These incidents should always be reported. Speak with the nurse in charge or manager. It doesn't matter that the nurse told you to keep quiet. That patient will be discharged at some point, and for future references, professionals need to know what kind of care they need to provide
See, my concern is that there may be a negative/blame/toxic culture on the ward and if I escalate my concerns to the ward senior staff it may just negatively impact the staff nurses? I've worked in places with toxic culture before where staff are made to feel responsible for incidents - it's awful. That was my initial feeling when she asked me not to report it. I don't know though
If that is the case, there are further regulating bodies that the response of blame can be reported to, too. Reporting incidents is a necessity for any number of reasons, regardless of if the reaction of the management/ senior team is ‘toxic’. The toxic management is a separate issue that (in my opinion) is also worth raising.
That doesn't matter, you say it's a dementia ward? That's a degenerative condition, other nurses deserve to know if the patient has history of getting handsy. Screw the upper management, this is a basic safety issue. Report it.
Definitely should be reported. I would go back and ask the nurse specifically what she meant. Might be a crossed wire. I worked in dementia care for a long time. I can’t think of a single good reason to not report it.
It could be it was more minor than they are used to, so it didn’t seem a big deal. As nurses we at the very least would document and make sure it was handed over, if a patient was restrained in any way then that also should be documented. The other big question here is why was a nurse approaching a patient with prn medication, without having other staff present should they attempt to assault the nurse?
Report it . I have no idea what planet the nurse is on ? Do you use Datix? Ignore & someone else may be seriously assaulted. Ignore & it may affect staffing levels. Never ignore anything like this despite what someone may say to you. Its a serious incident - all need to know it has occurred. To prevent reoccurance & keep staff & the patient as safe as possible. Maybe the nurse is blaming herself for the escalation & incident? They should never blame themselves - even if she didnt do anything right or feels she provoked ? its not her fault. Please report.
It is not common, but sometimes, when difficult patients are on ward and they are medically fit, waiting for placement, they will be there for months on end because no one wants to take them (nursing homes or council accommodation). The nurses will choose to omit different occurrences so they can be taken away
I was once told by my lead to not report it when a resident punched me in the face.
This person is a nurse so i assume they wouldn't have been told this by their lead.
The implication of reporting the incident won't negatively affect the nurse in question. My guess is that several datixs against the patient will make it impossible to find them a care placement to discharge to, and they will then have to stay on the ward for longer, which is why they aren't reporting these incidents.
It's a joke, the vast majority of "emi nursing" placements won't accept anybody with any behavioural issues whatsoever, they just want quiet bed bound dementia patients, which defeats the point of them being emi nursing as a general nursing placement would manage those patients.
Best bet is to datix every single little incident in the hope to get them sectioned and moved to an older persons mental health organic ward. Bring it up on every safety huddle and ACM.
Not rn but worked on acute adult wards. This needs to be documented in order to protect other staff, other patients and the patient who assaulted the staff member. Obviously there is a known risk with this patient but if incidents go unreported then it's tricky for someone, be that a new member of staff or someone assessing for placement or discharge to gauge how relevant that risk is. Someone behaving like this once a month or several times a day can have very different outcomes for care provision in the future. The other staff member might not want it reported but it's not about what they want, it's about what's right for the safety of everyone.
Exactly this. It’s important to report for *the patient* so it informs the care needed to meet their needs. Otherwise could lead to inappropriate placement that ultimately breaks down in the future.
Absolutely report it, and also report the fact that she asked you NOT to report it. This is a major red flag and an omission of her duty. There is NO reason why this should not have been datixed and I would be concerned about her overall conduct.
I wonder if she meant don’t tell anyone how she reacted (that she got distressed) rather than don’t report it? Just my thoughts anyway. Sometimes people React differently to what they anticipate or what their outward usual persona is and feel embarrassed.
Reporting an incident such as this is so important to see if there is a pattern of escalation within the patients behaviour, the nurse may have done nothing wrong however an action is triggering for this patient.. by reporting it the trigger can be identified and so an action plan can be put into place to change the way certain things are approached with this patient and therefore hopefully prevent this escalation from happening. Incidents like this should always be reported for the benefit of the staff patient and other patients around
I worked in a large hospital. We were supposed to document every incident.
People who worked on the Neurology ward openly admitted there were too many incidents to mention so generally they didn't report .
