She's fallen and can't get up! Now what do you do?

  1. The patient was over 6 feet tall and over 250 pounds and didn't walk.

    Two people came to "help" and wound up arguing with me about using the Hoyer to lift the patient. I was for, they were against.

    There was no way on this earth that I was going to lift that patient without equipment. They wanted to lift her up by lifting her under the arms. When they actually tried to, I ordered them out of the room.

    They were going about it wrong, plus they were insubordinate to me by absolutely refusing to use the Hoyer to lift the patient. They really could've hurt the patient and themselves with what they were trying to do.

    So I had my tech get the Hoyer and we could've transferred the patient back to bed at that point without fuss, except that those two were so convinced that they were right, they went to the charge nurse.

    Who also refused to use the Hoyer lift, telling me that it couldn't possibly lift the patient from the floor and refusing to allow me to demonstrate!


    I've learned an awful lot on this Board, and I'm counting on you all to chime in with your opinions of what I should have done next, given the fact that yes, the Hoyer would've been able to do the job.
    Last edit by UM Review RN on Feb 7, '07
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  2. 20 Comments

  3. by   canoehead
    Show them that the hoyer could do it. If they refuse to watch, or insist on going ahead with pickng the patient up do not assist them. You are going to write up the incident because the patient fell anyway, be sure you document that the Hoyer was about to be used, but pt manually lifted by FR and JG, under direction of SD charge nurse.
  4. by   vamedic4
    I'm so glad that someone (*you Angie O) know how to properly care for and lift a patient. How scary that not even your charge nurse is knowledgeable about an issue so terribly important to patients and staff.

    I'd write that one up, allright. Having had to lift those patients in the field myself I can tell you it is not a good idea unless you have NO OTHER OPTION. Clearly, in this situation you did. Anything you have that helps to safely lift and move patients should be used, period. It would seem that this would be common sense...guess not.

    Good for you Angie for being such a patient (and safety) advocate!!!!


    have a great day.
    vamedic4:chuckle :chuckle
  5. by   CaLLaCoDe
    lucky you who have hoyer lifts...my back aches just thinking of the 250 lb pts on the floor needing assistance with feses and blood all over the place and a pulled foley with urine on the floor to slip and fall on...ouch!


    i have really learned to take my time and get as many to help as possible before attempting a from floor to bed transfer...but really, now...you have the equipment and macho cnas refuse to use it...lol

    "...if i only had a brain!...":melody: :melody: :melody:
    Last edit by CaLLaCoDe on Feb 7, '07
  6. by   kittagirl
    In the UK you would be sued if you tried to lift this patient WITHOUT using a hoist.
    We have to follow EU working regulations and this means that the most any one person can lift is approx 4 stone (about 56 pounds I think) so 2 people can lift 8 stone etc.

    However the majority of hospitals etc now have a NO LIFTING policy, we will move we will handle but we will not lift
    In fact our Mandatory study day is called 'training on how to move and handle patients'

    Clearly there are emergency situations were some form of lifting is unavoidable, but other than that, no go.

    It does work, if all the staff and management are on the same page, management tend to be quite good as there were some very public cases of nurses suing having sustained back injuries (which left them unable to work) and wining.
    I know that you still get some ‘old school’ staff that think we’ve all gone soft but as someone who lives with a work related back injury I refuse to take any chances.
    And I always point out to students (the most easily led astray or bullied in unsafe practices) that you only get one back, it’s difficult to repair, a bad back affects all parts of your life, and if you get an injury at work where you should have used equipment there had better have been a fire or worse ‘cause otherwise Bye Bye, not our problem.

    And as I said before it is part of the EU regulations so the hospital can also be fined if the equipment is not in place and of good working order. Tend to keep them in check:roll
  7. by   Tweety
    I would have stood at the door way and asked them to lift the patient to the bed and refused to participate. On the incident report about the fall would have included the entire transaction.
  8. by   RNfromMN
    That's nuts! And this is something I can actually say, "trust me, I know" about. Shame on your charge nurse!

    I worked at a facility that required its employees to use a Hoyer lift (we had Arjos - same thing) for any patient that weighed over 60 pounds. And CNAs gotten in serious trouble all the time for taking short cuts & not using them. There were signs up & down the hallways, reminding us to take a few minutes to save our backs.
    (fftopic: - the unit I worked on provided a type of "respite care" for parents of disabled children & adults twice a year & whenever my little favorites would come back weighing in at 58-59 pounds, I used to hold them whenever I had time because I knew it would be the last time I would be able to.)
    It felt a little silly sometimes hauling the big lift in to transfer a 60 pound year old little kid, but we all did it because we knew if we got caught lifting, we'd get written up.

