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!
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.
this was a death visit for hospice...I felt I owed it to the patient and family to do the best I could, since I was already "ordered" to go alone.
Please go to the CEU courses page at the New York State Nurses Association website, click on "Violence in the Healthcare Setting: Keeping Nurses Safe", and print out for your attorney all that IS written on this topic. There are statistics, cases, history, employer obligations, nurses rights, OSHA standards and requirements, other resources for information on the topic, and it has a multitude of other important information. Its a very comprehensive, detailed report that your attorney may be able to put to good use for your case. Especially if your employer didnt do any of it or have any of the required programs in place to protect you beforehand. The attorney may be able to use it as a standard with which to hold them accountable. Heres an excerpt from the report, particular to the home care situation. After he reviews it, Id be interested to know if it helps your case. Good luck:
Workplace Violence in Non-Institutional Healthcare Settings
While much of the previous information is related to the hospital or other institutional setting, healthcare is practiced in a wide range of locations. Safety of healthcare workers is a significant issue in home care.
The OSHA Workplace Violence Prevention Program is also relevant to non-institution settings. The previously provided information regarding assessment of the patient, or other potentially violent person, assessment of the staff, assessment of the environment and the use of a continuum of interventions is supported as a means of managing potential violence in home care (Distasio, 2000). In addition, Distasio (2000) recommends the implementation of policies and procedures within the home care agency that focuses on prevention of violence and risk reduction for staff.
A critical aspect is an effective intake screening process that identifies potentially violent home care patients. Communication with the physician is important; often the physician has additional information that can be useful in determining the risk of violence (Distasio, 2000). The use of a formal security program with security officers and escorts for home visits has been identified as a successful strategy in the management of potential violence in home care (Nadwairski, 1992). Building relationships with community agencies and their leaders, as well as local government officials was also identified as helpful (Nadwairski, 1992). Additionally, a focus on good communication between visiting staff and the security department of the agency was identified as a helpful strategy.
Equipment can also be used to facilitate safety. Staff utilized cell phones (Sheehan, 2000); hand-held emergency alarms (small enough to fit in the palm of the hand and emits a loud screeching sound when activated); spotlights (plugged into car cigarette lighters) that can be used to locate a home in the evening hours; and police scanners that allow security personnel to monitor for any police activity in the areas where agency staff are visiting (Nadwairski, 1992).
Nadwairski (1992) also identified a "Safety Checklist" for staff:
-Before visiting a client, note the type of visit to be made and any history of violence, drug abuse, mental illness.
-A planned schedule of visits must be submitted daily so that supervisory staff know visiting staff's whereabouts at all times (Sheehan, 2000).
-Schedule visits as early in the day as possible.
-Do not take purses/wallets with you on visits; secure them before leaving the office. If you must take them, lock them in the car before leaving the office parking lot.
-Have accurate directions to the street, building, and apartment.
-If in an unfamiliar area, check with your supervisor for more detailed information. Always know exactly where you are going.
-Whenever possible, alert the family of your visit and have them watch for you. Upon arrival at your destination, especially in a housing project, check in with the building captain or managers, if one is available.
-If driving alone, drive with the windows at ear lobe level and
-keep all car doors locked. Keep the interior of the car free of personal belongings.
-If making an evening visit, park in a well-lighted, accessible and as safe an area as possible.
-Before getting out of the car, thoroughly check the surroundings, location and activities of people in the area, the condition of the building. If you feel uneasy, do not get out of your car; contact base security with a cell phone.
-Be alert at all times and trust your first instinct from the moment you leave the office until you return.
-Never attempt a visit on your own in an area predetermined to be high risk; take an escort.
-In a potentially threatening crisis situation, remain calm, speak softly and leave the area as quickly as possible. Do not panic.
-Keep all nursing supplies out of sight and in a nursing bag. An important factor in the prevention of violence in home care, as well as in other healthcare settings, is the attention staff should
-place on their own feelings. As stated in an earlier section of this course, when staff feel apprehensive, these instinctual cues must be attended to. Leaving the situation immediately is the strategy of choice, making sure to always have an awareness, within a client's home, of the nearest exit and making sure that nothing blocks one's exit (Distasio, 2000). Training in de-escalation strategies is also useful to staff in the home care setting (Distasio, 2000).
see full report at:
Violence in the Healthcare Setting: Keeping Nurses Safe
JCAHO is not the place to look for this. The agency to check with is OSHA. Lots of info, recommendations, standards, & programs are there. And the nurse should also report the violent incident to OSHA too.
