Freaking out over a patient fall!!

[Zenndaya]

Hi guys, it's been a while. I've just been sweating buckets about something and wanted to get some opinions.

So, I was at clinical this morning from 0630 to 1400. I had a patient with renal/hepatic problems. He was a stand by assist 1. I answered his call light & he said he wanted to go to the bathroom. I looked around for a gait belt & couldn't locate one. He said that he is fine with just a walker. Now, we're told to always use a gait belt. I messed up and took him to the bathroom without one. Once he was done with his business, I went in to get him off the toilet (he had his walker in front of him & I was helping him to stand up. We locked arms and he was getting up when his right knee buckled and he fell to the side. I held on to him and tried to lower him as far as I could until gravity took over. He fell on his butt and later stated that he had some back pain (he normally has chronic back pain & I guess this aggravated it). I assessed him at the time and called in his primary nurse right away. She told me I should have probably used a gait belt (turns out it was behind the open door, tucked away on top of a table). She did say that it probably wouldn't have mattered anyway considering his knee buckled under him. They called in the doc and he said the same thing & suggested that he be more mobile to strengthen his muscles.

My instructor on the other hand said that she would have to write me up anyway (which I completely understand). The thing is, she told me to meet her tomorrow after our exam to talk it over with the dean of nursing.

I am freaking out about this soooooo much and I can't afford to because of my exam but I can't help it. I'm worried this might cause me to fail my clinical portion (and in turn, the entire semester -- this is my last semester before my NCLEX btw). Thoughts? I feel like I'm overthinking things but its just how I am. I can't get this whole day off my mind. . .

[K+MgSO4, BSN]

On 3/7/2019 at 6:53 AM, C_M_L_R18 said:

I was so anxious about having this happen to me, that I actually bought a gait belt off of amazon. - I know how busy things can get and things might not be where I think they are or where I need them to be.... unless I have it right in my pocket. * maybe when you meet with the dean, tell them as part of your plan to make sure this never happens again- that you’re going to buy your own so you always have it on hand.

a lot of times folks don’t know their own limitations- (i mean don’t we all?!) I’d rather use a belt and it not be necessary than something bad happen

good luck tomorrow. I hope it’s just a “let’s talk about this CI and how to prevent it”

* ok it’s not just the gait belt, I literally have an entire orificenal of stuff , pulse ox, bp cuff.... planning on getting a temporal thermometer too at some point heh.....

Do NOT do this. If anything was to occur to a pt using your gait belt, or if your vs equipment is not calibrated by the biomed team at the hospital you are on placement at you WILL be crucified.

[Forest2]

I understand the position of the upper muckety mucks( they have to make it look like it was all on you to cover their butts), but it sure makes the student feel like a pile of doo doo. It was a mistake, that's all. No injuries. These upper mucks need a lesson in how to handle incidents and how to treat people with fairness. They should investigate the system that lead to what happened. Nursing today is all DEFENSE. One reason why medical care is so expensive in the US. Defensive medicine and defensive nursing. Make sure you get your own malpractice insurance. Never expect an employer to have your back, they won't.

[blackberry, BSN, RN]

Zara, I am happy you did not get kicked out. I think the school overreacted. I have worked with many types of patients. The most important thing I have learned is to always get use the proper precautions. I have patient's defiantly refuse to wait for the second person and I will document that they refused to wait for me to put the gait belt or if they refuse to wait for a second person. The key is to document that you educated the patient that since they are on fall precautions and you must endorse use of the tools used to help with transfers and ambulation. If the patient refuses, you document that the patient refused to cover your license.

Working with patients who have lost some of their functioning and are in rehab are some of the most difficult patients because they are dealing with a lifestyle change, body disfigurement etc. On top of the physical changes, some have underlying mental health problems that may be undiagnosed and need a neuropsychologist for further testing.

[Mandy2016, BSN]

You can do everything right and still be wrong. This is something I have had to remind myself of on more than one occasion and I urge you to remember it and not be discouraged! You knew what was right, made an honest attempt to try to follow policy, and, as a result of your diligence, the patient did not get seriously injured. I remember nursing school, they teach nursing with "ivory tower" ideals that are just unrealistic for many patient care settings. My hospital doesn't even have a lift team due to budget cuts! As a result, our bariatric patients often have wounds we can't find/treat in the ER because we simply don't have the strength or tools to even turn a 500lb pt to see their backs. This makes us feel awful and causes increased risks to our patients. But remember, it is not our responsibility as nurses to pay for equipment the hospital will not provide, or put ourselves at risk of injury because of this. What's most important is that you learned from this experience and it will make you more vigilant. Experiences like this will only make you a better nurse, and the fact that you care so much says a lot about what a good nurse you're going to be! Don't lose hope!

[Stella.didnt.doit, BSN, RN]

actually if you look up the teaching on use of a gait belt they are really only meant to be used by PT/OT. A patient that unstable should have a patient transfer equipment. Not just for the patient. Nursing and health care workers are the ONLY field that has not had a decrease in Musculoskeletal injuries according to OSHA. There really is no safe lifting and the belt is a bull$hi% lame way for hospital to not be ensuring for worker safety. Facts are that the injuries that take us out are not a one event cause but years or multiple stresses finally catching up.

[canoehead, BSN, RN]

Even with the gait belt, he would have gone down if I was doing it. Even with a second person, depending on his weight.