As therapists, part of our role is to make safety recommendations based on our patients’ physical and cognitive abilities. Much of our documentation explains how much help a person needs to do various activities.

Thus when I make a recommendation like “patient requires one on one supervision at all times”, I expect that to be taken seriously. And when the rehab supervisor and the entire nursing staff also recommend this I simply expect it to be done. However I was severely disappointed.

I previously introduced Nancy to you, the patient I worked with who was in a catatonic excited state. This recommendation was made for her as she was a danger to herself and others around her.

And yet I would find her wandering aimlessly down the hall alone, or screaming in another patient’s room. Frustrated, I would return her to her room where a staff member was supposed to be watching over her and several other “one on one” patients. The staff member was often unaware that she had been missing as he thought she was with one or another therapy discipline and in his defense, he was extremely preoccupied supervising at least 3 other patients who needed just as mention attention as Nancy.

We managed as best as we could until one day I again found Nancy ambling down the hall. I was assisting another patient to walk back to her room when I saw with horror that Nancy was about to walk straight into another patient who sat helplessly in his wheelchair. Nancy, completely unaware of her surroundings, continued to plow forward even though her leg was caught about the wheel. She keeled forward.

Forced to abandon my other patient, I reached out for Nancy and caught hold of her before she fell and before she could latch her hands onto the patient in his chair.

Furious that no one was with her again, I instructed one of the nurses to assist my other patient back to her room while I returned Nancy to safety.

Scratching and pulling at me the entire way, I slowly led Nancy back to her room.

“Why was no one watching her?!” I cried to the nurse at the station.

The nurse was clearly just as fed up as me. “We were told that we couldn’t spare any staff to watch her! No one is going to be sitting with her anymore!”

“Are you serious? This is not ok! She’s not safe by herself!”

“I know that’s exactly what I said too but apparently that doesn’t matter!” the nurse lamented.

“Who decided this?” I fumed.

“The director of nursing.”

“Come on Nancy,” I said, “we’re going to go talk to her.”

I took Nancy all the way to the office with me, afraid to leave her alone again. With every step I took I grew more and more enraged.

By the time I reached the DON’s office, I had morphed into the hulk. Without a warning I barged straight in and began to shout questions at the DON. After the surprise passed, I could see on her face she knew I was right but was going to give me her rehearsed answer anyway.

“We cannot afford to have staff here only to be supervising patients.”

“But she is not safe without it!”

“We are not legally required to provide patients with one on one supervision at this facility.”

“Then she should never have been accepted here if we can’t provide the care she needs!”

Another visiting manager frowned at me. “Who the hell is this?”

The DON continued however. “Well we had open beds that need to be filled and she is here now so we can’t change that.”

At this point I was so far gone that tears had accompanied my rage and my hands shook. “Right! She is here! So while she is here she has to be safe!”

The other manager jumped in. “She has no record of any falls.”

“That’s because we keep preventing them! I just stopped her from falling in the hall!”

“We have no evidence to show us she isn’t safe,” the ignoramus persisted.

I could see I was getting no where. “Well come on Nancy! I guess I’ll leave you to start that fall record!”

The next day, someone was watching Nancy again.