If anyone is really interested in all the info and whats available, I recommend saving time searching and just take the Violence in the Healthcare Setting: Keeping Nurses Safe CEU course 'cause all that info is in there. I thought it was one of the best, most informative courses Ive ever done. It was 5 CEUs for $25 (non-member rate). Took about an hour online. Immediate grading of 10-question post test & printed out a certificate. The best thing is it tells us exactly what to do, who to contact, & it had links to all the other sites & OSHA workplace violence programs.
Well, if you don't have a fax, maybe your lawyer has one, or you could pm me your home address, or your lawyer's address, and I'll mail it. Surely there is some way to get this info to you? It's here if you want it, all you have to do is tell me where/how to send it.
Specializes in Vents, Telemetry, Home Care, Home infusion.
the occupational safety and health act guarantees all workers to the right to a "safe and healthful workplace." your employer must provide a safe workplace, using written policies, employee training, proper staffing, and follow-up of any incidents. employers may be penalized by the occupational safety and health administration (osha) for neglecting to reduce the potential for violence.
from: workplace violence: can you close the door on it?
each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or likely to cause death or serious physical harm. this includes the prevention and control of the hazard of workplace violence.
workplace violence is any physical assault, threatening behavior, or verbal abuse occuring in the work setting.
a workplace may be any location either permanent or temporary where an employee perform any work-related duty. this includes , but is not limited to the buildings, and the surrounding perimeters,, including the parking lots, field locations, client"s homes and traveling to and from work assisgnments.
( i capitalized words)
info from: workplace violence - health care and social service workers. osha office of training and education. 47 color slides which provide an overview of the guidelines for preventing workplace violence for health care and social service workers.
the occupational safety and health act of 1970 (osh act)1 mandates that, in addition to compliance with hazard-specific standards, all employers have a general duty to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. osha will rely on section 5(a)(1) of the osh act, the "general
duty clause,"2 for enforcement authority. failure to implement these guidelines is notin itself a violation of the general duty clause. however, employers can be cited forviolating the general duty clause if there is a recognized hazard of workplace violence
in their establishments and they do nothing to prevent or abate it.
make sure there is a written incident report. because this was an incidence of workplace violence, it is reportable on the "osha log 200"---see articles above.
i can send to you or your lawyer my agency's policies since i co-chair the safety committee---send me a pm with info.
my agency would never have sent a nurse to a home when known potential for violence exists, even with a guard. we would have let police get person out of home then go back in to rescue client.
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i was involved in incident 6 hrs ago caring for bedbound 92yo husband and 72 yo wife---both clients of my prior agency. checked husband first, wife appeared asleep on sofa. 19yo grandaughter who had infant removed from her care 2 weeks prior ( iwas aware of this info) came in to ask her grandmom a question. she shook gm and started screeming she's dead, you killed her. granddaughter had been calm around me before. i called pcp, family members, coroner, office of aging (ooa) sw case manager, then police as granddaughter threatening violence. quickly saw care and meds give to my client along with the aide and left apt, only went back in after police arrived. returned to home 2 hrs later after assisting sw case mgr getting my client placed in a nursing home and with police arresting grandaughter, sw and i got my client in an ambulance and off to snf. if police were not involved, would have just dropped problem into sw lap.
All those links show there sure is a lot written on this subject. And many guidelines recommendations and legal requirements to prevent it. Im surprised the attorney wants YOU to find all this yourself. Isnt that what his job is? Or what his paralegal's job is??? Oh well - just think of all the money you just saved in their fees - and our Legal Nurse Consulting fees!
STM, maybe you should just print out this whole thread for him. :)
All those links show there sure is a lot written on this subject. And many guidelines recommendations and legal requirements to prevent it. Im surprised the attorney wants YOU to find all this yourself. Isnt that what his job is? Or what his paralegal's job is??? Oh well - just think of all the money you just saved in their fees - and our Legal Nurse Consulting fees!
STM, maybe you should just print out this whole thread for him. :)
GOOD LUCK!
Thank you I have printed it all out. It's pretty good, thanks for your help.
STM
20 Posts
this was a death visit for hospice...I felt I owed it to the patient and family to do the best I could, since I was already "ordered" to go alone.