Being blamed for fall after shift

[notyetnurse]

Hello all,

I have a question maybe you can offer some input. Even if you can't I need to vent a little to people who may understand.

I'm a relatively new ICU nurse. I've been on the unit for about 2 month now, 5 weeks or so on my own. I have never had less than 2 patients. Several weeks ago I had a very confused patient fall while I was next door working on a spontaneous breathing trial for a vented patient. I was told it was my fault because I should have asked someone to watch the confused one any time I stepped away from his room. OK I accepted this and took responsibility.

Fast forward to yesterday. I have a patient who is alert and oriented x 3. Orders are to get her out of bed and to bedside chair, commode, etc. I get her out of bed to the chair (with multiple BMs in the commode along the way). I look for a chair alarm - there are none - and I request it from our charge nurse. None can be located. Throughout the day we find 2 single alarms but utilize them for the 2 most confused patients on the floor.

Come shift change - this is long I know please bare with me - I give report to the night nurse and let her know about the lack of chair alarm. I also explain to patient that myself and night nurse will pUT her back in bed shortly. 5 minutes later I'm documenting and night nurse calls me and says she was in the room, saw patient attempt to stand up, aND she lowered the patient to the ground. Charge nurses are made aware, director is made aware. No injury.

Today I get in and am told that I am being held accountable for the fall because the patient was out of bed without a chair alarm which never should have happened .

Finally the meat and potatoes - your opinions are requested. Was this my fault for allowing patient to remain in chair with no alarm? Does the fact that we didn't have alarms matter? Would this fall under my shift given that I'd already endorsed the patient?

I should note that my employer is a huge corporation and that we are not provided sitters (not that an aox3 patient needs one), and we are unable to use restraint of any type except chemical if patient is agitated. Should I have left this patient in bed all day since we had no alarms? Moreover I pointed out today that the nurse being IN the room meant she was able to respond much faster than anyone would have upon hearing a chair alarm. No dice.

I feel this is going to become an issue and it looks very bad considering my newness. Would appreciate feedback.

[Nurse SMS, MSN, RN]

A patient lowered to the ground by a nurse is not counted as a fall.

[Anna Flaxis, BSN, RN]

You're being thrown under the bus.

[notyetnurse]

Agreed on both counts. I did make it very clear today that I will not be signing anything and that I will take this further up if necessary

[notyetnurse]

According to my facility "any unplanned descent to the ground" is considered a fall. So I guess if the patient plans to fall we are in the clear 😡

[nursej22, MSN, RN]

Wait, the nurse was in the room as the patient attempted to stand? I don't understand how a chair alarm would have changed anything.

This is a systems problem, that is, lack appropriate staffing (sitter) or equipment.

[RNJenn47201]

According to my facility "any unplanned descent to the ground" is considered a fall. So I guess if the patient plans to fall we are in the clear [emoji35]

In LTC we have the occasional resident that likes to sit on the floor. They have "allowed to put self on floor" written in their care plan.

[notyetnurse]

Yes the oncoming nurse was in the room and says that the patient attempted to get up on her own and the nurse broke the fall. I have my doubts as to whether the pt attempted to get up vs the nurse attempted to move her but regardless

[notyetnurse]

And you are correct - there is no way a chair alarm would have gotten anyone to bedside quicker than a nurse that was already at bedside

[Boomer MS, RN]

A patient lowered to the ground by a nurse is not counted as a fall.

This is also my understanding. And I'm confused about that second patient needing an alarm. Perhaps your hospital's policy when said patient is in a chair?? But you said she was A & O x3. Still needs an alarm? If so, it sounds as if the unit is working hard to prevent falls, and that's admirable. Regarding the first patient, am I to understand that any time you step away from the bedside of a confused patient, you are to ask someone to watch the confused patient? So there is staff available to do that? I don't know the physical set-up your ICU, but it is impossible to be two places at once. Duh...I appreciate the issues with physical and chemical restraints; reality dictates that without eyes on a patient or some sort of restraint, bad things can happen. No one wants that.

I'm sorry this happened to you and hope the first patient was not harmed. If you're a new nurse or just new to the ICU, there is a huge learning curve. You sound conscientious and caring. If you can look back and reassess (in your mind) how confused the first patient was, you might have taken a different action. Hindsight is always 50/50! Ha! You've learned something. First, keep following your hospital's policies. If there are not enough alarms to meet patient needs, that is a management problem. Nurses cannot do their job without the appropriate resources. So... you get creative sometimes with resources. I don't know what the culture is on your unit either, but I'm a huge proponent of having others' backs when they need it and expecting theirs too. (Another reason I loved ER)

Keep your head up. I hope your manager will use this as a teaching moment for you for your growth. Two months is not long to be on any new unit. Takes at least a year, IMO, to feel comfortable.

Let us know how it goes.

[Pangea Reunited, ASN, RN]

A patient lowered to the ground by a nurse is not counted as a fall.

At my facility, it's called an "assisted fall" and requires all the typical fall charting, reports and notifications.

[Nurse Leigh]

Ever think mgmt expects that nurses be able to split self in order to be in two places at once AND have the ability to levitate a pt who starts to fall?

Physics, people!

Sorry, OP, I hope this works out without you being penalized.