I'm on a floor where the population post-leadership/administration transition has been changing. Many beds have been closed and all staffing has become bare bones: RNs, MDs, CNAs and security. We've always had tough patients (many indigent, overall extremely noncompliant). Pts used to be mostly CHF, ESRD, COPD, sepsis, EtOH, with significant psychosocial issues, but not as severe as they are currently.
As the year has progressed, it's as if we have been slowly accumulating (gero)psychiatrically unstable pts in the area while having fewer and fewer resources to address them, as personnel flee this situation. We've been unable to find placement for some of these pts due to histories of violence, even in nearby tertiary/quaternary care facilities.
We're a small hospital without any locked wards. We can't even close the doors to some rooms as some have MCI/dementia and require bed alarms to keep them safe, particularly overnight.
I've expressed to nursing leadership that this has become a significant ethical issue, and they've said some variant of, "I agree! You should bring that up with someone." Mentally I respond to this with, "I thought I just did."
Although we've had several disturbing incidents, what troubles me currently is a pt who is almost continuously restrained now. He's not a sympathetic character: he's either hit, kicked, spit on, or tried to do some variant of those to all of our staff. He cannot be let out of restraints because he is a serious danger to himself or others: he immediately tries to escape and falls, attack staff, or worse, attempts to enter other pt rooms.
For whatever reason his care seems to get delegated to the midlevels, who don't seem to be confident or experienced enough to change his inadequate medication regimen. According to one of the RNs who has recently cared for him, telepsych said his issues weren't psychiatric in nature (??) so a psychiatric placement was not possible. He has been medically cleared for months to my understanding.
He is terrifying the other pts with his constant screaming of threats and profanity. One pt called 911 because she thought there was a fight going on. Apparently several law enforcement officers rushed on to the floor, hands on guns, ready to go.
I have offered earplugs to patients so they could sleep. One of them said, "No, I need to be able to hear if that guy is coming to my room." I thought this was chilling, and totally INSANE. It's not like I wouldn't throw my body in front of a pt to keep them safe, but for one, what if I'm not nearby? And more importantly, why should this even be happening??
There are other pts like this, honestly some incidents with others are just as, if not more, concerning (bomb threats, suicide attempts). But this guy has to be restrained and some personnel have started closing the door to his room so others can rest. It makes sense, but how disturbing is it to close the door on a restrained individual?? No matter how often you check on them.
Please help with your advice. We're trying our best, but I just feel like we have no backup.
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