Physical Abuse of Resident by Registered Nurse
Penalty
Summary
A deficiency occurred when a registered nurse (RN) engaged in physical abuse against a resident with severe cognitive impairment and multiple psychiatric diagnoses, including intellectual disability, schizoaffective disorder, and anxiety disorder. The resident, who required substantial assistance with daily activities and had a history of verbal aggression but not physical aggression, was subjected to an incident where the RN threw a cup of juice in the resident's face and chest. This action was in response to the resident having thrown juice at the RN and a certified nursing assistant (CNA) during a period of agitation. The RN later admitted to 'mirroring' the resident's behavior by intentionally throwing juice back at the resident, believing it might discourage future incidents, despite recognizing afterward that this was not permitted. Observations and interviews confirmed that the resident was left visibly distressed, crying intermittently and unable to articulate their feelings following the incident. The care plan for the resident included interventions for staff to use calm approaches, provide cues, and allow the resident time to adjust when agitated, but these were not followed during the event. Staff interviews indicated that the resident's aggressive behaviors were typically managed through verbal de-escalation, medication, or giving the resident time alone, and that the resident was not considered a physical threat. The facility's policies on abuse prevention and resident rights explicitly prohibit willful infliction of injury or punishment and require staff to treat residents with kindness, respect, and dignity. Despite these policies and staff education on abuse, the RN's actions constituted physical abuse, as confirmed by both facility leadership and the abuse coordinator. The incident was reported internally after another RN received a text message confession from the involved RN, which was then escalated to the administrator.