can I lose my license...

3dayRN · Mar 29, 2011

You won't lose your license for this. Now, if you tried to cover this up to get out of trouble then that would be a problem. You however were honest and the fact that you are so upset shows you care about this resident. Good luck.

mRpeNa · Mar 29, 2011

The greatest problem in this situation you described is that a fellow resident saw this happen, who appears to be cognitively alert, and whose account seems reliable. Moreso, the said patient has an injury suffered from a recent fall -- It depends on this facility, how they tackle their risk management. At worse you will be let go without a warning. The CNAs will be let go, most likely as well. Were the family members notified? How involved are they with this pt care? This too could have an impact.
While this may never go to your BON, as this may bring a tag/fine of any kind to the facility, you should please always CYA, by way of proper interventions/documentation. Incidents happen every so often, many really can be avoided, but when it does happen, what we do as nurses is what matters most. I hope this serves as a wake-up call.

she has no family that's involved and the numbers we have for contacts are no longer in service.

marthyellen · Mar 29, 2011

The thing that is more concerning is why did the CNAs get a resident off of the floor without notifying the nurse and allowing the nurse to do a complete assessment? I would be concerned about what the CNAs are hiding. Does the resident have osteo? Is she high risk for fractures?

We had a resident with left side weakness ad chronic back pain. She tried to self transfer and fell onto her left side. She was assessed and sent to the hospital for left shoulder pain and left hip pain. She returned to the facility with an order for pain meds for her shoulder.

Three weeks later, the CNA is turning the resident and the CNA noticed the hip looked "funny" We x rayed her hip to discover a fracture. We requested original xrays from her ER visit and discovered they had x rayed her left hip and there was a slight fracture at that time. We were ever notified of the fracture. We reported this to their QA committee for review. But it is very distressing that no nurse or doctor felt it necessary to notify us of this.

My point is EVERYONE makes mistakes what matters most is your willingness to take ownership for your mistakes and learn from them. Remember the incident report is not as important as the documentation in the chart. Notifying the family, the doctor and doing a complete assessment for EVERY fall.

Good Luck.

joy1 · Mar 29, 2011

she has no family that's involved and the numbers we have for contacts are no longer in service.

Well, that could be good news for the facility, if there's no family contact or appointed state guardian. While this will help the facility to cover themselves from liability, it doesn't take away the fact that staff members involve will not be discipline in some way. Just pray for the best, if they let you go, take it with good faith, as long as yr license is safe you could easily apply some place else. Best advice protect yr license, u can always get jobs. Best wishes:)

Chin up · Mar 29, 2011

i was questioned today and i told them what i knew and i was honest and i told them i take full responsibilty because i was the nurse on duty.

I am glad you told the truth, but you should have done it the day it happened. This looks like you tried to cover for a fall, to avoid doing an incident report, call Md, family, and all the other things that go along with it. Did you even assess the resident? Did you do ROM, neuros, vitals? Did you do a full body assessment?

if ROM had been done, did you note anything? Was the resident in pain? Anything that may have led you to do an X-ray? Or were you rushing to get your meds done, or charting completed? You knew the resident was dropped and did nothing. This is serious neglect. You may get a suspension, until a finding. The CNA's are never to pick up a fallen resident and they know it. She could have blown a PE and or further damaged any injuries caused by the drop/fall. You state here, you are responsible because you were on duty. No, you are responsible for neglect, pure and simple. The resident could have died. I will not sugar coat this, especially because you are a new nurse and need to know that you don't choose to not act, when it is inconvenient. We don't have to witness a fall to act on it. We must act on it, as soon as we learn of it. Imagine that resident being you, there for a week in pain and no one doing anything. Or that resident crying out in pain and some dummy medicates her to keep her quiet, or thinking it may be just a headache. There are so many things that could have happened and did happen, that you can't just come to a nurse forum to get soothing words. What you did is mean, neglectful, abusive and wrong. You need to get training and should not accept any more shifts, until you get it.

