Sunday, May 4, 2014

Your Opinion Counts

An administrative person appeared behind the desk of the ward while I was on the main floor.  She asked about a violent patient (the one involved in the supposed patient abuse).  For years, he has been on special observation:  a staff member is always with him, though not within five feet because of his violence tendencies.

This administrative person asked me, "Do you think he still needs a staff member with him?"

My answer:  "Yes."

She smiled and said, "He has someone with him to prevent him from hitting people, yet he still hits people."  She stood there, still smiling, but cocking her head to the side.

My response:  "He attacks fewer people because he is being watched."

She persisted:  "Shouldn't he not be able to attack people if he is being watched?"  She smiled really big, as if she was waiting for me to finally agree with her.

My response:  "The staff are not human shields.  They do not throw themselves in between the patient and his intended victim.  They verbally redirect the patient away from trouble, but if the situation escalates, the staff member calls for help in breaking up the fight."

She was no longer smiling.  She laid out her position:  "I think he no longer needs to be watched continuously.  I am asking you for your opinion."

My response:  "I gave my opinion.  He needs to be watched and my nursing notes reflect that position and will continue to do so, even if the order to watch him is discontinued."

Her response:  "Well, we are discontinuing his special observation.  Your opinion counts.  That is why I am asking you."

My response:  "I gave my opinion and you overrode it."

The patient was on the main floor with me, but across the room, with a male attendant watching him.  No other staff members were present.  "Let's take him off observation right now," I suggested to the administrative person.  "I will send the male attendant away and stay over here.  You go and sit with the patient, in your skirt and high heels.  When he grabs you, I will call for help."

She flounced off, not coming onto the floor.  And the special observation was not discontinued.

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