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Hello everyone,

I'm a brand new RN. , just passed my NCLEX last week. :)

I have been volunteering at my local hospital as a "patient care companion" since February of this year, just to get that extra experience outside of my clinical curriculum and to increase my marketability as a new grad RN coming on to the workforce. As a companion, I often do 1-to-1's with acutely confused patients who are major fall risks (although, RN's are NOT supposed to assign volunteers to do 1-to-1... however, this occurs very regularly). Today, I had a patient unlike any that I had to deal with as both a volunteer or as a student nurse.

The patient was a middle-aged alcoholic who was admitted in DT's. He was completely delirious, and only oriented to himself. Alcoholics, as many of you know, get very aggressive and agitated in withdrawal. I was assigned to him as a 1-to-1.

All through the day, this highly tolerant gentleman kept trying to get up despite respectable doses of librium and PRN ativan. I haven't been volunteering for a few weeks, so I felt a little timid today, especially with such a patient.

The patient kept getting up, and instead of using an effective amount of force to hold him down and keep him in bed, I was simply following him and redirecting him, asking him to please get back into bed. His gait was extremely unsteady, and in multiple instances I had to prop him back up into alignment so he wouldnt drop down.

In this middle of this day, He aggressively got up and said he had to go somewhere, in his hallucinatory state. I tried redirecting him, but he shoved me aside and marched forward. I was asking the nurse for help as he walked forward. Next thing you know, he was on his hands and knees on the floor.

An incident report was filed. I felt like I should have known better, as a new graduate RN whose sole purpose in life should be the safety of the patient, no matter how many times they tell you to go ".... yourself". It made me question myself and my abilities. I knew what I should have done differently (be more aggressive in demanding he stay in bed), but at the same time I couldn't help but feel that the responsible nurse should have followed a hospital algorithm and put this extremely volatile patient on, at least, 2-point restraints or heavier chemical sedation.

Eventually, a high-level nurse came to interview the responsible RN on the details of the incident. I overheard her say something about "penalizing" someone. I'm not sure if she was referring to me, but I feel like she was (the RN downplayed it and said I wouldn't get in trouble). My stomach churned. At this moment, I felt like these 110 hours of volunteering would go down the drain as I would get terminated. In addition, I felt incompetent and felt like my job or license would be so vulnerable to termination if this had happened to me as a new hire RN.

So what do you guys think? Am I justified in feeling the way I do? Does this happen all the time and is it "no big deal" for the sake of your job security (so long as it doesnt happen in a consitent pattern)? I know falls are HUUUUGE things for hospitals, and they can get in trouble and lose JCAHO money and general prestige. It's really eating me up inside...

Please share your thoughts and advice. Thank you.

Specializes in retired LTC.

I don't know is anyone else has recommended this, but if you have your own at this time, call them for advice.

If he shoved you and clearly overpowered you (irrelevant of whether or not you are a volunteer or rn) what else would people want you to do to prevent him from falling?

Unfortunately, Patients still fall when they are on 1:1s even when they are fully trained 1:1s. It's not your fault but everyone involved should still be debriefed to help understand what happened and how to prevent the same occurrence from happening again.

Specializes in MDS/ UR.

You, on the other hand, should be aware of your licensure status and what that means no matter where you are. What if you had engaged with a drunk at the local Piggly-Wiggly, knew he was unstable on his feet, helped him for a minute, and then left him reeling in the vegetable aisle, and he fell and cracked his head on a cooler? You could be held liable for his fall because you knew he was incapacitated and you left him alone. If you had never approached him in the first place, or didn't even see him, you wouldn't be liable. But once you assume that connection (as with your volunteer job, too) you are held to RN standard, which means you don't leave an emergency situation until relieved by someone more competent.

