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.
It's a nurse power trip thing. Charge didn't help when you asked. Then you get blamed after already giving report and the other nurse was in the room. Doesn't make any sense. Sound like they are not playing nice with the new girl. Not your fault.
It is the fault of the person against whom documentation can prove it. The strongest documentary evidence is against the nurse who did not follow protocol by not applying an alarm where it was needed. It is another story that she would have been guilty if the patient would have been kept in bed against orders for whatever reason.
Moral of the story. Your patient is the neediest on the floor. Your butt is the most precious part of your anatomy. Make it a priority to save it. You should have fought tooth and nail to get the alarms for your patient and have placed it on her. End of story. If there were no alarms available, it should have been an incident report and a call to the hospital administrator.
In the future, stay focused on the priorities of your own patient. It is those you are responsible for.
First, if you are a brand new ICU nurse and you have only been on this unit for 8 weeks, and you have been on the unit on your own for 5 weeks, that means you only had 3 weeks of orientation? That is unsafe and meets no safe benchmark. New ICU nurses should have a minimum of 16 weeks of orientation with a preceptor.
Second-
This fall is not your fault. Your employer is failing to provide the necessary equipment and resources to you to safety care for patients. You should have access to chair alarms and patient monitors if needed.
I am a chief nursing officer and if I were you I would find new employment. You are a valuable asset and in high demand. Don't settle for an organization with no cukture of improving patient safety and blaming staff for their inability to provide you the resources you need to provide excellent patient care.
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.
This right here is the basis for your defense should "they" continue to try and throw you under the bus. IF THEY CONTINUE I would consider talking to a union rep if you have one and or your malpractice insurance rep if the facility pursues this, otherwise make a plan of action for how you will practice in the future under same circumstances. I would call the provider and get an order to be up without an alarm or a hold on the activity order. Leave it to them to fight the facility for not providing sitters or alarms (which would have been useless anyhow).
As a nurse of 30 years it sounds to me that you have followed all procedures to maintain your patients safety. You have documented and escalated to management about lack of equipment. Informed colleagues taking over from you. You cannot be in 2 places at once and staffing also comes into question. Your managers and senior nurses are there to guide and support you no matter how long you have been qualified. They were aware of the situation and failed in their responsibility to the patient and you. I am appalled at the lack of support they have given you. Sounds like they are looking for a scape goat. My advice is firstly seek support from your nurses union. Reflect on what has happened and use it as a learning experience. If in any doubt seek advice from senior colleagues and document the outcome in full. If in any doubt don't do it. Please don't get disheartened you appear to have done everything you could in this situation, your obvious upset shows you are a caring and professional nurse. Hope this helps.
For my hospital it is also called an assisted fall and we are responsible for charting it like a fall. However, it would fall on the nurse that is in the room. Also, if the equipment is not made available to you how do they expect you to use it?
In answer to your original question, in all situations that you encounter as a nurse, remember today. When things go wrong, people generally do not take ownership for the mistake. This was definitely a mistake albeit unintentional. I would have gotten this patient up and put them back due to the fact that there was no safety feature in use. I want to steer clear of the conversation that starts off with -- you knew that you were supposed to do this and what were you thinking? I would rather err on the side of caution and explain that I did what I did for the safety of my patient. If they ask why, I would say, "Perhaps tomorrow this patient can have the alarm." Don't quit. We've all had these days. Onward and upward....
Neither of those falls are your fault! The first fall was a culmination of your hospitals horrible policies. If you are given two patients, you cannot take care of them at the same time. Ideally someone can keep any eye on them while your not there but if that's the case you're really getting into 1:1 territory or the patient needing a sitter. If your hospital refuses to meet either of those situations, it's their fault he fell. It's unreasonable to expect that another nurse be available to babysit every time you need to take care of your other patient. As for the second fall, there's no reason a a&o person needs a chair alarm. I assume you told her not to get up without help and gave her a call light. If that's the case, it's the patients fault they fell and no chair alarm would have helped. Sorry your being targeted like this! Do you have a union to represent you?
In LTC a patient "assisted to the ground" is considered a "fall", technically. It requires extra charting (incident report); but is, typically, not considered a big deal. Certainly, shouldn't be blamed on a nurse who has, already, given report!
When you needed a chair alarm and none were available was this documented? In the future, fill out a variance report. This is a problem that needs to be addressed. The patient should not have to suffer and be forced to stay in bed due to your facilities lack of equipment. You were off shift, this fall is not on your clock. After you report off, you do not own it anymore. The other nurse WAS IN THE ROOM. No chair alarm would be better than that, it did not contribute in anyway to this incident. nor would it have made a difference in the outcome.
Are you Union? You have a good case here they are trying to blame you, but its the other shift nurse unfortunately that owns this fall.
This is a very sticky situation and a hard one to figure out because on one hand there should have been an alarm there in the room. In fact, a person would assume that the ICU in every room has an alarm there. On the other hand, if the patient is coherent and aware of their surroundings, then as long as they are in the chair, they should be fine for at least two minutes. It is hard to say what the right answer should be because there are so many answers that come into play. I truly believe that if a patient is coherent and if they understand where they are, then as long as they stay in the chair for a one or two minutes, then that is OK. If the policies in the ICU however don't want any patient to be left alone, then that is another issue that needs to be brought up in the policy hand book and perhaps having another nurse like a floater nurse step in to check on that particular patient would have been OK. My advice would be to talk it over with the supervisor, charge nurse, and head of the hospital to see about these particular issues. If you can work it out with your charge nurses in having more of a buddy system on the floor in that you work as a team and if your buddy needs to go see another patient STAT, then she or he takes over. Having the buddy system covers you as well because there are another set of eyes and another brain that helps you do patient care more effectively. I also think of having those alarms in every room ready and available would be extremely helpful. Just remember that you are a human being and you do the best that you can each and every day. Whatever happens, just be sure to learn from everything that comes your way. I hope that by having an honest and open communication, the charge nurses and your supervisor will be able to help you out and you will continue to be the ICU nurse if that is where you still want to work. Best of luck to you and I hope things will get resolved. Marcella 5/19/16
This is not fair to you. Falls happen ALL THE TIME to all nurses!!! It doesn't make you a bad nurse. Say you asked another nurse to watch your confused pt....would they have done that or would they tell you they were busy or look upon you like you couldn't keep up with your own 2 Patients? And what about earlier in the shift....certainly you were back and forth between both rooms all shift! Were you supposed to get another nurse to watch one of your patients every time you went to see your second pt? Fact of the matter is, unless there's a sitter at the bedside, you can't be with each pt 24/7, and falls are going to happen.
And with your a&o pt....so because the unit lacked chair alarms (THEIR problem not yours!) you should leave the pt in bed all day?? I bet if you did that you'd get dinged but you got them up and you're still dinged. Not right. The CN was aware of the situation. And I agree with other posters, if a nurse was in the room how was it your fault?? A nurse there is able to respond quicker than a chair alarm could alert you!
Sounds like this unit needs sitters and chair alarms otherwise a nurse CANNOT watch each pt, even just two, 24/7. don't beat yourself up.
Nurse LoReyna
2 Posts
It's a nurse power trip thing. Charge didn't help when you asked. Then you get blamed after already giving report and the other nurse was in the room. Doesn't make any sense. Sound like they are not playing nice with the new girl. Not your fault.