A very complex patient was on the medical/surgical unit with a severe systemic neurological disease (Huntington's Chorea) and psychiatric illness. Patients with HC are often difficult to manage. The patient was combative, agitated, non-compliant, had been restrained for two weeks and had a 1:1 sitter or sometimes 2:1 staffing. Some of this was a result of her illness and some because she was frightened by being restrained. The staff were afraid of her because of her behavior and because they would get hurt when working with her. After an IDT (interdisciplinary team) meeting with med/surg, social work and BHU associates, a plan of care evolved to ambulate her to prevent complications of immobility. After several attemps failed, Frankie, who was the BHU Charge Nurse for the day asked "would you like to hear my opinion"?
He said this is OUR patient, why is she on med/surg where her needs for psychiatric care are not met well and the nursing staff are afraid of her? I think she should be in our unit--BHU. When asked what was preventing us from taking her, Frankie replied "US". There was an order that the patient be transferred to BHU once approved by unit leadership written a week prior. Frankie, seeing himself as a leader worked with the Sr. Director, med/surg CN and manager to established rapport and asked the patient if she'd like to take a walk and see the sunshine, and after two weeks, the patient was no longer combative. This patient spent more than a month on BHU and with appropriate psychiatric care, the leadership provided by Frankie and the other nurses, and the support of the interdisciplinary team, the patient established positive relationships with the staff and was able to be discharge successfully to a facility where her needs continue to be met.