What do I do...I witnessed pt. physical abuse

BadBird, BSN, RN · Feb 13, 2004

I would document exactly what happened, I would notify the nursing supervisor or administrator, notify security, write up a incident report, write up a statement of concern (keep copies for yourself). If you have to call the medical director at home then do so,actually the supervisor would probably do this.

findingmywayRN · Feb 13, 2004

I would document exactly what happened,

I have a question about documenting this type of event. I've been taught to not send up legal red flags in nursing notes (I know, the dr. did that himself). So I am just wondering how specifically would you write your nursing note? Would you say "Dr. X took patient by hair and chin..."etc. I'm just curious, because I know notes are supposed to be objective and all but it seems hard to not say something like "Dr. X came in and grabbed patient by hair and chin and threw onto stretcher..."

SmilingBluEyes · Feb 13, 2004

Perhaps the answer becomes very clear to all of us IF we can imagine this were :

our mother/father

sibling

gramma/grampa

best friend

We would DO EVERYTHING ON EARTH TO SEEK REDRESS and speak for their rights.

IT would be UNACCEPTABLE for them, as so it is for anyone. Follow procedures to write this up and DO take it up the chain. THIS was HORRIBLE. I Cannot imagine if it were me and I would want SOMEONE to advocate for ME in a similar case.

You are in a horrible positon; I feel awful about it. But your instincts are right. The others here gave you great suggestions; I hope you have strength to do these things as they are right. Bless you.

zumalong · Feb 13, 2004

I have a question about documenting this type of event. I've been taught to not send up legal red flags in nursing notes (I know, the dr. did that himself). So I am just wondering how specifically would you write your nursing note? Would you say "Dr. X took patient by hair and chin..."etc. I'm just curious, because I know notes are supposed to be objective and all but it seems hard to not say something like "Dr. X came in and grabbed patient by hair and chin and threw onto stretcher..."

Find out what policy is for reporting abuse in your facility--follow it, contact state's medical board and report this scumbag. If this "Dr" :uhoh21: does this in front of others with an alert and oriented patient--imagine what is done with no one witnessing actions. An incident report should be filled out by you, the other nurse, the direct supervisor. :angryfire this is where you would put objectively what you heard and saw. Also keep account of incident for yourself--if a lawsuit every did come out of this--it could be years before it gets to court--protect your self and your license. This person should not be taking care of people. And should have criminal charges placed.

berry · Feb 13, 2004

I know this will catch some flak and, I wasnt there but you state:

Yes dear, they do hurt but we must do this since you took 70 or so miscellaneous pills." Attempted several times to drop the tube, she kept closing her throat. Dr. was informed as was the whole ER by her screaming, He walked in the room, began yelling..."we are going to do this one of 2 ways, My way or Your way. You can fight all you want (the pt. had her head in her hands over emesis basin, crying). Since we can't do it your way will we do it my way"...he proceeded to grab her by the hair and the chin, picked her up off the bed and slammed her back into the back of the bed and she is screaming bloody murder
.

The law states he is obligated to treat an overdose/suic pt an acceptable standard of care for an overdose to lavage pt, from what you descride he grabbed her by the hair and slammed her back into the bed. If her grabbed her by her hair to pick her up that not acceptable. Or did he just jerk her up into a 90 positon and put her back to the bed. I have fought to many overdose pt to deal with BS you also stated

Patient was combative to the fact that it hurt

It is a felony assault to strike a healthcare worker even in a drug induced state. If the pt had been a 19m crack overdose who was combative with staff and was repostion forcefully and the tude placed would as many people have issues. My feeling on overdoses that are combative and need to be pumped paralytics, intubate, and drop an ewol tube.

Again I dont want to start a huge riot in here, but 1) it was a attempted suic/overdose you dont take 70+pills by mistake 2) did you remember the event just as it happened and 3) i agree if he picked her up by her hair not acceptable but just to jerk some one who is fighting staff up in bed is not assualt

Shotzie · Feb 13, 2004

I was a PRN nurse working at a local, small town ER. I worked Q Saturday, 3pm to 3 am...the shift from He**.

One night we had a young teen come in about the age of 12 to 14...skinny kid with glasses and covered in freckles. This happened about 12 years ago and sadly, I don't remember all the details of the diagnosis or why we had to get this kids mouth open (tube?..medicine?) but I do remember the action. Because the kid wouldn't open his mouth and was perceived to be taking a lot of time, the MD and a huge man-type nurse went into his room, forcibly held him down and used an intubation blade to wiggle in between his teeth. They then put in a bite block to hold his mouth open and restrained his hands. The kid was absolutely hysterical during all of this. When I strongly questioned what they were doing they told me to "BUTT OUT".

I then went to the charge nurse who leisurely strolled down to see what they were doing and told me that I was "overreacting" and if that upset me then "maybe I wasn't cut out to work in their ER" (nevermind the fact that I had previously been working in a university-basedbig city major trauma center). I'd been having trouble in that ER already and knew the staff there had major problems as I had watched them ask 3 very good nurses to move on but this was the clincher for me.

If I was going to end up looking incompentent because I stood up for patient rights and protection then I didn't need to work at this place. I wrote a letter to the director and CC'd it to the hospital attorney and CNO and I turned in my resignation.

At that time, calling the police was not even an option but now, with the stronger emphasis on patient rights I think this type of situation should most certainly be followed up the chain of command.

mattsmom81 · Feb 13, 2004

Berry makes some very good points. I agree the better way to handle this would be to address the agitation chemically and then do what needed to be done to help her, as she was incompetent by her own actions to make an informed decision to refuse.

