First Time Fall

[Nola504]

I've been a nurse for 3 years. I've never had a patient fall before. At shift change I got a quick update from the day shift nurse, he needed to go drop his labs off at the front, I told him to go. I would go check on the patient. I'd see him in a minute. I went to see the patient, asked if she needed anything, if she had to use the bathroom. She said no. I told her I would be right back. I went across the hall to introduce myself to the next patient. Told them I had not received report but that I would be back. Just wanted to say hello. I turned to leave and go back into the previous room and the patient hit her call button. I told her I was walking back that way, did she need to use the bathroom? She said she tried to go and she fell and that she needed help. PANIC. I ran in. She was on the floor and I reached down and picked her up. Pandemonium!!!! Long story short..she broke her hip. I assumed responsibility for the patient. I was the last one in the room. It was my fault. I feel horrible. I feel bad for that patient. I feel bad for myself. I had 5 patients. High acuity level on 3 different hallways. I always try to do things efficiently to get things started and taken care of because I know that I have a certain amount of time to get things done. I made mistakes and it was my fault she hurt herself. I should have just waited in the room to get report or found someone else who was ready to give me report. I should have checked the bed alarm. I didn't do those things and now my patient it hurt because of them. I can't eat. I can't sleep. I'm teary. This just happened so it's all still fresh. I don't know what is going to happen to me. I don't know what is going to happen to my poor patient. I should have said to the day shift nurse we need to give official report in the room. I should have persuaded her to use the bathroom when I was in there. I should have checked the bed alarm. Should have. Would have. Could have. I already had a conversation with my manager. I work nights and was sitting by the phone all morning because I knew she was going to call. I have to go to a meeting on Monday with the risk manager. This is a bit of a nightmare. I feel sick. How could I have been so careless! Rules are in place for a reason. I got an email saying 3 weeks ago I didn't document a bowel movement on a patient. One time. One patient. In 3 months. And I get an email stating what is expected of me and that I did not fulfill that obligation and that further incidences will have consequences. For not documenting a bowel movement. I can't even begin to think of what is going to happen that a patient under my care fell and broke a hip.

[JKL33]

Whoa, whoa, whoa.

You are in for a rough ride in your career if you plan to heap loads of blame upon yourself in this manner every time anything unfortunate happens.

Yes, there is much we can do toward the goal of preventing falls. And yes, we should take responsibility for our actions whenever it is reasonable to do so.

Just the same, every bad thing that happens is not always because someone else did something wrong - regardless if others try to shift blame by acting as if every bad thing should have been able to be prevented by someone else (anyone but themselves, usually - and I'm talking about the employer, not the patient, just to be clear).

Now let's be rational here. Let's say that you had not been going around doing these quick checks/introductions and instead you had been standing at the desk receiving a full-on lengthy report. The patient woudn't have fallen then?

I would never work in a situation where I would be blamed as if I'd personally pushed the patient down to the floor myself just because someone fell down after being checked within the past 5 minutes. Actually, if I'd been raked over the coals about the BM documentation I would've already been looking for another job. I do my best and I aim to provide excellent care, but I'm looking for an employer that is interested in buiding up and supporting my effort, not constantly tearing down.

I'm glad you have compassion and concern for what has happened; obviously a fall and hip fx are both very unfortunate things. Just the same, I think you need to compose yourself a bit before Monday rolls around.

