No one told me if I did something wrong! can you tell me. - page 2

I am a student nurse working as a nursing assistant. Today I was a sitter for a patient that in report I told was stable, he had episodes of seizure activity three days ago but has since been... Read More

  1. by   TazziRN
    You'll do fine, Kaeky. You didn't do anything wrong. The pt would have fallen no matter who was assisting him.
  2. by   jmgrn65
    Quote from purple_rose_3
    Why was this pt. not on bedrest? That is what completely baffles me!
    patients can't be on br forever he had no activity for 3 days the op said.
  3. by   tencat
    I don't think you did anything wrong, except maybe (depending on the facility's policy on sitters) not being in the room. BUT, being in the room would, in all likelihood, NOT have prevented the fall. Pt probably should have either been on bedrest or have had a bedside commode if he was having episodes like that. As for the docs.......what comes around goes around. Some docs act like jerks. And sometimes in the heat of a moment they say some stuff that's downright snippy. Hold your head high and it's even ok to be snippy too....
  4. by   msdobson
    Quote from p_rn
    now this is why we were told over and over to tuck the word "apparently" into every sentence. as for sitters where they sit should be in the room. it's "avoiding the appearance of wrongdoing" and it's all just a cover your behind game.

    apparently.
  5. by   Altra
    To the OP: the main concern expressed in your post was did you do anything wrong in that instance with that patient. No, you did not. Patient falls are not automatically someone's "fault."

    Your post did raise a lot of questions for me, although they aren't directly related to your main concern.

    1. Admission to the hospital for 3 days for seizures?? (I see multiple seizure patients every week - most of them aren't even admitted)

    2. What happened that warranted the central line insertion and transfer to the unit? (are these not seizure episodes but syncopal episodes, accompanied by hypotension?)

    3. Why did the patient require a sitter, when family was present? (at my facility, fall risk patients don't get sitters)

    Just curious ...

    Try to lighten up on yourself a little. You did nothing wrong. If you're getting a bad vibe from co-workers, take a minute to see it from their point of view. Would you grow weary of someone walking around w/an almost desperate look-what-happened-woe-is-me attitude? Do you really forgo all of your breaks? Really? You don't need to use the rest room, get something to eat, make a phone call, etc. ... ever?

    I'd tell you that this not the worst thing that will ever happen, but I'd be afraid you'd freak out ...
  6. by   Just Angi
    Sorry this happened to you. Patients fall with staff present and not present every minute. Don't take it personally, but learn from it how you could handle the next situation better.
    Good luck to you!
  7. by   Daytonite
    kaeky. . .I don't see where you did anything wrong or that you are a bad CNA. If the definition of a bad CNA is someone who had a patient fall then you and I are sisters. One of my patients managed to get one of her side rails down and fall out of the bed breaking both hips in the process. I was sick about it, but there wasn't anything I could have done to stop it. Try to put this behind you. It's normal to feel bad when something like this happens to a patient, but we can't prevent everything. This kind of stuff happens all the time. I guarantee you that in a few years after some seasoning and experience you will react to this same kind of situation much differently and with much less personal fear for yourself and your future career. And, don't worry about your assessment skills. As a CNA you're excused from any mistakes you might make in assessment. A doctor is taught, like RNs are taught, how to make an assessment of their patients. That includes considering who and where the information is coming from. It's not your job as a CNA to assess patients, but to report what you observed. You learn this through experience. And, you've just had an interesting experience, haven't you? Learn from it and move on. The doctors who allowed nurses to hear that conversation of theirs were insensitive and jerks.

    And, just FYI, Medicare and most of the insurance companies don't normally pay for a hospital stay of three days for observation of seizures without a lot of activity being performed for those patients that can't be done as an outpatient. I think the charge nurse was very wrong to tell you that this patient didn't really need a sitter. Someone with more authority than her made the decision that a sitter needed to be with this patient because they thought he needed it and it turns out that they were right. Imagine what would have happened if you hadn't been there. He might have physical injuries to deal with as well today.

    Don't you for one minute think that it doesn't matter what you do! I worked for over 30 years. I seldom took breaks. Before I sat down I would take one last walk down the hall to double-check on all the patients and often find that somebody needed something. I would always take a few extra minutes to talk with a patient who seemed to need that extra time. I learned to prioritize so that I could make time for these things. I didn't have near the problematic patients that I used to hear other nurses complaining about all the time. In earlier years I used to think I was just lucky. But, after some time I realized that it was because people like you and I put our patients first and bend over backwards to make sure their needs are met. That's the way it's supposed to be. So, don't compromise your standards. Nursing is a service career. Part of service is to serve. Now I know a lot of people don't like to hear that as a description of what they are supposed to do. Then, I say get out of the business because disdain to serve others is the wrong attitude to have to be a nurse. You are definitely on the right track. Just wet behind the ears yet. But that will be remedied with time and experience.
  8. by   momdebo
    I agree with the rest of the replies. You asked for instruction and did as you were directed. And yes, patients manage to fall/arrest/stroke out etc. even when we are right next to them. Just pat yourself on the back for being there to assist the pt. when he needed you. You did good.
  9. by   YooperNurse
    Don't get your underwear in a bundle! You are just causing yourself a bunch of stress you don't need! You asked, and were told it was ok to sit outside. This is common many times when family is there. The patient would have fallen anyway, it isn't your fault he did, he just did. Just take it as a learning experience and welcome to the wonderful world of nusing where anyithing can and will happen. Here is something to take away from this---don't diagnose. Don't say "he had a seizure". You can say "it looked like a seizure" or he had "what looked like seizure activity". Important when charting, also.
  10. by   nursemike
    In the Epilepsy Monitoring Unit on my floor, we document "events," but in our casual conversation, we often refer to "seizures." As nurses, we don't diagnose--the classic example I was taught in nursing school was to write "The patient had a thick, red liquid discharge..." rather than "The patient was bleeding." When notifying a doctor of an event, we describe what we see--generalized convulsions, starting, whatever happens. Our docs don't rely on nurses exclusively to come to a diagnosis, but do generally consider what we report as part of the evidence.

