Recently a nurse I know talked about a stressful shift where a patient with dementia and long history of agitated behaviors in a variety of facilities was repeatedly verbally abusive, using the call bell inappropriately (to ask for a cookie and then refuse it when staff brought it, to complain about how messy his room was and order the staff to clean it up, and a variety of other creative manipulations), and intentionally setting off the exit alarm by sitting on the floor and leaning on the door and once was observed walking out of his room, pushing the door setting the alarm off and returning to his room. She believed it was deliberate. In addition he frequently told staff members that the their father was a pimp or mother a whore along with other explicit sexual remarks.
Imagine a relentless siren going off! Or listen to this nursing minute over and over again for 8-12 hours! Can you imagine trying to think in the middle of such chaos?
She contacted physician on call. The physician was supportive of sending the patient to the emergency room, but the nursing supervisor said that that had been done earlier in the week several times and the patient repeatedly came back with no substantive changes in medication. She warned that this would add a slew of paperwork and that it would be ineffective. The patient held his thumb on the call bell for three hours straight and then fell asleep.
What’s even worse, she explained, was that she had expressed her concerns to the Director of Nurses and Assistant Director of Nurses 2 weeks earlier following a similar shift and from what she could see, nothing had been done to protect the staff or residents. She also mentioned that this patient’s roommate was a quite and mild mannered man who was not able to use the call light or likely to complain.
This nurse was extremely stressed and frustrated. Does the administration understand how this kind of behavior impacts staff and patients? Do they take it into account when deciding staffing ratios? Do physicians consider this when ordering prn, (as needed medications) such as a topical sedative?
I think these kinds of behaviors are abusive! And that the safety of staff and patients should be a factor when determining staffing and chemical restraints. Is there a lack of awareness/concern about how this impacts staff and patients? Would more staffing would minimize need for medication? Probably! I also think it is irresponsible for a facility to admit a patient without considering these and putting them in place, especially when there is a trail of documented abusive behaviors.
What do you think?
If you are a healthcare leader looking for ways to support staff, check out Elizabeth Scala’s Rejuvenation Collaboration virtual self-care program. It is a great resource to offer staff and the fourth in the series starting the week of Oct 21st 2013. Show them you care and support the hard work they are trying to do!