Fall with injury in ltc

  1. Recently I was put on "suspension pending on-coming investigation following an unwittnessed fall in your fall." My patient was in front of me at nurses station as she is a fall risk because she constantly tried to get up from her chair when she physically can't anymore. I noted she was urinated so I took her to her room and asked the first aide i saw down the hall if she would her resident be changed as she was wet, cna clearly stated "no, I have to do something else." I told the resident give me a few seconds while I get someone to help dont get up, she understands for the most part but does have Hx of cog. Def., I walked out of room yo find my other aides and they were both giving a bed bath, so then I helped the aide that told me no to pass out lunch trays so she can go help resident, then I ended up helping another patient with a complaint on her food. I went to dining room to fix it and a cna went yo get me because my patient was on the floor. I went, supervisor was already there along with another nurse. I got xrays to rule out any fx as she was laying on her side against foot rest. Came back a fx rib that family was saying was old. The incident was reported to state and I was suspended while the aide that told me no is still working. I know I should have just stayed at bedside or changed resident myself, but can someone give me their input. Our administrator doesn't back up the nurse's at all in any which way. Something happens that was out of our control at times and its automatically out fault and nurses get fired. Same incident happened almost exactly similar and the nurse was never suspended nor reprimanded in any way. Im just really scared for my license and job. This isn't fair.
    •  
  2. 20 Comments

  3. by   purplegal
    Hmm, I've never heard of someone being suspended for an unwitnessed fall. Mostly, because, it's impossible to be everywhere at one time, and some people are not going to call for help, no matter how many reminders you give them. Since there is no NEW injury according to family, suspension also seems a little harsh. What might get you is that you left the room knowing that the resident is a fall risk and had an immediate need, even though technically an aide could have met that need. Once you realized that all your aides were already busy, you probably should have just gone back to help the resident right away. Issues regarding food could have waited. Not trying to criticize you, as you yourself know that maybe you didn't prioritize tasks as best as possible. I also try and delegate tasks such as changing a resident...IF an a aide is available. However what I like to do is put on the call light, stay with the resident and start the task. If they come to take over, that's great. But sometimes it's easier to just do the task myself. However since there were no new injuries, I don't know that you necessarily have to worry about losing your license, although I would be nervous too. As far as your job, maybe reach out and explain what you would do to prevent this in the future. If this is your first time, hopefully they will take that into account. Sorry that you are going through this, as you were actively trying to get help for your resident.
  4. by   Paws2people
    Yeah you're correct... As soon as you saw she was wet, you should of just changed her yourself since all the other aides were busy. Helping pass out trays can wait. A food complaint can definitely wait.

    I realize this was a task that could be delegated if you were too busy doing other nursing duties. However, you had time to look for aides and help with meals.

    In the time it took you to go look for an aide to change her, you could of done it on your own. Lesson learned.

    A lot of times when a resident is soiled and uncomfortable, they will get up and that leads to a fall. Would she have fallen regardless? Maybe.

    I don't know that there is anything you can do now, except take this experience and learn from it.
  5. by   Sour Lemon
    Your patient was such a high fall risk that she was placed in front of the nurses station, but when you saw that she was becoming agitated and behaving dangerously, you pushed her off somewhere where she was unable to be observed. I don't think you were "wrong" to delegate, but she probably should have been in someone's line of sight while waiting for care. Then again, maybe the facility or family needs to provide a sitter for her if things are that extreme. Nurses and CNAs have many patients to care for. It's easy to say "should have" or "could have" when you're not neck-deep in the bustle.
    X-ray results usually specify if an injury appears old or new.
    I wish you well.
  6. by   dishes
    Agree with paws2people, learn from this experience, you need to show remorse for not prioritizing the patient's need to be changed and for leaving them soiled and unattended. Also you should not blame the aide who was busy, as laying blame on the aide makes you look like you shirk your responsibility and do not clearly understand the factors that contributed to the fall.
  7. by   Nrsvn11
    she wasn't pushed off anywhere, I took her to her room to be changed as she was urinated on. Leaving her in front of the nurse's station gives no privacy nor modesty. She didn't want to be seen by people urinated on. But yes, I should have stayed with her instead of answering the complaint.
  8. by   Nrsvn11
    I keep going back and fourth on this. I should've stayed with her. I should've done it myself as I usually do. Thank you for your feedback.
  9. by   4boysmama
    I very much doubt that you will lose our license over this, but you might lose that job. While it is appropriate to delegate personal care to the aides when available, it is also well within our scope of practice to provide that personal care and you should have done so instead of leaving the patient alone while you went to search for another aide.
  10. by   dishes
    I agree with 4boysmomma, i don't think you are at risk of losing your license as it was a lapse in judgement. However, if you are terminated for cause, you may face a disciplinary hearing with the BON and need to do some type of remediation. You should consider contacting your malpractice insurance provider to discuss the incident with them. Also, if there is a complaint filed against you with the BON, suggest you contact an attorney familiar nursing license issues, you can find one through the American association of nurse attorneys (taana). If you talk to an attorney they will tell you not to discuss the matter in public, as it is not in your best interest.
  11. by   rkitty198
    If every nurse who had a fall lost their license we would have some major problems!!
    It's so hard to make the right decisions within a split second and much easier to make the right decisions in retrospect.
    I would tell your managers what happened, what you should have done, and what you plan to do right the next time.
    I would also add that your priority was to prevent the patient from falling as well as her privacy and dignity. She was trying to get up from her chair in the hallway soaked wet with urine. Either way this patient was a fall risk at the desk or in her room. What if she were at the desk when you went to help the patient with their tray? Who would have been there to assist her then?
  12. by   Nrsvn11
    Thank you so much for your answer. I pray my administrator sees this point of view. I do my best to provide the best care I possibly can. As one of the others said, I should've changed the patient myself; I have done that many times. In my experience in that facility, myself and one of the managers are the ONLY ones that don't mind getting our hands dirty. I change, give showers and bed bathes all the time to help my aides. Once a CNA always a CNA, and I don't mind the work. I just wish administrator backed me up to understand that I had only good intentions for my patient. My intention was not to allow her to fall even though that is what happened. Family backs me up and still THANKS me for taking care of it right away. I stayed 4 hours after my shift to get xrays done and waited for results yo come in to keep family updated. I would be caring if I just left my shift wether patient was taken care of after or no. Again, thank you for your response.
  13. by   dishes
    I hope the administrator allows you to keep your job and views the incident as an opportunity to create a non punitive culture of safety in the workplace. I know it feels awful when an error in judgement causes a patient incident, we have all experienced it to some degree. Acknowledging that the incident happened, why it happened and how we can prevent it from happening in the future is a far more effective strategy to ensure patient safety, than punishing health care professionals for an error.
    Last edit by dishes on Dec 10, '17
  14. by   amoLucia
    By and large, almost every poster has hit the nail on the head re this incident. But there is still the that this pt suffered an unwitnessed fall as a result of a MAJOR cascading errors.

    Although painful and seemingly harsh, your suspension for this incident is pretty much what most facilities would do. And it depends on the rest of your employment record if there will be further action, up to & incl BON involvement.

    What I think I see is new nurse 'newness' contributing to this incident. Inexperienced decision-making improves with time. You alone are responsible for your actions. And while you meant well, "people do wrong things for the right reasons".

    Other people may also be disciplined, but it is NOT Administration's responsibility to notify you. Those things should be kept private.

    Good luck.

close