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.

[RescueNinjaKy]

If the oncoming nurse was in the room, how the heck was that your fault?

[Maevish, ASN, RN]

Your "newness" should have nothing to do with this. I could see myself (or anybody else) having this exact thing happen. You did your best. However, seeing shift change was coming I might have put her back in bed before report since I wouldn't be back very soon. Otherwise, if the doctors want their orders to be followed to the letter, then they could always come help out:rolleyes:. That sounded b*tchy, but come on. Sometimes getting OOB TID just doesn't happen. I'd rather have that, but turning the pt regularly, than have a potential fall.

That being said, I'm unclear how an A+Ox3 pt needs any sort of alarm. If she'd tried to stand up without help, she's not 100% there because she can't follow directions.

Just my 5 cents:cheeky:

xo

[cecile9155, BSN, RN]

We don't use alarms where I work if the patient is alert and oriented x3. Is it unit policy there to always use alarms?

[djh123]

You needed to get them up, couldn't find an alarm, had handed patients over to the next shift, and you get blamed? As my mother said in her last few years, 'What a load of crap!'. That's my opinion, anyway...

[Guttercat, ASN, RN]

Welcome to the undercarriage...of the bus, that is.

See nurse. See nurse run. See nurse go splat.

You have orders to get the A/O x 3 pt. OOB, but there are no chair alarms, but you have orders, but there are no chair alarms, but you have orders, but there are no...

You took a logical and calculated risk based on what was best (and ordered) for an A/O x 3 patient, despite the facility's lack of necessary equipment needed to follow its own protocol.

This makes my blood boil.

[oldpsychnurse]

This is why I always chart when necessary equipment is unavailable. (I don't see why you would have needed to chart that an alarm wasn't available for an A&O patient, but that's a story for another day). Anyway, the powers-that-be hate it when I do that because it puts the blame back where it should be if anything happens - squarely on the hospital's back. I don't cover up for inadequate staffing or supplies because the hospital is always willing to let the nurse take the fall-out while they stand back and tsk tsk at us.

BTW, if I were you I'd be looking for another job. Either they don't like you in particular, or they are always on the look-out for a scapegoat if something goes wrong. Neither option is good for the nurses trapped in that environment.

[Here.I.Stand, BSN, RN]

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.

Nurse Leigh wins the internet!!

[Boomer MS, RN]

You have orders to get the A/O x 3 pt. OOB, but there are no chair alarms, but you have orders, but there are no chair alarms, but you have orders, but there are no...

This made me giggle. "Who's on first?" :-))

[nutella, MSN, RN]

The problem is that the pat "fell" while in the critical care area/ICU. Granted it would be a problem on a regular floor but even more so in an ICU. In the ICU literally every pat is a "high risk for falls" and safety comes first. Having said that - there are system errors as well contributing to the fall like not having a chair alarm. The lesson to be learned (and I am not saying that they were right to ding you for that) is that if the pat is a fall risk (and they all are in ICU) make sure they are supervised when OOB and have chair alarm. If you do not have chair alarm just have them sit on the bedside with you or stand up to shake out legs and go back to bed with bed alarm on.

When a pat in ICU falls it is a huge "thing"because no pat is supposed to fall in a critical care area (like nobody is to fall off the stretcher when they transfer from the table to bed in the OR...).

[jdub6]

1. You need to document that there were no chair alarms and how you tried to get one several times either in pt record or the incident report.

2. My experience with using bed alarms on truly a/o pts is they quickly learn to disable them, thus making them not only useless but perhaps more dangerous.

3. Disagree with pp saying to keep her in bed if no alarm. In my experience anyone near a/o who needs to have "multiple bms" will try to get out of the bed as much if not more than the chair. Also you have orders and mobility is important in healing.

4. Agree with pp who state that since a nurse WAS IN THE ROOM that a chair alarm would have done you no good in this case.

Basically, as others have said, you are being thrown under the bus. I encourage you to find a way to ask management what you should have done to prevent this after giving them full explanation of how you tried to obtain an alarm. And maybe once this blows over, ask them to buy more alarms if they are going to insist on them. I don't see how you could have prevented this...except maybe as someone else said put the pt back in bed before report- but that depends on where she was trying to go when she got up from the chair. If it was the commode you still probably would have had the same outcome.

[sallyrnrrt, ADN, RN]

I agree with all the above post.......

and and I am that stubborn patient, that when I don't want assistance, disable or turn my own alarms off... Oh how I just do not "love" patients like me........thankfully rarely a patient.....

but out the real issue, is the nurse that has assumed care is in the room, And we know all alarms do is alert movement, as attempting to get up......so nurses can come to the room......there is no special "safety net that magic springs from these alarm systems......they are just audible alerts.....the nurse was already there....... The attempt to make you at fault, is in error......and I question the reasoning........

as as an over four decades critical care experience, I call bull.......hockey..........

[RHope]

Hearing about situations like this make it all more clear to me that I should not invest anymore time and money into getting a BS in a profession as awful and unfair as nursing.