[Nola504]

JKL33

I know you are right. It just happened last night so my nerves are very jittery right now. When the day shift RN said that the patient had been calling all day to go to the bathroom but she had not called in awhile my first thought was she was going to have to go so I should go check on her. When she said she was ok I gave her the call light and told her to call when she needed anything because I knew she would be calling soon. She still had the call light in her hand when I found her on the floor. Which is why I knew she was on the floor....she called me. Sigh. When I spoke to the family they told me that they understood and that she was very headstrong and kept trying to do things on her own even though she knew she shouldn't as she has fallen numerous times and hurt herself the latest was the beginning of the year when she broke her pelvis. I was trying to be proactive. I was ok it was management that made me feel awful. My manager said that because policy was not followed by giving bedside report and checking the bed alarm I broke protocol and a patient was seriously injured because of it. I know all the blame is not on me. It is hard to forgive oneself when something tragic happens and u think of all the things u could have done differently after the fact. It's hard not to be shaken after the first time especially when the higher ups are sitting on top of you so hard. I often feel like I cannot do anything right at this place. My husband thinks I should leave and go elsewhere. Maybe he is right. My ultimate goal is to get out of nursing maybe find a new career path or shift my nursing career elsewhere. I have already started applying to my masters in forensic science program. I think floor nursing is just wearing me out. Thank you for your clarifying words and your honesty. I have already taken them into account.

With great thanks,

Nola

[RainMom]

JKL33

My manager said that because policy was not followed by giving bedside report and checking the bed alarm I broke protocol and a patient was seriously injured because of it.

I disagree. That pt was going to fall whether you did bedside report or not. She refused the offer to get up to the restroom & then tried it on her own; it would not have mattered if 2 of you were at the bedside at that time or not. The bed alarm would have just saved her from calling you herself.

My first pt fall was a doozy. At that time, we did not do bedside report & we only had a handful of pad alarms that could be placed under pts in bed so not everyone automatically got one. I had 5 or 6 pts on nights on an ortho floor. As I went to assess my last pt, I could hear a weak cry for help. There, near the entrance of the room, was my pt on the floor leaning against the wall. Blood everywhere. EVERYWHERE. From the linens, to the bedrails, huge puddles on the floor, smeared across 2 walls, all over my pt. Looked like a scene from a horror film.

Pt was a fresh cervical spine surgery. Woke up confused thinking he had to pee (had a foley), got up & tripped over the scd's. He had a drain which I initially thought had been pulled out due to how much blood was everywhere. Turns out it was all from his IV.

This happened when I was barely off orientation & was my first experience with filling out an incident report. Thankfully, the pt did not have any injury & I learned a lot that night. My charge was great. We talked about prioritizing which pts to see first (I had seen him last when I should have seen him before a couple pts who were 1-2 days post-op), but also reassured me that even if I'd seen him early, he likely would have tried getting up at some point between rounding & still would have fallen.

I expected to be called into talk to the manager but never did. Falls happen & staff cannot be with every pt 100% of the time.

[JKL33]

JKL33

I was ok it was management that made me feel awful. My manager said that because policy was not followed by giving bedside report and checking the bed alarm I broke protocol and a patient was seriously injured because of it.

I am very sorry you are working with this type of management. They are looking for a scapegoat - which, amongst other things, means they are not devoted to actually contributing to patient well-being through their policies and their staffing.

Your husband is correct. If these people can't treat a conscientious, dedicated nurse such as yourself well, you need to find another position, pronto.

Also, a point of clarification about my first comment: Please know that I didn't write any of that to criticise you - - but because I sincerely believe that you must stand up for yourself. You sound like someone who is dedicated to doing your best for patients, and you should expect to be treated as such. Don't give your employers reason to believe their scapegoating behavior is appropriate or "serve yourself up on a silver platter" for them to pick apart. This is what people mean when they say that, to some extent we determine how others treat us (by the way we feel about ourselves, and by the expectations we have for others' treatment of us).

Your account of this incident should be nothing more than the fact that you had arrived for your shift and were waiting to get report when this incident occurred. You don't have anything more to say about this except that you said a preliminary hello to a few of the patients and this one in particular was doing fine and denied any needs and had her call light. You should not accept responsibility for WHY the bed alarm was not functioning as you were coming on shift.

Be pleasant but strong. Let us know how this works out. You're in my thoughts!