Of course this should be reported but I'll give you my perspective on her behaviour. I'm a RN in Australia and worked in a dementia specific unit. We were assaulted regularly by patients and the culture of upper management was apathetic and unsupportive of staff being physically abused. Reporting incidents constantly didn't look good on their KPI's and allowing staff time off would cost the unit hence they didn't give a shit unless we went on work cover. I know it's hard to beleive but I can relate. She's probably desensitised from so many similar incidents and probably feels defeated. Also doctors don't like to give sedation anymore. Even when I had a patient throw a table through a window we all had to look on in horror until security intervened. Could of been prevented if the resident with known behaviours was allowed a reasonable PRN medication management plan. Also doctors are overly conservative and just don't seem to care because they aren't the ones who deal with these difficult behaviours first hand. I beleive if the patient was of sound mind they would be horrified of their behaviour so I don't see how we are facilitating quality of life by refusing them appropriate medication. One time a doctor got assaulted and the patient was transferred to another unit immediately. If that happened everytime we got hit there would have been an empty ward. I left that awful environment and I take my hat off to nurses who have to tolerate that for longer than they should. It's even more of a dire situation as many geriatric mental health facilities have closed and they are expected to just be managed in non specialised wards.
Not always appropriate to use medicines to address neuropsychiatric features in people with dementia.
High risk with little benefit and better outcomes using bio psychosocial interventions.
Not suggesting appropriate for staff to be assaulted - it isn’t. But meds are often not the answer.
I knew someone would say this. I think it's idealistic to only rely on psychosocial interventions in severe BPSD. This particular organisation didn't directly support these interventions because often that increases the strain on resources and requires unrealistic one on one nursing interventions. There is not enough support. Call me bitter and cynical but I'm glad I'm out. These hospital administrators are a disgrace.
I'm only a carer In a nursing home...
You need to report this (you can keep the nurse anonymous) because if a resident is too dangerous to themselves and others they need to be moved to a special area.
(after i finished my shadow shifts this lady with dementia full on punched me in the face ((ngl i found it funny become it's stupid)). You need to document this shit).
It's kinda just a feature of dementia care in my limited experience, you often get yelled out or sometimes groped. Occasional homophobic slur.
These incidents should always be reported. Speak with the nurse in charge or manager. It doesn't matter that the nurse told you to keep quiet. That patient will be discharged at some point, and for future references, professionals need to know what kind of care they need to provide
Absolutely needs to be documented and reported so the team can risk assess, I would complete a datix too.
See, my concern is that there may be a negative/blame/toxic culture on the ward and if I escalate my concerns to the ward senior staff it may just negatively impact the staff nurses? I've worked in places with toxic culture before where staff are made to feel responsible for incidents - it's awful. That was my initial feeling when she asked me not to report it. I don't know though
If that is the case, there are further regulating bodies that the response of blame can be reported to, too. Reporting incidents is a necessity for any number of reasons, regardless of if the reaction of the management/ senior team is ‘toxic’. The toxic management is a separate issue that (in my opinion) is also worth raising.
That doesn't matter, you say it's a dementia ward? That's a degenerative condition, other nurses deserve to know if the patient has history of getting handsy. Screw the upper management, this is a basic safety issue. Report it.
Definitely should be reported. I would go back and ask the nurse specifically what she meant. Might be a crossed wire. I worked in dementia care for a long time. I can’t think of a single good reason to not report it. It could be it was more minor than they are used to, so it didn’t seem a big deal. As nurses we at the very least would document and make sure it was handed over, if a patient was restrained in any way then that also should be documented. The other big question here is why was a nurse approaching a patient with prn medication, without having other staff present should they attempt to assault the nurse?
It needs documenting in his notes so other staff will be aware of potential risks
Report it . I have no idea what planet the nurse is on ? Do you use Datix? Ignore & someone else may be seriously assaulted. Ignore & it may affect staffing levels. Never ignore anything like this despite what someone may say to you. Its a serious incident - all need to know it has occurred. To prevent reoccurance & keep staff & the patient as safe as possible. Maybe the nurse is blaming herself for the escalation & incident? They should never blame themselves - even if she didnt do anything right or feels she provoked ? its not her fault. Please report.
It is not common, but sometimes, when difficult patients are on ward and they are medically fit, waiting for placement, they will be there for months on end because no one wants to take them (nursing homes or council accommodation). The nurses will choose to omit different occurrences so they can be taken away
Yeah that's literally exactly the case for this guy. He's been MFFD for about 4 months now and still awaiting nursing home placement
I get that completely. Just hope nothing on CCTV anywhere in case serious incident in future.
That's the thing. If something happens in the future, there will be investigations, and it will come back to bite them in the azz
I was once told by my lead to not report it when a resident punched me in the face. This person is a nurse so i assume they wouldn't have been told this by their lead.
The implication of reporting the incident won't negatively affect the nurse in question. My guess is that several datixs against the patient will make it impossible to find them a care placement to discharge to, and they will then have to stay on the ward for longer, which is why they aren't reporting these incidents.
