Should I inform the UM or should I wait for them to do it first?

  1. I am just amazed how my coworkers covered up an incident that occured with so many witnesses and no one said a word about the true story. If I don't say anything, I'm just as guilty.

    The story goes like this. Last Saturday morning about twenty minutes after the change of shift, we had a resident climb over the side rails and hit the floor. I was still around doing my charting on the computer when someone yelled, "------ is on the floor!" Myself and three other people ran to his room and there he was lying on his left side on the floor. We picked ------- up and put him back into bed. One of the other nurses did a quick assessment and said, "I'll go call the doc." I went back to finish my charting and then I left. It was their problem. I just helped put him back to bed on their shift. Sunday I was off. Monday we were so busy I hardly had time to go to the BR and really forgot about the incident. Today it dawned on me to look through his nurses notes to see what they had done for this resident. In the one note written by the nurse who said, 'I'll go call the doc!', she typed, "Mr ------ was trying to jump over the side rails.'' I couldn't believe what I was reading! nothing about him hitting the floor, but she typed that she got an order for restraints from the Dr. Now I'm thinking what if he broke a rib, or a hip or hit his head??? The nurse that found him on the floor arrived this morning and I pulled her aside and asked her, "Why didn't you make out an incident report or tell the doc he fell over the rail and hit the floor?" Her reply was, "Well I know so n so called the doc..." I said, "But YOU found him and YOU should have initiated the incident report. She went flipping through the 24 hour reports and found that the other nurse wrote the same thing...Dr notified, restraint order obtained due to him trying to jump over the siderail... I reminded her that he didn't try to jump over the rail, he DID jump over the hit the floor. And I recall her being the loudest when we were placing him back into bed that morning saying, "I've told ------- (the UM), that he needs to be in a low bed. If he were in one, this wouldn't have happened!" When I left this morning I told her she and the other nurse who is on afternoons today better rethink their story on what actually happened because if they don't I'm going to have to be the pt's advocate. I checked him out this morning and didn't see any bruises, lumps or bumps, vitals were good, but God only knows. I didn't want to run into the UM's office right away since he looked ok. .....OK,ok,ok,ok I know I probably should have, but I wanted them to change their story to the right story first so that I wouldn't look like a "Rat." I hate being stuck in the middle. How wrong am I? Should I even have gone there? If we want him in a low bed this documentation would only prove that he really needs one. I bet stuff like this happens more than I want to know, but why does it bother me so much? Because I know the truth! It surely didn't bother the other nurses, but it probably does now...It'll bother me more if I have to play the role of "The Rat." What does one do in this case???
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    About night owl

    Joined: Mar '01; Posts: 3,254; Likes: 53


  3. by   NurseLili
    Night Owl, you have good instincts. So use them. I promise you, if you end up reporting this to the pt. advocate, she will believe you.

    Remember, we are patient advocates first and colleagues second.

    I can tell you this because I've already reported a co-worker. He gave the nurses a lot of grief over it and intimidated us, but I was glad I did it because he wasn't a good nurse to begin with. Believe me, I felt much better and confident after that.

    You'll be surprised how much more careful and conscious those nurses who hide the truth are after they've been reported, (tha't the purpose).Hopefully this will be a lesson.

    Best of luck to you.
  4. by   night owl
    Thank you NurseLili, I appreciate your response a great deal.
  5. by   BadBird
    I would fill out the incident report, hand deliver it to the nurse manager and have a frank discussion with her regarding the other 2 nurses. I don't understand why it is a problem to report what you see or found, why the big coverup? Lying will only lead to trouble down the road. You are 100% correct, what if he had his his head and ended up with a subdural hematoma? There is no excuse for not advocating for our patients.
  6. by   nursenoelle
    I think that the UM needs to be notified first. I don't look at it as being a rat. We as nurses are the only advocate for the resident at times , and that should be taken seriously. The nurses involved with getting the restraint order clearly flasified records, it makes me angry to see short-cuts like that. Yes we are busy- but that is no excuse. You are right- what if he had broken a hip ?! They may be generally good nurses, but they showed very poor judgement. How are they going to fix it ? Get rid of the old notes? Would you do a late I&A?
  7. by   Shamrock
    Go with your gut. (not yogurt)
  8. by   jnette
    Originally posted by NurseLili

    Remember, we are patient advocates first and colleagues second.

    Best of luck to you.
    That's correct, Moo. You must concern yourself with the patient and not with how your colleagues might see you. You're not there for them, but him (or her.. whichever the pt. was in this case).

    If no one actually SAW the pt. climb over the siderails, then they should have simply documented the FACTS... "pt. found lying on floor next to bed, siderails in raised position". And yes, this should have been written by the one who found him or witnessed the incident.

    We are responsible for documenting the FACTS; nothing more, and certainly nothing LESS. Anything other than that will certainly come back to haunt us in one way or another. For this PATIENT'S sake and possible injury, the facts should have been clearly documented and the physician informed of just what actually occurred.

    I agree with BadBird and the others. Write your own incident report just as YOU saw it or were involved with it at the time. Nothing more, nothing less.
  9. by   Nurse Ratched
    Nightowl, I'd write that incident report today and hand it to the UM with the statement that it had come to your attention that the incident may not have been reported for some reason. Return to unit and wait for poo to hit the fan. Good luck!
  10. by   dosamigos76
    I certainly am sorry you have to be in this position. I am glad you are there for this patient and all your other patients.
  11. by   tlc054
    What was their reason for covering it up? Other than the mountain of paperwork we must do to document a fall/incident. We can't stop all falls but we can certainly do what we can to prevent future ones.
  12. by   LauraF, RN
    I would do an incident report to the best of your ability. State what you saw. It sounds like your co-workers not only need to courses on honesty they need help with documentation. To put in the notes he was trying to climb out of bed...... How do they know that is what he was doing? That is putting information that they can not be sure of. Was he climbing over the rail? Maybe, but did anyone see him. Nurses notes are not intended for subjective data. Good luck.
  13. by   LauraF, RN
    I forgot to mention. At our facility we end up taking vitals for 3 days once a shift on fall residents.
  14. by   night owl
    Originally posted by tlc054
    What was their reason for covering it up? Other than the mountain of paperwork we must do to document a fall/incident. We can't stop all falls but we can certainly do what we can to prevent future ones.
    I don't understand this myself. There really isn't all that much paperwork. An incident report with a carbon copy, a nurses note in the computer and notation on the 24 hr report. I'm thinking it might have been too much trouble for them to send the resident to x-ray and if something was found, then they'd have to send him out to the hospital. I guess they were just trying to save themselves "the trouble". Awe gee... Anyway, I'm sure the UM will want to know why they failed to mention he was found on the floor by his bed.
    He wasn't actually seen climbing over the rail, but he was found on the floor and it's that very reason why the Dr should have been informed so that the resident could have been examined. He had that right and they took it away from him. The poo can hit the fan, I really don't mind. I've been playing in it for all these years so it doesn't affect me anymore.
    There's one thing I've learned in my years of nursing and that is always cover your butt no matter what. I guess because he didn't show any visible injuries maybe they thought it wasn't necessary to inform the doc. I've seen that before too, only in that resident's case, he had a humongus bruise and a Fx hip two days later. The unit physician found it during an annual physical.
    The sad part about this story is, he'll be found on the floor again unless he gets his low bed.