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.
So here are my thoughts. Technically once the night nurse has accepted report and is the room with the patient that patient is now her responsibility. Second your facility is responsible for providing you with the necessary equipment to keep your patients safe. I work in an ICU as well and we had to make a to get a larger number of bed alarms, chair alarms and gait belts. This seems to be more of a system failure than your failure.
A patient lowered to the ground by a nurse is not counted as a fall.
Though I don't necessarily agree with it, lowering the patient to the ground still qualifies as a fall… "an unplanned descent to the floor with or without injury".
Right!! I am so sorry OP. I was set up like that at my first job. I had NPO orders for a patient EXCEPT MEDICATIONS. I gave the medications crushed and with pudding just like the night nurse told me to do. The charge nurse said it was okay, and my preceptor said it was okay. I even called the doctor and he approved. ( I charted all phone calls and communications with the charge nurse and my preceptor).That was how the patient took her medications at home. She was NPO because family wanted a swallow eval because they thought she had a stroke. Stroke had already been ruled out. She was actually on observation for hypokalemia. Anywayssss..... I got put on unpaid administrative leave for 9 days so the manager could "investigate". I got fired for "Unsafe patient care."
You covered all of your bases and I think that one of the hardest things to accept is that when we DO cover all of our bases, we cannot control what our patients do. I think that the circumstances are all bad :/
So with a doctor's order, you were deemed unsafe? Did Charge Nurse and preceptor step up and back you up (did they affirm that they'd told you it was ok to use a little pudding?)
Right!! I am so sorry OP. I was set up like that at my first job. I had NPO orders for a patient EXCEPT MEDICATIONS. I gave the medications crushed and with pudding just like the night nurse told me to do. The charge nurse said it was okay, and my preceptor said it was okay. I even called the doctor and he approved. ( I charted all phone calls and communications with the charge nurse and my preceptor).That was how the patient took her medications at home. She was NPO because family wanted a swallow eval because they thought she had a stroke. Stroke had already been ruled out. She was actually on observation for hypokalemia. Anywayssss..... I got put on unpaid administrative leave for 9 days so the manager could "investigate". I got fired for "Unsafe patient care."
You covered all of your bases and I think that one of the hardest things to accept is that when we DO cover all of our bases, we cannot control what our patients do. I think that the circumstances are all bad :/
Next time, when you contact the doctor for order clarification, take a verbal order. Just charting that the MD said it's ok doesn't cover you like having an order does.
This sounds like a no fault situation or a non-compliant patient isssue if she was oriented x 3. Also, you cannot be accountable if 1.) You gave report and the new nurse assumed care 2.) You stated another nurse stated they would put that patient back in bed. 3.) The patient was in the room with a nurse. In the future document in your notes the name of the nurse that said they will put the patient back in bed and document that you reported exactly all of this to on coming nurse in report.
I am not sure if you have a union but if you do I would consult with them as well. Refuse to put similar patient in chairs with am alarm and document reason not done if part of plan of care.
Whether assisted or not, if the butt hits the floor, it is considered a fall in my state.
Did you give report on the patient to the other nurse?
Did other nurse call for help because she saw patient standing unsafely?
Any chance the other nurse was actually trying to get the patient into bed and patient was too weak or the night nurse somehow messed up the actual transfer "contributing to the fall".
The lack of chair alarm is a non issue in this case since the other nurse was in the room and the chair alarm doesn't alarm until the pressure is off and patient already trying to stand. The only real good part is that you know when the fall occurred instead of finding them on the floor randomly. [minor editorial comment].
Now, the $64,000 question. . . did the charge nurse and others that you involved in asking for a chair alarm back you up and indicate you had tried? If not, the unit has a bigger issue than the fall. Fear from other leadership around manager or lying about your request are bigger concerns in my book.
Having worked in geriatrics, falls are a major concern for all patients. With that said being new to any unit there is always a learning curve. This is where any and all documentation will save you, no matter who is trying to 'throw you under the bus'. Always assure you leave call light in reach of oriented patients and place disoriented patients in eye sight. Doing this and documenting these precautions will decrease the amount of falls you are experiencing. Also for as long as I have been a nurse lowering a patient to the floor is in fact preventing a fall. Just know your policy and procedures and always document. Good luck.
A Nurse that was NOT you was in the room when it happened and you had already given report, correct? So you were at a computer completing your documenting. That occurrence in THAT room with THAT pt has NOTHING at all to do with you what so ever. Sounds like your new unit has some big issues. Don't sign a thing because you did not do a thing wrong. Good luck! And these two events happening to you so close together might be a sign...thing happen for a reason.
A patient lowered to the ground by a nurse is not counted as a fall.
Uh, not entirely true. It depends on the facility. I know of two major facilities where I live where it is considered a fall regardless of whether or not the patient was lowered or if they truly fell.
Specializes in Medsurg, Homecare, Infusion, Psych/Detox.
Ummm... once you have endorsed a pt over, the receiving nurse is responsible for anything which happens thereafter. If she felt the no chair alarm was an issue, then it was on her to not accept the pt until you returned him/her to bed or do so herself at the time of hand over. You are the newbie so it is natural to blame you. I recently had episodes of pt's falling that I could write volumes about. But in the interest of time...
My defense is always, " the pt fell, I did not push them down."
it has always been my understanding that once you have transferred care to oncoming nurse, it's that nurse'so responsibility. Clearly, they are making you to fall guy because they can. I would start looking for somewhere else to work, because they sound super shady and like there is some kind of "culture" there that is not healthy for you. When people operate like this, it is usually the status quo with little likelihood of change [or reason] on the horizon.
TraumaKittyRN
15 Posts
So here are my thoughts. Technically once the night nurse has accepted report and is the room with the patient that patient is now her responsibility. Second your facility is responsible for providing you with the necessary equipment to keep your patients safe. I work in an ICU as well and we had to make a to get a larger number of bed alarms, chair alarms and gait belts. This seems to be more of a system failure than your failure.