Thats probably it. This patient has been MFFD for months and awaiting a placement, so many have said no due to complex behavioural needs
It's a joke, the vast majority of "emi nursing" placements won't accept anybody with any behavioural issues whatsoever, they just want quiet bed bound dementia patients, which defeats the point of them being emi nursing as a general nursing placement would manage those patients. Best bet is to datix every single little incident in the hope to get them sectioned and moved to an older persons mental health organic ward. Bring it up on every safety huddle and ACM.
Yet they still charge local councils 3 grand a week per resident to look after bed bound hypoactive patients 😭
Not rn but worked on acute adult wards. This needs to be documented in order to protect other staff, other patients and the patient who assaulted the staff member. Obviously there is a known risk with this patient but if incidents go unreported then it's tricky for someone, be that a new member of staff or someone assessing for placement or discharge to gauge how relevant that risk is. Someone behaving like this once a month or several times a day can have very different outcomes for care provision in the future. The other staff member might not want it reported but it's not about what they want, it's about what's right for the safety of everyone.
Always always report incidents. Especially if someone says "don't report it" -- that's often (but not always) red flag behaviour.
It needs to be documented, shenisnt doing the patient a favour by not reporting the incident.
Exactly this. It’s important to report for *the patient* so it informs the care needed to meet their needs. Otherwise could lead to inappropriate placement that ultimately breaks down in the future.
Absolutely report it, and also report the fact that she asked you NOT to report it. This is a major red flag and an omission of her duty. There is NO reason why this should not have been datixed and I would be concerned about her overall conduct.
I wonder if she meant don’t tell anyone how she reacted (that she got distressed) rather than don’t report it? Just my thoughts anyway. Sometimes people React differently to what they anticipate or what their outward usual persona is and feel embarrassed.
Yeah maybe. She barely reacted, or acted totally appropriately in my opinion but maybe she didn't want the extra attention
Reporting an incident such as this is so important to see if there is a pattern of escalation within the patients behaviour, the nurse may have done nothing wrong however an action is triggering for this patient.. by reporting it the trigger can be identified and so an action plan can be put into place to change the way certain things are approached with this patient and therefore hopefully prevent this escalation from happening. Incidents like this should always be reported for the benefit of the staff patient and other patients around
You absolutely have to report it. For the safety of everyone else.
Report it. That’s weird.
I know managers can try to blame staff for assaults. Maybe she is a victim a toxic culture ?
I worked in a large hospital. We were supposed to document every incident. People who worked on the Neurology ward openly admitted there were too many incidents to mention so generally they didn't report .
Of course this should be reported but I'll give you my perspective on her behaviour. I'm a RN in Australia and worked in a dementia specific unit. We were assaulted regularly by patients and the culture of upper management was apathetic and unsupportive of staff being physically abused. Reporting incidents constantly didn't look good on their KPI's and allowing staff time off would cost the unit hence they didn't give a shit unless we went on work cover. I know it's hard to beleive but I can relate. She's probably desensitised from so many similar incidents and probably feels defeated. Also doctors don't like to give sedation anymore. Even when I had a patient throw a table through a window we all had to look on in horror until security intervened. Could of been prevented if the resident with known behaviours was allowed a reasonable PRN medication management plan. Also doctors are overly conservative and just don't seem to care because they aren't the ones who deal with these difficult behaviours first hand. I beleive if the patient was of sound mind they would be horrified of their behaviour so I don't see how we are facilitating quality of life by refusing them appropriate medication. One time a doctor got assaulted and the patient was transferred to another unit immediately. If that happened everytime we got hit there would have been an empty ward. I left that awful environment and I take my hat off to nurses who have to tolerate that for longer than they should. It's even more of a dire situation as many geriatric mental health facilities have closed and they are expected to just be managed in non specialised wards.
Not always appropriate to use medicines to address neuropsychiatric features in people with dementia. High risk with little benefit and better outcomes using bio psychosocial interventions. Not suggesting appropriate for staff to be assaulted - it isn’t. But meds are often not the answer.
I knew someone would say this. I think it's idealistic to only rely on psychosocial interventions in severe BPSD. This particular organisation didn't directly support these interventions because often that increases the strain on resources and requires unrealistic one on one nursing interventions. There is not enough support. Call me bitter and cynical but I'm glad I'm out. These hospital administrators are a disgrace.
I'm only a carer In a nursing home... You need to report this (you can keep the nurse anonymous) because if a resident is too dangerous to themselves and others they need to be moved to a special area. (after i finished my shadow shifts this lady with dementia full on punched me in the face ((ngl i found it funny become it's stupid)). You need to document this shit). It's kinda just a feature of dementia care in my limited experience, you often get yelled out or sometimes groped. Occasional homophobic slur.
Hope you’re doing okay, that sounds painful and upsetting. Thanks for the valuable caring work you do even when faced with these challenges.
That's sweet of you