Failure to Protect Residents From Verbal Abuse by RN
Penalty
Summary
The deficiency involves the facility’s failure to protect cognitively intact residents from verbal abuse by a registered nurse (RN 1). One resident with multiple sclerosis and chronic pain due to trigeminal neuralgia, and another resident admitted after an accident with bone fractures, both had Brief Interview for Mental Status (BIMS) scores of 15, indicating normal cognition. According to interviews, when the resident with multiple sclerosis questioned RN 1 about the timeliness of his medications for chronic pain, RN 1 began yelling and “freaking out.” The resident reported withdrawing from the area, hearing RN 1 “bad mouthing” him in the hallway, and then blocking it out by putting on headphones. He stated that the interaction made him feel “like shit,” “crazy,” and anxious because he needed his pain medication. Another resident reported that RN 1 was yelling at the first resident, saying she did not have to deal with administering his medication at that time and that she was already late, and described RN 1 as aggressive and yelling, which upset the first resident enough that the second resident went to calm him down. A third resident, located approximately 40 feet and four doors down from the first resident’s room, reported overhearing the incident and stated that RN 1 was yelling at the first resident about the timing of his pain medication, describing RN 1 as very unprofessional and disrespectful. This resident emphasized that RN 1’s yelling was audible from his room and reported feeling anxiety about any potential interactions with her afterward. Social Services staff, after meeting with the involved residents, stated that the residents reported RN 1’s tone as loud, that she may not have maintained her composure in a stressful situation, and that she was loud talking and dismissive toward the first resident. The DON reported that CNAs 1 and 2 had brought forward the incident, and the DON characterized the behavior as verbal abuse based on yelling that could be heard down the hallway. CNAs 1 and 2 confirmed that the third resident reported RN 1 was irritated and yelling at the first resident about medication, and one CNA noted having previously heard RN 1 talk “a little loud” toward others. The facility’s abuse policy defines verbal abuse to include use of a tone of voice that causes a resident to feel frightened or threatened, and notes behavioral indicators such as fear, withdrawal, anger, and anxiety.
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