This is why I rarely advertise being a nurse. 0o

Specializes in Complex pedi to LTC/SA & now a manager.
This is why I rarely advertise being a nurse. 0o

My son is proud that I am a nurse, but he knows better than to rat me out if I don't volunteer that I am a licensed nurse. We've witnessed a few incidents over the years sometimes I can help sometimes I can't stop. Even as a former EMT with field experience and knowledge it's not always the best choice to stop, I alert someone in authority and/or call 911.

Check with your malpractice carrier, if you don't have one get one. Follow up with volunteer services. You have already stated that volunteers should not be doing 1:1 sitter assignments your job is companionship not supervision of at risk patients. Do onto to accept such an assignment if the nursing staff push the issue contact the volunteer manager or supervisor support.

1. Call and get .

2. There are some facilities who will not "under-employ" an RN. Meaning that now that you have a nursing license, you may still be able to be a volunteer, however, being held to the standards of your license--regardless of scope of the job at hand.

3. It is astounding that a volunteer would be asked to sit 1:1 for hours with a patient who is in active withdrawal and said medications and interventions are not working. Did the primary RN not see this? Seriously?

4. You can not force someone to be in bed. You can not physically hold someone down. You need to be really, really careful about any sort of aggressive tone. This would be the exact time that a family member comes into the room, and you are in hot water for battery or some other inappropriate intervention. Which may seem somewhat warranted at the time, but never the less, not appropriate. Restraints require MD, orders, protocol--and physically stopping a patient is restraining said patient.

5. Most 1:1's have forms that one documents on. Be mindful of documenting everything. When it becomes apparent that a patient is not safe, primary RN needs to be notified immediately, as well as the charge RN if there is no intervention.

This is the exact reason why the primary nurse can not leave a sitter with a 1:1 for hours on end and not continue to assess the patient, and check in with a sitter. I have seen sitters who literally are stuck for mulitple hours trying to control a patient that needs an alternate plan of care after about hour 1. Any restraint would require the RN to be more engaged with said patient.

Going forward I would be more apt to absolutely know what the plan for the patient is, what your role is with a patient who is not stable, and what exactly your options are should the patient want to get out of bed. Primary nurses can not expect that a sitter--regardless of if it is a volunteer or not (

Get yourself your own malpractice insurance. Then have discussion with them regarding volunteering,

From my understanding, you ARE responsible for persons under the good samaritan law if you decide to initiate the patient-nurse relationship. I.e.; if you actively stop and help, you are right there responsible for the care of that individual until emergency services arrive to take over the situation. However, if you do NOT engage the person, you are not responsible as an RN, even if you have your scrubs and ID badge on you.

Specializes in Clinical Research, Outpt Women's Health.

That could have happened even to an exprienced RN as restraint is hard to get authorized.

If he shoved you and clearly overpowered you (irrelevant of whether or not you are a volunteer or rn) what else would people want you to do to prevent him from falling?

Unfortunately, Patients still fall when they are on 1:1s even when they are fully trained 1:1s. It's not your fault but everyone involved should still be debriefed to help understand what happened and how to prevent the same occurrence from happening again.

I agree with you. It was the primary RN's responsibility to maintain the safety of the patient, and she failed to do so by 1. delegate 1:1 duties to a volunteer (regardless of my status as an RN - she did not know this upon assigning the patient to me), and 2. not contacting the physician to modify the plan of care.

Surely there must be some protocols in place to deal with such patients. Restraints, while they are made out to be the devil himself when you're studying for the NCLEX, definitely are necessary in many situations where less invasive interventions fail to work (and believe me, I tried every method of distraction I could come up with). Perhaps the patient's nurse didn't want to have to deal with the extra work associated with maintaining a restraint, such as extra paperwork and assessments. In retrospect, in makes me so angry...

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
That could have happened even to an exprienced RN as restraint is hard to get authorized.

As I was reading through the thread, I thought the same thing. The only thing I would have done differently is put the restraints on the patient and then called for an order. Our providers are liberal with the restraint orders, and I understand everyone isn't so fortunate.