    As far as the patient falling, one thing we have to keep in mind is that, ultimately, a competent patient has a right to fall if he so chooses. I work my butt of to keep patients from falling, but I can't restrain someone for bad judgement. Many patients with seizure disorders are accustomed to falling on a regular basis--epilepsy was once called "falling sickness"--and going on about their lives despite the seizures.

    Having a sitter assigned suggests that your patient may not have been completely intact, cognatively, and not competent to decide whether he wanted to risk falling. If that was the case, his nurse should have explained that to you, and made clear what you were expected to do. I don't find sitting outside the room while family was with him unreasonable, but I would recommend strongly urging them to let you help him to the bathroom, instead of family doing it. I'd just explain that you were trained in help patients ambulate, and in controlling a fall if it couldn't be avoided. If you were working with my patient, I'd want you to be as insistent about it as you comfortable being, and call me right away if the patient still refused.

    I don't love the term "sitter." Yes, we all use it, but I've seen a few who take it too literally. It really grates when a sitter asks me to medicate a patient so the sitter won't have to get out of his/her chair so often. But sitter or no sitter, my patients are my responsibility, and I wouldn't criticize someone for calling me over a situation they can't manage on their own. I've seen too many that I couldn't manage single-handedly, either.
  11. by   holdensjane
    Quote from MLOS
    To the OP: the main concern expressed in your post was did you do anything wrong in that instance with that patient. No, you did not. Patient falls are not automatically someone's "fault."

    Your post did raise a lot of questions for me, although they aren't directly related to your main concern.

    1. Admission to the hospital for 3 days for seizures?? (I see multiple seizure patients every week - most of them aren't even admitted)

    2. What happened that warranted the central line insertion and transfer to the unit? (are these not seizure episodes but syncopal episodes, accompanied by hypotension?)

    3. Why did the patient require a sitter, when family was present? (at my facility, fall risk patients don't get sitters)

    Just curious ...

    Try to lighten up on yourself a little. You did nothing wrong. If you're getting a bad vibe from co-workers, take a minute to see it from their point of view. Would you grow weary of someone walking around w/an almost desperate look-what-happened-woe-is-me attitude? Do you really forgo all of your breaks? Really? You don't need to use the rest room, get something to eat, make a phone call, etc. ... ever?

    I'd tell you that this not the worst thing that will ever happen, but I'd be afraid you'd freak out ...

    1. No the patient wasn't admitted for seizures, he had seizure activity when he was there.
    2. Syncopal episodes, thats what they were beginning to suspect after the second fall, at the time it wasn't diagnosed. Some docs suspected seizures, some said not. And his BP was fine, no hypotension.
    3. If a patient needs a sitter, he gets a sitter regardless of whether or not the family is present, at least thats how it is at my facility. You never know when family decides to up and go and sitters aren't available whenever you want them, its either for the shift or not. Not all fall risk patients get sitters, just the confused, stubborn or really unpredictable ones.

    I didn't address these points because I wanted to be concise, but hopefully it quenches your curiosity.

    Sorry, i don't forgo ALL my breaks, there was one or two 15 minute breaks in the past month that i did use to get something to eat. But other than those times and my lunch time, yes, I hardly ever take breaks. If i need to go to the restroom I just go, but I don't hang around somewhere for 15 minutes. And I can honestly say I've NEVER made a personal phone call at work. Its really not difficult not taking a break if you keep in constant communication with the patients, someone ALWAYS needs something, water, ice, something repositioned, blinds opened, something picked up, missing straws, etc. Anytime I get a free moment, I go and do rounds. I just hate when the nurses walk into one of my rooms and have to do something that I could have done cause I know they're busy.
  12. by   Jamie1
    You were following through with your assignment. I agree with P_RN: sitters should be in the room - would it have prevented the patient's fall? Most likely no. Was the patient on the list for Fall Risk - or whatever it's called where you are. As to the verbage - this old nurse has used the phrase 'seizure-like activity' Please put this behind you, give yourself a treat and remember the sun's coming out tommorrow and all will be well. Best of luck in Nursing School - our Noble Profession!

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