Fall in the ED!

Specialties Emergency

Published

Hello to all my fellow nurses out there, I need your help! I have been a nurse for close to 3 years, with 18 months in gen med and 11 months in the ED, and 6 months or so as a pedi home health nurse. I don't know what to do in this situation and im kind of worried and mad at the same time. About 3 months ago I had a pt that had a high ammonia level (he is a frequent flyer for the same thing) but he was alert and oriented and followed commands. I helped him to the restroom and told him to not get up. He verbally agreed and I would check up on him (he was a hold patient in the ED cause we were backed up in the hospital). He got up and fell down in the doorway of his room right after I had just left. No injury occurred. That particular matter was settled and nothing came of it. Last night I had a person who came in for a seizure but who was also evidently intoxicated. I put him on all seizure precautions both siderails up, fall risk band, and told my charge who placed him in a room across from the nursing station. He was medicated to stop the seizures (Ativan and loading fospheny) and he went to sleep without incident and had his CT without incident. He comes back to the room and starts having multiple seizures again (at his point after medicating him again I believe these seizures are faked based on presentation) but I treat him like they are real. I go to see a new patient I received and as im walking away a tech tells me this patient is on the floor. Per the pt he crawled out of bed through the bottom because he "wanted to go home" and "didn't belong here". He had no injuries so we placed him back on the stretcher and placed him in restraints. He then breaks the cloth restraints and climbs out again while I am gone. Despite doing everything I could to stop this short of getting a sitter ,which me and the MD, thought was uneccessary due to the restraints, this happened. I was told to not come in the following night by my clinical coordinator (the one who took every opportunity to throw me under the boss) and now I am going to have to go to a meeting with my CNO and medical director of the ER. This ER has treated its nursing staff in general very badly and has had unsafe practices in the past despite nursing objections but I stuck it out. Now I fear they are going to fire me over this incident because the two separate falls are close together. I am at a loss about what to do but I will update after my meeting in the AM. Any help would be appreciated. If it does come down to it maybe I can find a PRN position at another facility or travel.Again, any help or suggestions would be appreciated.

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Wow that's extremely unfortunate. I'm a new grad and I haven't started working yet so I probably can't provide too much advice. I guess all you can do is tell your side of the story, be truthful and hope for the best. Definitely update after the meeting.... I'm curious how this turns out. Best of luck.... I'm crossing my fingers for you

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Thanks, even that little bit helps. Don't let this turn you off to nursing and if something bad happens to me, learn from my mistake whether that ends up being working at the wrong hospital, my own fault, or something else. I plan to go in there with proposals about changing how things work in the ED so hopefully something will change even if I don't get to keep my job

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The thing is idk what I would've done in those situations. I mean the ED is obviously not 1-1 so you have other patients to care for. Maybe you should've gotten a tech to assist them in the bathroom? And as far as the seizure pt idk.... I mean you said the MD didn't want a sitter and you clearly can't sit with them their whole stay. As far as the proposals I think that's a good idea.... Sort of like when a nurse makes a med error how they have to teach others so that error doesn't happen again. Not that I'm saying you made a mistake, it just seems like a proactive thing to do. And ya DEFINITELY be honest and just explain to them why you made the decisions you did. Obviously you didn't want the patients to fall so you should tell them the justification for your actions. At least that's what I would do...

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I start a new grad residency in March and honestly my biggest fear is that I make a mistake or someone gets hurt. I'm sure everyone goes through these feelings but it's so intimidating!!

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The biggest advice I can tell you is to trust your gut, you will develop a good gut feeling with some OJT and experience. They will train you well enough I hope, just don't cut corners cause your tired and you will be fine. hopefully some ED nurses out there will respond to this thread!

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Specializes in Med/Surg/ICU/Stepdown.

Did you have any sort of debriefing after these patient falls? Any QI paperwork? I ask because there shouldn't be this fear of termination over what can be inevitable in some situations. Falls in the hospital happen in spite of even the best prevention efforts. Did anyone speak to you regarding the events leading up to the fall? Ask you what you think you could have done differently?

I'm sorry that you're being reprimanded as opposed to your administration utilizing this to implement fall prevention strategies in the ER.

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I had a debriefing and the Chief nursing officer asked me what was going on and was very nice about it. He suggested a couple things like bed alarms and I told him that we don't have any bed alarms or the other things he suggested and he was kind of out of things to say at that point. He concluded that it wasn't preventable and I didn't sign anything or received any reprimands from it. The fact the clinical coordinator tried to throw me under the bus at every opportunity is what has me worried and the closeness of these minor "falls". still to date we don't have any of those suggestions available to us for intoxicated/high/AMS patients. If I feel that it is going to where they are going to can me over it im going to fight with everything I have to keep my job and get something changed. They are setting us up for failure I think.

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Specializes in ER I/CCU Cath lab LTC.

If the doc nixed getting a sitter, I don't see what else you could have done. He was even right across from the nurse's station. Please let us know how this meeting goes. I'm curious to see what the big dogs say you should have done. Hope they listen to your safety proposals. Good luck tomorrow!

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thanks, the support you guys are helping me with means everything. I have never been fired from a job in my life and I don't want to start. Beyond the mortgage and bills aspect, its a pride thing as well. I do take excellent care of my patients and I would hate to have this hospital put a bad taste in my mouth in regards to nursing.

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Specializes in ER.

I'd look at the restraint policy. Our old ER required a sitter because someone aspirated while in restraints in the ER. I would also bring a few things such as allowing more use of sitters or portable chair/bed alarms.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Thread moved for best response.

Neither of these falls were any kind of neglect on your part. Other than more sedation for agitation on the second patient...I don't see what else could be done. Sitters are helpful but in the ED are usually only for SI psych patients. What is up with the supervisor? waht is his/her beef with the ED? I would speak to you manager and educator to see what else you could have done and what the deal is with this person.

Maybe you do need to leave this facility.

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