    However, when our census was low, we'd get floated to other units & I remember always groaning when I got floated to Building 5, because I would always get what I called "Building 5 Back" by the end of the night. The aides that normally worked in this building would tell anyone that floated over there that certain pts that were obviously >60 lbs were up-with-assist...I'd go to get somebody out of their w/c & have them just fall limp in my arms - almost taking me down with them. And the only reason these aides were reporting that these patients could transfer with assistance is because if it was noted in their charts that they couldn't, all these CNAs would be required to use the Hoyer lift from then on.

    The unit I worked on was also sort of an "E.R." for sick pts from other buildings that lived at the center - we had low pt/CNA-RN ratios, so we were able to provide better care for residents that had pneumo, dehydration, etc. We took care of a patient once that came from the buildings with a broken leg & it was discovered once the cast was removed that she had a stage 4 pressure ulcer on her foot. How did her leg get broken? A CNA tried to use a little short cut & transfer her to her w/c instead of getting the lift & the pt broke her ankle...while the pt was recovering from her broken ankle, another CNA did the same thing & this time it broke the pt's leg! This pt was non-verbal & rarely showed any facial expressions, but I remember how she use to cry cry cry whenever her foot had to be soaked in betadine solution, as per our pressure ulcer tx protocol. And this all could have been avoided if these CNAs had taken the little extra time to get a lift.

    Did your charge nurse think of the consequences of these aides calling in sick the next day had they thrown their backs out? There's no reason for this - it's always safer for the pt & safer for the staff to use a lift - the only exception I can think of is pts we had that seizured a lot or were very very very spastic. And even then the staff would modify their slings so we could still use the lift.

    So Angie, are you getting a lot of flack about how you should do your job & let the aides do theirs? I'm a huge supporter of CNAs & I remember resenting RNs telling me how to do my job sometimes, but absolutely not in this case. If this continues to be a problem, I would search the internet for resources advocating for the use of lifts in healthcare settings - I'll bet you a million bucks you could find a ton of research backing up the their use & the long & short term effects of lifting pts. And I like Tweety's advice, too. As long as you document that you advised using the lift & health care staff refused, you're covered.
  9. by   UM Review RN
    Ahhhh....I'm totally embarrassed to admit this, but the one aide who was involved sided with me.

    All the ones who refused to use the lift were nurses.
  10. by   rn/writer
    What was the charge nurse's rationale for NOT using the lift? I can't imagine having such device available and not using it.

    BTW, aside from the risk of obvious injury to staff and patient, lifting such a heavy person under the arms could cause nerve damage, even if the transfer itself was successful.

    You might want to look up your faclity P&P as well as any available literature on the Hoyer itself to see if there is any reasonable contra-indication to the lift you wanted to do. If you can't find any, sounds like some re-eduaction might be in order.

    Thanks for advocating for your patient, even if the others didn't listen to you. At least you tried.
  11. by   muffie
    hoyer for sure

    for gosh sakes
  12. by   RGN1
    Quote from kittagirl
    In the UK you would be sued if you tried to lift this patient WITHOUT using a hoist.
    We have to follow EU working regulations and this means that the most any one person can lift is approx 4 stone (about 56 pounds I think) so 2 people can lift 8 stone etc.

    However the majority of hospitals etc now have a NO LIFTING policy, we will move we will handle but we will not lift
    In fact our Mandatory study day is called 'training on how to move and handle patients'

    Clearly there are emergency situations were some form of lifting is unavoidable, but other than that, no go.

    It does work, if all the staff and management are on the same page, management tend to be quite good as there were some very public cases of nurses suing having sustained back injuries (which left them unable to work) and wining.
    I know that you still get some ‘old school’ staff that think we’ve all gone soft but as someone who lives with a work related back injury I refuse to take any chances.
    And I always point out to students (the most easily led astray or bullied in unsafe practices) that you only get one back, it’s difficult to repair, a bad back affects all parts of your life, and if you get an injury at work where you should have used equipment there had better have been a fire or worse ‘cause otherwise Bye Bye, not our problem.

    And as I said before it is part of the EU regulations so the hospital can also be fined if the equipment is not in place and of good working order. Tend to keep them in check:roll
    MAN you took the words right out of my keyboard!! So all I can do is :yeahthat:
  13. by   jjjoy
    Was the charge nurse afraid that since are usually used for bed to chair and the like that the lift was dangerous to use from the floor? That it might tip over or something like that? Otherwise, why not use the lift instead of arguing over it?
  14. by   deleern
    The only time we didn't use the hoyer was when it was an obvious broken hip then we used a bath blanket and 6 staff to lift her to the bed (83 lbs)
    the only hoyer we had to work with would have caused further injury. the hoyer is save as we have a special sling that has longer straps just for that situation.

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