[Nola504]

Rain Mom,

Thankyou for sharing your experience with me! I appreciate your support and your words of wisdom and kindness. I know that patient would have fallen eventually. I know that despite what I did all that I had done. The situation wouldn't have necessarily been any different. However, management does not see it this way. For some reason they think by putting a fall band on and using a particular color gown, yellow in this case, and having a bed alarm, this would have changed the outcome. I'm trying to get myself together to try to get ready for what I know is coming. My husband, my friends (all nurses) are very supportive of me. I'll go to my meeting. State the facts and let it be what it is. I don't think I will necessarily be fired but I know that I've already been branded. I'm the one whose patient fell and broke her hip because I didn't check the bed alarm. It is what it is. A learning experience for sure. I'm hoping this makes me stronger, better and a support for a future coworker. Because as all nurses know...and even though managers pretend they don't.... falls happen, despite our best efforts. Again thank you!

[Nola504]

JKL33

I took no offense to anything you said. I am taking everything you said as a means for preparing myself for Monday's meeting. I thank you for reminding me that I try my best to do what is right and I need to remember that I have to stand up for myself because no one else will. I'm an advocate for others every shift. Something I'm going to have to do for myself now. I'll stick to the facts as they are. I'll listen to what they say and take into account what I can learn from all of this. I will be pleasant. I will do my very best to be strong. I'll try to remember that it's not necessary to set myself on fire just to keep others warm. I'll see this through and let you know how it goes. But I am already looking for another position elsewhere. The way things have been handled since I started...94 days ago have been a continuous snowball headed downhill. I know this is not the place for me. I'm very lucky to have a supportive husband, amazing friends and all of you here at all nurses! Thank you for taking time out of your life to reach out and touch mine!

With the utmost respect and greatest thanks!

Nola

[Nola504]

My Monday meeting has come and gone. It went surprisingly well. The risk manager was a fellow RN and I think that helped that she was able to understand my position and what it was like to work on the floor. She made it known upfront that the meeting was informal and that it was not meant to make anyone feel bad or to place blame or point fingers. I explained and answered all the questions presented to me. After all was said and done she told me that it was obvious that this fall would have happened no matter what we would have done. She asked for my opinion on what we could do to help to decrease the number of falls. She thanked me and just like that...it was over. I felt much better after the meeting than I did before. I still think that this institution is not the one for me. The constant emails and threats for the most mundane of infractions gives me anxiety and I have enough tot worry about to include these other things on my list. Thank you all for your words of wisdom, your strength and most of all your support! You'll never know how much you helped!!!! With greatest of Thanks!!!!

Nola

[JKL33]

I've been waiting for this update!

So glad it went well, Nola. I think with time it becomes easier to put things into perspective and get a sense of who you are as a nurse. This will be a growth experience for you, all of it - both the fall and the follow-up. In the end, what we do is take the absolute best care of patients that we can and then learn to accept that we actually aren't in control of everything.

Best wishes to you in your career ~

[RoyalTeaRN]

Glad things worked out better than you expected, despite the understandable anxiety you went through up to that point. I hope you land somewhere that shows appreciation for your effort and dedication.

[NotAllWhoWandeRN, ASN, RN]

When an alert & oriented patient does something they know is risky and gets hurt, it is their fault, not yours.

I've only had one fall in acute care (tons in LTC before that) and I did feel bad for not anticipating my LOL's nighttime confusion. I did a thorough assessment (no injury), followed protocol for follow-up vs/assessments and notifications, and charted the dickens out of it - as I'd learned to do in previous work where falls were commonplace. Management didn't scold me for allowing the fall, they praised me for my thorough care afterward.

If management continues to frighten you over minor infractions, I promise you can find better places to work.

[MunoRN, RN]

You clearly care about your patients and the quality of care you provide, that's good, but you don't need to blame yourself for things that are in no way your fault.

You've stated a few times that the fall was your fault because you didn't check the bed alarm, which assumes that if the bed alarm had been on the patient would not have fallen, however there is no evidence to support this, bed alarms don't prevent falls, the evidence actually suggests they can increase the incidence of falls.