I'd like some feedback from other nurses about how they handle self-injuring patients when staffing is too low to do one to one monitoring. We are currently holding a young Borderline Personality DO client until a bed in a state facility comes available. She is prone to cut on herself when the nurses are busy. Attempts to redirect her are usually in vain.She doesn't stop until she has brought blood on herself. It's interesting to note that the more attention we give her, the more likely she is to act out. I worry about the nursing liability of this situation. I know it's my job to keep her safe but she is only safe when in restraints. Obviously, she can't live in restraints. We're also starting to shy away from restraining because she weighs over 300 lbs and we usually end up with injured staff when we take her down. I am beginning to notice that staff is turning a blind eye when she self-injures. She has literally caused such a drain on staff time that our other patients tend to get poor care. I've been a psychiatric nurse for 20 yrs and she is the most challenging Borderline I have ever seen. Any suggestions?
I admit I know nothing of Psych nursing but this is absurd. Would a pregnant patient be held on a peds unit until a bed was open..... Yell at the top of your lungs to the powers that be and don't shut up until she gets the care she needs...
OMG...Sorry for the rant but I can't believe this..Not your post the situation..
WR,,, three commas for Becca
probably not a pregnant patient held on peds but we do get pregnant psyc patients in OB/L&D guess they'd rather us have the psyc then the psyc handle a delivery...really our hospital has closed the psyc ward a couple of years ago so now any female psyc patient that comes in that bad gets transfered to the state hospital several hours away and a female nurse has to go with them for male patients a security guard goes.
Cass what I was saying is this patient is in the wrong unit.. She needs to be transferred NOW not two days away.
WR,,, three commas for Becca
again not an argument at all with you you are right just saying at my hospital we get them in labor and they have major psyc problems and noplace to go but all other severe psyc patients get transferred now several hours away to a state facility...bad thing is across the state line 15 minutes there are psyc facilities but they can't go there without insurance they have to stay in state and go hours away and many psyc patients don't have private insurance.
Yeah Cass I hear ya.. But there is a place this patient can go.. And if I were her nurse I make a loud noise...
WR,,, three commas for Becca
I think maybe I didn't make myself clear enough in my original post. This patient is on a psych ward. Even so, our capabilities to care for her are limited, both staff-wise and acuity-wise. Our patients are not generally this sick. Even our most psychotic schizophrenic patients are easier than this gal. Bottom line is that she's going to self-injure no matter what we do. No matter how many security codes are run, unless this pt is deeply sedated or restrained, she's either threatening to hurt herself or actually doing it. The nurses have all tried so hard to establish some sort of rapport with her and nothing seems to work. She really needs longterm therapy in a speciality unit for this disorder. Another ironic piece of this is that she had been in the system of a neighboring state for most of her life. They refuse to take her back even though our hospital has pointed out to them that they are breaking "antidumping laws". Besides being worn out, we all fear that she's going to really hurt herself and we'll feel responsible. We've been shouting this very loud to our director and she says that all we can do is wait for the state bed to open.
Do you have a State Senator or Congressman.. You need to go up the ladder here..
WR,,, three commas for Becca
What about your BON.....
Does your staff have something like "treatment team" meetings with RN staff, psychiatrist, social worker, etc. What is there recommendation for her "treatment" plan???? I have worked as a geriatric psych nurse for one year but have helped out on the reg psych unit on the other side from us. Some "repeaters" want attention and have taken up a lot of time. I would think your head nurse (what ever your's is called these days!) or clinical manager would want to bring this to the attention of the DON and Risk Manager for your facility as you are working hard to prevent injury......and if this patient finally suceeds in really harming herself.....what are the liablity outcomes....especially if you are documenting (and I hope you are!) her actions as well as keeping your superior and nursing supervisor informed......I don't know enough about ECT therapy but several of my patients who didn't respond to anyother type of treatments had this recommended.
Also, the fact that patient is 300 lbs should also be cause for hospital concern in that staff could be seriously injured. Any state hospitals nearby???!!!
Thanks for the great post..Fortunately, this is not my problem..But I sure would like to see it resolved for the original poster.
WR,,, three commas for Becca
Of course we all have opinions... So here's mine:
I truly feel bad for this patient, and for the nurses who are charged with her care, but it is an unfortunate reality that we are faced with in this profession... as far as staffing goes, you can't sqeeze blood from a turnip, so we are forced to do what we can with little or no resources. I'm not saying we should just lie down and take a beating. We should absolutely continue to shout at the top of our lungs, and push for healthcare reform... something has got to be done.
On the other hand, there are just so many beds to go around, therefore many patients are released from hospitals AND mental institutions before they are medically or mentally ready, thus leading to the fact that many mentally challenged or even disturbed patients wind up among the ranks of the homeless with little or no follow up care.
It is truly a sad state of affairs. All I can say is that I hope she will get the best care that you are humanly able to provide while she is in your hands, and when she leaves you, she will be in Gods.
Keep up the good work, and don't let the system beat you down.
"No pain is greater than the knowledge that no one cares or understands."
well, i dont do psych, and this is only one classic example of why!!!
even though you may be trying to get away from restraints, you didnt say they were being eliminated all together...
restrain her... for her own safety...
it would be easier to check on her every fifteen minutes and do a circ check than to check on her every 15 minutes and clean up her mess with a blood spill kit...
and i seriously question the "borderline" part of her diagnosis!!!
i thank God i'm not a psych nurse... i couldn't do it!!! if i wanted to work in a cracker factory, i'd be at Keebler's by now!!!