If you asked the nurses what they would have done in your situation, they would have probably done the same thing. You have to be cautious with a grown man in DTs. They are abnormally strong, and I wouldn't get in their way if they push you aside. I once saw a withdrawing man hold his IV pole like a javelin.

I am too surprised that a volunteer would be given that much responsibility. Where I work, volunteers do things like answer the phones in the visitor lounge, never patient care.

Why would I be liable for a drunk falling and getting injured if I had previously tried to help then left him? Where's the statute, regulation, or case law that would allow that drunk to successfully sue me? What really doesn't make sense is if I know he's in trouble, but I choose to not intervene, I'm free and clear?

People talk about the "RN standard" all the time, but nothing is said in my Nurse Practice Act about it. Where does it come from? It has to be case law.

and

How does an unstable drunk in a public place = emergency situation?

and

I never left him alone. He shoved me and marched forward as I was calling out for help in the hallway. I didn't explicitly leave him. He was steps away from me. I was overpowered...

You will find this in your Good Samaritan Act. It says that if you can reasonably foresee that something could be harmful to a patient (in this case, a falling-down-drunk guy) as a result of your professional training (the RN part), and you involve yourself in the situation you then have to stay and do what you can to keep the person safe until you are relieved by someone more competent (like EMS, for example). Note: In some states, if you are identifiable as a healthcare person/EMS/nurse, you can be held liable for not giving aid to the extent of your licensure, experience, and training even if you do not step forward. This is why New Hampshire EMS guys don't put EMT stickers on their private cars.

For example, once I saw a car pulled into the median strip on the highway and saw a guy leaning on the steering wheel. I pulled in behind him as he was getting out of his car, staggering, confused, not drunk (or at least not smelling like it), but incoherent and unsteady. Another car with an off-duty EMS guy came to join us, and we got his wallet out and discovered he had a seizure disorder. OK

I don't recall the OP saying she was shoved away from this guy and that's when he fell. I was under the impression that she went to the door to call, moving away from him to do so, and that's when he fell. OP, if he pushed you away and then fell from the effort of pushing you, that's different. But if you moved away from him first (and is that what you mean by "explicitly leave him"? You were still in the room but you didn't say, "I'm leaving"? Not clear.) and then he pushed you and fell, you were wrong to do that.

Specializes in Critical Care.

You will find this in your Good Samaritan Act. It says that if you can reasonably foresee that something could be harmful to a patient (in this case, a falling-down-drunk guy) as a result of your professional training (the RN part), and you involve yourself in the situation you then have to stay and do what you can to keep the person safe until you are relieved by someone more competent (like EMS, for example). Note: In some states, if you are identifiable as a healthcare person/EMS/nurse, you can be held liable for not giving aid to the extent of your licensure, experience, and training even if you do not step forward. This is why New Hampshire EMS guys don't put EMT stickers on their private cars.

You're thinking of "Duty to Rescue" laws, not good samaritan acts. Except for a single state's good samaritan act, which no longer exists, all good samaritan laws refer to the protections from liability given to someone who assists another person in need of assistance.

Duty to rescue laws exist in some states and require someone who witnesses a person in need of urgent assistance to notify authorities. In a few states this also includes the expectation that assistance be provided by the witness under limited conditions, although those have never really been enforced to a significant degree.

As for the drunk in the grocery store, as a nurse he's not your patient and no legal nurse-patient relationship exists. If you're employed as the grocery store's nurse with the responsibility of caring for anyone who comes in the store, then that's different, but no BON in any state has of yet determined that an interaction between an 'off-duty' nurse and member of the general public constitutes a nurse-patient relationship, which means the nurse-patient expectations do not apply. That doesn't mean these interactions can't affect your license; grossly negligent actions even outside of a nurse-patient relationship can result in BON action, such as if you came across someone having a seizure and stuffed a wallet in their mouth and the person suffocated, you may be liable for grossly negligent behavior for a nurse, but you aren't held to the same standards as if this was truly your patient as defined by the BON.

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