We cannot just 'let' people refuse help when they are incompetent, altho it is tempting sometimes isn't it?? Was the doc too rough? Possibly. I was not there so cannot speculate. As someone who deals daily with abusive addicts and OD's in ER and ICU who fight US, I can see both sides of this. The question in the OP's mind is 'was this too extreme'. How to handle this depends on what you want to accomplish, IMO. Tough situation. Go to your EAP and your manager definitely....protect yourself from accomplice allegations. The other things are your call.Some nurses here will disgree with what I am saying I know.

I watched a coworker get reported to peer review and to the BNE for letting an OD refuse treatment, so this issue is a big one for me.

Good luck to you...I know this is not easy.

abnurse · Feb 14, 2004

I know this will catch some flak and, I wasnt there but you state:
The law states he is obligated to treat an overdose/suic pt an acceptable standard of care for an overdose to lavage pt, from what you descride he grabbed her by the hair and slammed her back into the bed. If her grabbed her by her hair to pick her up that not acceptable. Or did he just jerk her up into a 90 positon and put her back to the bed. I have fought to many overdose pt to deal with BS you also stated
It is a felony assault to strike a healthcare worker even in a drug induced state. If the pt had been a 19m crack overdose who was combative with staff and was repostion forcefully and the tude placed would as many people have issues. My feeling on overdoses that are combative and need to be pumped paralytics, intubate, and drop an ewol tube.
Again I dont want to start a huge riot in here, but 1) it was a attempted suic/overdose you dont take 70+pills by mistake 2) did you remember the event just as it happened and 3) i agree if he picked her up by her hair not acceptable but just to jerk some one who is fighting staff up in bed is not assualt

The patient was in a 90 degree position with her head bent down over the emesis basis, so he did not pull her into position but picked her up off the bed and slammed her into the back of the bed. We tried several times with her head held in place before the doc came in...once the tube passed thru the nares she would shake her head and body to fight it from going any further, therefore there was nasal trauma in the way of bleeding. She could not be treated with narcan d/t her taking seroquel, and other psych meds. No narcotics or ETOH in her system when tested. She did not strike the staff nor threaten us in anyway of harm to us. The doc was irked that we had not accomplished what he ordered done.

I am not upset with what you are saying but his behavior was totally out of line. I too have fought with combative pts. to prevent them from injury to themselves as well as staff (11 people to hold a 125 lb man down from hurting us, while in 4 points restraints...another story another time)

abnurse · Feb 14, 2004

I had a meeting with DON today with charge nurse present. Told exactly what I witnessed. They stated the other RN's story was almost identical to what I witnessed. I had to file an interdepartmental incident report that was reviewed by the Director of the ER. Saw the director out in public tonight and was informed that immediate action has begun on this incident. He told me we would discuss it further on Monday and a formal investigation would ensue and the doc would be severly reprimanded and not with a slap on the wrist. The ER director is a fair man with a large conscience who doesn't put up with poo from anyone and has very high standards of patient care. Will keep you informed.

Thanks for all the support and advice.

Alnamvet · Feb 14, 2004

I had a meeting with DON today with charge nurse present. Told exactly what I witnessed. They stated the other RN's story was almost identical to what I witnessed. I had to file an interdepartmental incident report that was reviewed by the Director of the ER. Saw the director out in public tonight and was informed that immediate action has begun on this incident. He told me we would discuss it further on Monday and a formal investigation would ensue and the doc would be severly reprimanded and not with a slap on the wrist. The ER director is a fair man with a large conscience who doesn't put up with poo from anyone and has very high standards of patient care. Will keep you informed.
Thanks for all the support and advice.

OK, I have my fire retardant scrubs on...it looks as if the "male" ED Director can do what only men are very good at doing...not cowtowing to miscreant medical staff...sign me Dirty Harry! :)

Erin RN · Feb 14, 2004

ab

Sounds like you did the right thing. On any given week when I worked in our ER I lavaged or helped lavage at least a couple of pts. Most of the time these individuals were very combative and there was force used however that force was not abuse. There is a fine line and I think all ER nurses would be able to recognize the difference. What needs to be done needs to be done..leather restraints, several people at the head of the bed holding the pts head while he/she is screaming are necessary to accomplish the lavage, period. However, what you describe would not be necessary in order to accomplish it..We have a right and a responsibility to save people from themselves however that right does not extend to what this MD did. Sounds like he was very angry and took it out on the pt..if he is unable to control his anger the ER is not a good place for him to work. Erin

Dayray, RN · Feb 14, 2004

Way To Go abnurse!

I am glad you are standing up for your patient. Don't feel bad that you didn't act right away, yes it was probably the right thing to do but when things happen so quickly and you are unprepared for it, sometimes it's hard to make a quick decision. Next time this happens you'll know what to do and know that you'll be backed up if you speak out against this type of behavior.

As for those suggestion that the doc was doing what was necessary to treat an OD patient, I disagree. Yes I have also been involved in treating combative patients and many times physical restraint was used and even some verbal intimidation to prevent abuse of the staff but in this case the doc was using physical force as intimidation and that is abuse. He didn't restrain the patient he attempted to hurt them so they would do what he said and thats wrong.

As for the doc, maybe he is a jerk or maybe he just got carried away and went to far. With combative patients it can be hard to control them without hurting them so I'd give him the benefit of the doubt until you know otherwise. Regardless he does deserve some discipline from management.