt tied to her bed and gagged. Thank God that visit was made, the pt was finally able to get out of the situation.
Sorry I don't have a fax...
I'm at home...and don't have access to fax, unless I send one, and then I go out and do it
I'm at home...and don't have access to fax, unless I send one, and then I go out and do it
he
Sorry meant to answer the question...I would have driven on now that I am not in the situation...and suffered the consequences, but I was literally told in threatening tones to go alone. I would have been in the same place I am now, but probalby
I was in such a state of...I don't know, trying to do the right thing and take care of the entire situation, even though I am not qualified to deal with psychotics, etc. She had refused to send help and ordered me in alone. I figured she would be reprimanded, but the best defense is a good offense so that is what she did.
passing thru
655 Posts
Don't take my remark personally. I UNDERSTAND why you did what you did.
I'm just saying, that from a totally objective persons' viewpoint, they might expect the nurse to consider the
risk, especially if she was forewarned.
they might say,
"maybe the nurse could have been/should have been a little more assertive
in protecting her own safety."
The police, and soldiers,are trained to get into
the middle of a potentially combative and violent situation,
and, they wear the gear for it.
Nurses aren't.
I understand your position. I'm just not sure a judge or jury would.