Lost on the Floor

As I was walking down the hall on the unit doing midnight rounds I heard it. Faint at first, just enough to prick my ears up, then more distinct, "let me out! Let me out!" in an ongoing chant. I knew that it wasn't anyone on my end of the unit, it had to be coming from the other side, 40-50 yards down the hallway. When I got back to the nurses station, it started again. Someone jokingly said, "sounds like a nurse!" We all laughed.

Later that night, I heard what it was all about. It was one of our patients, screaming out about being kept in the room. Guess she liked to wander. (Later heard that day shift had found her half-way down the fire escape at one point.) In the course of all of this, the nursing supervisor cam by and asked why the door had been closed, y'know, against JCAHO regs and all. They simply told her that the woman's yelling and abuse had finally gotten too much, so they closed the door for a little bit of quiet...maybe to let the other patients sleep.

"Well," she said, "I'll go and see what is going on." She walked over to the door and opened it, stuck her head inside.

The patient looked up and said. "What the f*ck do you want?!" Then began cussing her out, using more four-letter words than the proverbial sailor. The supervisor, quickly exited, closed the door and without another word about it, went on her way. Just smiled and nodded.

I wonder what JCAHO would really have us do in this situation? I know that closing the door is probably not the best thing, but it was what we had to do. (She was being checked on frequently and sitting in a geri-chair, so she was safe at the time.) Really, there is the ideal world that the surveyors and policy makers inhabit, way up in the ivory tower of administration and then there is the reality of life on an acute nursing care floor. Considering the new report out that nearly 5 million adults in the US has Alzheimer's, we better figure this out, or else instead of being greeted warmly by our patients, we'll be asked "what the f*ck" do we want on a more regular basis.