Dangerous Mental Health Ward Manager

What it’s like working with a dangerous mental health ward manager

I recently found out that one of my old Managers was transferred to yet another hospital within the same Trust. Yay! He’s finally been demoted again.

Why he wasn’t dismissed and why the heck it’s taken so long to demote him, I don’t know.

Well, I suppose I do and I’ll come to that, but first let me tell you about a few of his other misdemeanours.

Some years back a patient came onto the ward with what appeared to be Extrapyramidal Side Effects (EPS), which can include:

• tremor
• slurred speech
• uncontrollable grimacing
• akathisia; a sense of restlessness and intense need to move. To relieve this feeling, you need to stay in motion, pacing
• dystonia; muscles contract uncontrollably. The contraction causes the affected body part to twist involuntarily, resulting in repetitive movements or abnormal postures
• anxiety and/or distress and, in some people there’s the
• Oculogyric crises; acute dystonia characterized by spasmodic movement of the eyeball(s), usually upward, and each spasm lasts from seconds to hours. It’s not usually life-threatening but it can be very distressing to the patient and family (and staff).

These symptoms are primarily associated with either improper dosing of or unusual reactions to neuroleptic (antipsychotic) medications. The EPS tends to occur with the older type of antipsychotics and I witnessed many of these disturbing side effects over the years. I’ve also experienced dystonia with my physical illness and therefore know how painful it is.

Dispensing non-prescribed medication

The aforementioned patient (Craig) appeared to be experiencing akathisia and acute dystonia and came to tell me that Perry (my manager) had given him a box of 30 antipsychotic tablets the previous night.

• Risk factors for acute dystonia are young age and male gender, history of substance abuse, hence the side effects in Craig!

He needed side effect medication like — now! Hmmm, his meds chart was blank. I couldn’t give him anything. I had to contact the on-call SHO to prescribe Procyclidine — to counter the side effects of the illicit antipsychotic drugs given by my errant boss.

Craig happily admitted he’d taken two over the agreed dose (with alcohol and lots of cannabis) because he couldn’t sleep. But now he was pacing, edgy, grimacing, anxious and agitated, so he asked for Procyclidine. It’s used to treat symptoms of Parkinson’s disease or involuntary movements due to the side effects of certain antipsychotics.

Nursing Code of Conduct

“As nurses, we can advise on, dispense or administer medicines within the limits of our training and competence, the law, our guidance and other relevant policies, guidance and regulations.”

Nursing & Midwifery Council’s Code of conduct, 2018

In accordance with the Royal College of Nursing (RCN) Code, nurses must adhere to the five “rights” of medication administration. This includes right patient, right drug, right time, right route, and right dose. These rights are critical for nurses.

Within each Mental Health NHS Trust, there are medication processes in place to limit errors, along with an audit trail and clinical documentation.

However, Perry chose to prescribe and dispense a whole month’s worth of antipsychotic medication, without seeking advice from the on-call doctor! Furthermore, there was no clinical documentation anywhere and there was no message to communicate this information to staff on the next shift.

As nurses, we must ensure that our colleagues are working within the scope of their experience and capabilities, particularly when prescribing medication. And as Perry wasn’t a nurse prescriber, he should never have prescribed meds for Craig! So

What was I to do?

It was busy on the ward the following day and I thought I’d give Perry a chance to ‘hand over’ the above information to staff. However, there was no mention of it during our one hour morning handover. I didn’t want to call Perry out in front of the team. So, I waited until the next day.

I didn’t sleep too well that night and my stomach was turning at the thought of how a meeting with Perry would go.

Duh! I knew exactly! When I mentioned the meds he’d given to Craig, his face turned puce, his eyes bulged and he snorted with rage. “How dare you question me?”

I explained that as a fairly new nurse and recently promoted charge nurse, I had a duty of care……. “The NMC’s Code states…………………”

“Don’t you quote all that crap to me. If a patient’s in need, then we give them meds,” he ranted. “I made a rational and informed decision.”

“You know we’re not qualified t…………” I tried, to no avail. I said that all he had to do was to explain to Craig’s Consultant, document the transaction in Craig’s notes and complete an incident form. At this point I willing to view it as oversight, something we can learn from and move on. But

Professional jealousy

I knew Perry wasn’t fond of me, he made that quite clear from the start — completely ignoring me, in front of the team and patients. His predecessor had promoted me from another ward in Perry’s absence, and he was absolutely furious.

I’d initially thought he might be happy to use my Human Resource Management skills? I’d hoped he’d share his knowledge and skills with me. Ha!! Anything I could do, he could do better; which would’ve been excellent — if only he’d actually showed me. Rather than tell me.

Anyhow, he obviously resented that I’d questioned his actions so told me to leave it at that. He wasn’t going to do anything. “End of!” he nearly spat as he tried to shoooooo me out of his office with a sweeping flourish and a conniving grin.

Not so quick Perry, “Look, I’ll leave it a few days to give you the chance to complete the necessary paperwork — and — job done,” I smiled as I left. “I can’t unknow this situation, Perry.”

Modern Matron to the rescue

The thing is, Craig had quite happily told me, the rest of the team and all the other patients that Perry had given him “unauthorised meds.” This could all go terribly wrong! As we knew about this incident, the team was in fact colluding with Perry to keep it quiet. And that alone is a disciplinary!

Moreover, imagine if Craig’s dystonia had occurred at home — without the Procyclidine? He’d be in agony and would probably have taken himself to A&E via ambulance, where everyone would’ve found out that he’d been given unauthorised antipsychotics.

Long story short, Perry refused to complete any documentation and I said I’d have to speak with his Manager, a Modern Matron. She asked me in front of Perry what was my agenda here? Was I after his job because it seemed like I was trying to get him sacked!

Oh, my word! All I’d wanted was for Perry to deal with the situation himself. Full stop. However, Matron loved all her boys, something known to everyone on the unit, and was covering Perry’s back. No problem. I no longer had to carry this indiscretion around, but it p’d me off as I was made to look like the baddie.

What next?

So — what was I to do when Perry flirted with his male patients — in full view of the team and other patients? Or when he regularly gave them money for cigarettes, and cannabis or alcohol. And what about the fact that he took a male patient on holiday, and started a fight with a colleague on a night out, and ……..

Whoa! Let’s back up a bit!

He took a patient to Portugal for a week? He kept that quiet. But surely he knew how patients talked to other patients, and to staff? So now we all knew he’d taken a vulnerable patient, who’d just come out, on holiday!

I asked the team what we should do — collectively, believing they would feel the same outrage? “Hmmm, I don’t like grassing him up.” and “Maybe we should just leave it – this time?” wasn’t very helpful.

It got even worse. Well, Perry’s erratic behaviour did.

Over to you

Do you want to take a guess at what Perry does next? What do you think about the situation i.e. morally, professionally, ethically? Have you ever worked with someone like Perry? I’d love to hear from you.