mRpeNa · Mar 29, 2011

I am glad you told the truth, but you should have done it the day it happened. This looks like you tried to cover for a fall, to avoid doing an incident report, call Md, family, and all the other things that go along with it. Did you even assess the resident? Did you do ROM, neuros, vitals? Did you do a full body assessment?
if ROM had been done, did you note anything? Was the resident in pain? Anything that may have led you to do an X-ray? Or were you rushing to get your meds done, or charting completed? You knew the resident was dropped and did nothing. This is serious neglect. You may get a suspension, until a finding. The CNA's are never to pick up a fallen resident and they know it. She could have blown a PE and or further damaged any injuries caused by the drop/fall. You state here, you are responsible because you were on duty. No, you are responsible for neglect, pure and simple. The resident could have died. I will not sugar coat this, especially because you are a new nurse and need to know that you don't choose to not act, when it is inconvenient. We don't have to witness a fall to act on it. We must act on it, as soon as we learn of it. Imagine that resident being you, there for a week in pain and no one doing anything. Or that resident crying out in pain and some dummy medicates her to keep her quiet, or thinking it may be just a headache. There are so many things that could have happened and did happen, that you can't just come to a nurse forum to get soothing words. What you did is mean, neglectful, abusive and wrong. You need to get training and should not accept any more shifts, until you get it.

i understand completely what you are saying. but i'm not on here to get soothing words!

TMS1980 · Mar 30, 2011

I am glad you told the truth, but you should have done it the day it happened. This looks like you tried to cover for a fall, to avoid doing an incident report, call Md, family, and all the other things that go along with it. Did you even assess the resident? Did you do ROM, neuros, vitals? Did you do a full body assessment?
if ROM had been done, did you note anything? Was the resident in pain? Anything that may have led you to do an X-ray? Or were you rushing to get your meds done, or charting completed? You knew the resident was dropped and did nothing. This is serious neglect. You may get a suspension, until a finding. The CNA's are never to pick up a fallen resident and they know it. She could have blown a PE and or further damaged any injuries caused by the drop/fall. You state here, you are responsible because you were on duty. No, you are responsible for neglect, pure and simple. The resident could have died. I will not sugar coat this, especially because you are a new nurse and need to know that you don't choose to not act, when it is inconvenient. We don't have to witness a fall to act on it. We must act on it, as soon as we learn of it. Imagine that resident being you, there for a week in pain and no one doing anything. Or that resident crying out in pain and some dummy medicates her to keep her quiet, or thinking it may be just a headache. There are so many things that could have happened and did happen, that you can't just come to a nurse forum to get soothing words. What you did is mean, neglectful, abusive and wrong. You need to get training and should not accept any more shifts, until you get it.

Ouch! This was quite harsh in my opinion!

I think you completely miss read the situation... Perhaps try going back to re-read the original post. She stated the patient had an X-Ray and was found to have a fracture after that another resident informed someone(Rehab) that the patient in question had fallen... The original poster was then notified and questioned a CNA who advised she did assist another CNA with the patient who stated she fell to the floor during a transfer- this incident had happened the prior week and the Original poster was not notified by either CNA involved so it doesn't appear they knew to not leave patient on floor after fall to be assessed by nurse. I feel the original poster was wrong not to fill out an incident report when she learned of the incident but she was not "mean, neglectful, abusive and wrong"- She needs to make it clear to the CNA's (which they should already know) that if any patient has a fall that the need to be assessed by the RN immediately which requires notifying the RN on duty!!!

It sounds to me like the CNA was trying to cover up the fall to avoid getting in trouble- Just my thought!

I hope everything worked out ok for you, mRpeNa!

joy1 · Mar 31, 2011

ouch! this was quite harsh in my opinion!
i think you completely miss read the situation... perhaps try going back to re-read the original post. she stated the patient had an x-ray and was found to have a fracture after that another resident informed someone(rehab) that the patient in question had fallen... the original poster was then notified and questioned a cna who advised she did assist another cna with the patient who stated she fell to the floor during a transfer- this incident had happened the prior week and the original poster was not notified by either cna involved so it doesn't appear they knew to not leave patient on floor after fall to be assessed by nurse. i feel the original poster was wrong not to fill out an incident report when she learned of the incident but she was not "mean, neglectful, abusive and wrong"- she needs to make it clear to the cna's (which they should already know) that if any patient has a fall that the need to be assessed by the rn immediately which requires notifying the rn on duty!!!
it sounds to me like the cna was trying to cover up the fall to avoid getting in trouble- just my thought!
i hope everything worked out ok for you, mrpena!

tms1980, i agree with you that the tone of chin up's response seems rather harsh.

but, i just wanted to clarify what i believe the original poster meant --also, since the original poster is a new nurse she would benefit from it.

