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.
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.
Do not agree to help put her back to bed. In a way, doing so makes you voluntarily still on duty. New nurse can get her coworker on shift to help.
Boss is at fault for not making sure you had a chair alarm available to use.
Being in ICU, IMHO, makes a pt confused, not fully "with it' mentally. So even if she was A&O x3 doesn't mean she knew not to get up alone. Why was she getting up anyway? Toilet? Stretch? Other reason?
You yourself say that "the 2 most confused Patients" got what two alarms you did find. Pts in hospital, whether ICU or not, are there due to sickness, injury, are medicated, are not fully responsible for themselves. Your boss is remiss for not making necessary equipment was available.
Why didn't the other nurse lower the person into a chair or onto the bed? Where exactly in the room were the two of them?
Don't argue or blame. Just truthfully write your statement, including having asked for alarms earlier from boss and having endorsed pt to oncoming nurse.
In future - no alarm, no up to chair. But do inform MD that you can't carry out the order to get up, and why you can't, who you've approached and when to get alarm - like Charge Nurse, Manager, Central Supply, Nursing House Supervisor, etc.. Don't just drop the matter. Where do the alarms come from?
In a way you are responsible, I guess, as much as I don't want you to be, and you are not the only one at fault.
For those of you saying that this is not considered a fall, go back to your hospital policy of how they define a "fall." I'm pretty sure this is considered an assisted fall in most hospitals, if not all. Regardless of whether the patient was A&O x3-4, every ICU patient is still considered at high risk for falls. Honestly, it looks like you were partially at fault for not utilizing a chair alarm. Having none to use is not an excuse. If this was the case, you should have assisted the patient to ambulate in the hall or room (or wherever to help your patient get mobile) and THEN put the patient back in bed. Also, prior to you documenting outside the room, you should have placed the patient back to bed.
And then again, yes, it does look like your night shift nurse is throwing you under the bus. Because she was in the room with the patient, not you. If she knew the patient was being uncooperative and attempting to stand up, she should have yelled for help so as to prevent the fall from happening.
I think once the argument is focused on who's "fault" it is and what counts and doesn't count a fall to blame someone for then the process has failed. What the focus should be is to how best care for the patient, and just leaving them in bed because there's no chair alarm isn't what's best for a recovering ICU patient. It may not seem like it, but chair time is essentially a work-out for a patient recovering from a critical illness, and research shows improved outcomes for patients who get two periods of chair time per day. All efforts should be made to avoid preventable falls, but you still have to take into account what's best for the patient overall.
It is considered a fall anytime anyone goes to the ground regardless of reason. Various falls have various names, but a fall nonetheless. If you put her in the chair/whatever, than IMO you are responsible. From what you say the patient was getting up so oncoming staff had to intervene to help patient to ground. Sorry...
is it possible this particular noc nurse has it in for you? we only have her/his word about what happened...
This is exactly what I was thinking, but in Nursing! (how shocking). How low have we fallen. From experience we fall to new lows every year, and nothing shocks me anymore. Or perhaps that oncoming nurse was in there and wasn't paying attention.
Specializes in Infusion Nursing, Home Health Infusion.
How long was the patient up in the chair? Your patient may have had to use the restroom or was getting tired...but how odd she did not tell the nurse in the room! I am a bit suspicious that this nurse is placing the blame on you. She had assumed care and no matter what state the patient is in when you assume care you get! I agree that if the policy is that all patients must have an alarms while up in a chair then I would have rotated chair time with the 2 alarms.You also could have stayed with the patient and done some charting while they were in the chair,although I realize how difficult this is! I do not think this is entirely your fault but if your organization is into blaming nurses then you better learn to practice in a defensive manner.In other words find a way to always follow the fall policy and be very proactive in your prevention.I would write an incident report every single day I worked if there are not enough alarms.
Document when there are safety shortfalls. No chair alarms? Document it. I had to document a "system" problem when the phones were apparently down and my trauma patient decided to de-recruit a lung. Not my fault, not the physician's fault.
Tell the doctors you can't follow their orders for up to chair and explain why. Document if you cannot get a patient up due to the above reasons.
Tell patients and families when they're frustrated about things like this that they should mention it on their survey.
My hospital's been really into arbitrary rules made up on a whim, and this has been my strategy to address it and safeguard myself.
Would it have been your fault too if the patient developed a blood clot, delirium, HCAP, or an extended stay in rehab from lack of mobility/deconditioning?
You did the best you could with the lack of proper safety equipment. Sorry this is happening to you.
"Please do not try to get up on your own, after I assess you, we will assist you back to bed" so should have said the nurse who was now assigned and reported off to. Who was in the room. And the patient I assume had a call bell that was know how to use, no?
Did the scenario go a little something like "Pt in unit 2 is a 55 yo A&O times 3 blah, blah and is currently up in the chair...." Nurse 2: "You did not put the patient back to bed?!" "No, the patient is completely comfortable up in the chair at present and has a call bell" "Well, she is a pain, wants to go to the commode and do 500 other things, I have 2 patients, so you need to get her back to bed" "Well I would be happy to help, as soon as I finish up with the vent dependent patient in unit 3...." (can you see my eye roll...was that to be nurse 2's patient as well that you needed to stay over and trial???)
It was an assisted fall, but a fall. And a chair alarm for someone capable of call bell use, and documented "Pt informed to call for assistance" is a bit nuts.
With all that being said, nurse 2 needed to caution the patient not to attempt to get up on her own. You had reported off. Just be sure going forward, you report off and leave. Or you report off and as end of report, you introduce your patient to the new nurse (a la HCAPS stuff) and then finish up helping.
Be careful in the crosswalk. Seems like the bus speeds up for you.
Kooky Korky, BSN, RN
5,216 Posts
Do not agree to help put her back to bed. In a way, doing so makes you voluntarily still on duty. New nurse can get her coworker on shift to help.
Boss is at fault for not making sure you had a chair alarm available to use.
Being in ICU, IMHO, makes a pt confused, not fully "with it' mentally. So even if she was A&O x3 doesn't mean she knew not to get up alone. Why was she getting up anyway? Toilet? Stretch? Other reason?
You yourself say that "the 2 most confused Patients" got what two alarms you did find. Pts in hospital, whether ICU or not, are there due to sickness, injury, are medicated, are not fully responsible for themselves. Your boss is remiss for not making necessary equipment was available.
Why didn't the other nurse lower the person into a chair or onto the bed? Where exactly in the room were the two of them?
Don't argue or blame. Just truthfully write your statement, including having asked for alarms earlier from boss and having endorsed pt to oncoming nurse.
In future - no alarm, no up to chair. But do inform MD that you can't carry out the order to get up, and why you can't, who you've approached and when to get alarm - like Charge Nurse, Manager, Central Supply, Nursing House Supervisor, etc.. Don't just drop the matter. Where do the alarms come from?
In a way you are responsible, I guess, as much as I don't want you to be, and you are not the only one at fault.