from my understanding of the situation, the original poster's seems to be aware of the incident the same day it happened, ("well last tuesday she fell but it was not notified to me. i was speaking to a restorative aide that day and she asked me what happened to resident a i said nothing, why, and she proceeded to tell me that resident b told her that resident a got dropped.") though, not directly reported by the cnas. but by the restorative aide that day. original poster, stated she questioned the cnas, then went on to assess pt ("so i go and look at resident a head no bumps noted resident didnt complain of any headaches."). the original poster does admit to have made a mistake by not following up with an incident report, after assessing pt. ("and this is where i screw up, i didnt fill out a incident report and 1 week later her leg is swelling and bruising noted.")

i agree that the cnas, were trying to hide the fall, generally, cnas, are in-serviced about what to do when a pt falls, & proper techniques for transfer. same is true for the nurses; nurses generally are in-serviced by the facility on their fall/incident protocols. it is clear that the original poster accepts full responsibility for neglecting to follow the facility protocol. however, i don't believe the original poster is a mean nurse. though, her actions may be construed as abusive by way of neglect; for failing to follow standard protocol. remember the old saying "if its not documented, it wasn't done." even a 24 hour nurses communication log, will assist in monitoring pt for 72hrs, ....but it took 1wk.

debRN0417 · Apr 2, 2011

As soon as you were notified that there was an allegation/concern/report that the resident had fallen you were correct in going in and doing an assessment. A full assessment including range of motion and body audit should have been completed. An incident report should have been done and the physician notified. The DON should have been made aware. All this should have been documented thoroughly in the record or incident report. An investigation would have been initiated at that time. The problem with this whole thing is that if you were notified on the day that the incident allegedly occurred and did not document or report, then it could be construed as negligence because the resident had been with a fracture for 4 or five days now. There is the whole issue of the resident possibly being in pain for that length of time which could be considered harm to the resident as well as timeliness of receiving appropriate treatment. If there was documentation in the clinical record that the resident was having signs or symptoms of pain then it only makes it worse. I hate to make you feel worse about the whole thing, but as nurses, we have the responsibiity of the care and well-being of our residents. Your facility will have to report this to the "state" and I am sure there will be an investigation by them, so be prepared for them to question you about your actions and why you did not follow proper procedure and standards of practice regarding your resident. I am sorry, but in my state this is what would happen and you should be prepared. The CNA's are also at fault for not immediately reporting accurately what occured to you.

gentlegiver, ASN, LPN, RN · Apr 4, 2011

I have been crying all day about this situation...
so today i had a resident that had an xray done and it showed that she had a fractured femur so i sent her out to the ER. Well last tuesday she fell but it was not notified to me. I was speaking to a restorative aide that day and she asked me what happened to resident A i said nothing, why, and she proceeded to tell me that resident B told her that resident A got dropped. So i went to one of the aides and asked her what happened and she said that CNA A called her and told her that resident A had slipped down to the floor when she was transferring her and she needed help geting her off the foor and she didnt tell me because thought that the other CNA was going to tell me, so i go and look at resident A head no bumps noted resident didnt complain of any headaches. And this is where i screw up, i didnt fill out a incident report and 1 week later her leg is swelling and bruising noted...i feel sooo horrible that this happened to the resident!!!! I am a new nurse and still learning but i cant believe how bad i screwed up! so i was wanting to know if anyone else had been in this situation and if so what happened? im soooo scared!!!

This does not make you a bad Nurse. That being said, Whenever you recieve a report from anyone that a patient was dropped, fell, lowered gently to the floor, no matter if it's the same shift or a later shift, you should fill out an incidient report stating that you were told this had happened and complete an assessment. If it occured a few days ago and you are unsure if the paperwork should be filled out late, the very least should be that you speak to or send a note to the DON reporting the situation and requesting guidence. I had this happen to me, a patient was complaining of leg pain, I went in to look and saw bruising surrounding the area, so I contacted the Dr and got orders to send her out to the ER for evaluation. Now the ER was very familiar with her, so when I gave report to them I did state that I was concerned about the bruising and requested an x-ray be done. Sure enough her x-ray showed that her leg had been broken and had begun to repair, the patient then told us it probably happened when she was dropped during out-patient therapy a week before. We had never been informed of the situation. A quick call to the DON for how to handle the paperwork saved both my and the companies behinds. When in doubt, call the DON, and document, document, document!!

indigonurse · Apr 6, 2011

I don't know what state you are in. In my state an MD has to be notified and it needs to be documented within a certain time limit and a policy is followed after a report of a fall. Anyone can report anyone to the nursing license board. It doesn't mean that they will. You are saying that one week later swelling and a bruise were noted. That could be from a different incident from the one that was originally reported to you. I would think that bruising and swelling would appear sooner than a week after an injury.