Healing within Healing: Patient Falls

[yaleli]

I started this job in March of this year. I work as an oncology nurse in a very supportive unit. Our UD is amazing beyond words. However, she is very big on patient falls as she has to. She gets very upset when one of our patients fall. People who take care of such patients as a result feel very guilty and upset letting this great woman down. People gossip behind these nurses- how they were incompetent and how such fall was predictable.

I never ever in million years thought my patient would fall during my care. Since I am new, I have unreasonable expectations about myself. I have this alert patient for four days now and every time he wanted to go to the bathroom, he would call me. But, this time he did not and guess what he had his scds on which he tripped over. He did not get hurt at all, he just slipped from his bed and got up and started to walk again.

I was very confident in this patient that he would call me since he callled me 30 minutes prior to his fall and I helped him. Again it was surprising.

and I just feel so down... When my UD gets to her office first thing on Monday will see my report. I am not going to be her lovely nurse anymore. Some of nurses will talk behind my back and by the time it is Friday, everybody will know and perhaps think it was my fault.

I do not know what to do, I really would like to talk to somebody about this.

[Mulan]

One can be standing right next to a patient and they can fall.

Sometimes there is nothing one can do about it.

If he didn't call and got up by himself, how are you supposed to be responsible for that?

It could have happened to anyone including those perfect people you work with.

Just ignore them.

She's just upset because it ultimately reflects badly on her and her evaluation and her raise or bonus.

[calivianya, BSN, RN]

The only falls I've had have been while I was in the room with the patients. You could argue that I am more responsible for those falls than you are for yours, but in both cases mine were with extremely confused and agitated young, strong men who literally knocked me out of the way to get out of bed and fall. One of them left nail marks on my arm so deep that I had them for more than a week, and the other had this great trick where he pulled on my arm while using his foot to push my foot out from under me and I had to catch myself so I didn't end up on the floor, hence taking my hands off the patient for long enough for him to get up and fall. It happens. I don't blame myself and I don't blame you - if a person is determined enough to get up on their own, nothing short of five point restraints is going to keep them in the bed, and if they're also unstable they're going to go down. I try to prevent falls as much as possible (and it sounds like you do, too) but when they happen you can't beat yourself up for it. You sound like a fantastic, caring nurse - you could not have done anything else to stop the fall from happening. Patients fall - it is what it is.

[Morainey, BSN, RN]

Don't be so hard on yourself. I see you are a new nurse but seriously. Patients fall. Not every fall is predictable or preventable. Sometimes you can do everything right and the patient still falls. It doesn't necessarily make you, or anyone else, a bad or incompetent nurse. Especially since you mentioned you just toileted the guy 30 minutes prior.

Also I don't work on your unit and I don't know the politics there but if your unit is so supportive they shouldn't be gossiping about whose patient fell and why, and passing judgement on nurses whose patients fell. That doesn't sit right with me.

[Cammack, RN]

I agree with everyone else! There is only so much a nurse can do to prevent falls. My patient fell just last night. She had a bed alarm AND her daughter was staying at the bedside. Sure enough she took off the alarm, crawled out of bed and fell right on her backside. Hit her head and everything.

Those that will talk about you behind your back over a fall are ridiculous. If they are so perfect they should be teaming together to ensure such an awesome fall prevention program.

[chrisrn24]

Don't be so hard on yourself. I see you are a new nurse but seriously. Patients fall. Not every fall is predictable or preventable. Sometimes you can do everything right and the patient still falls. It doesn't necessarily make you, or anyone else, a bad or incompetent nurse. Especially since you mentioned you just toileted the guy 30 minutes prior.

Also I don't work on your unit and I don't know the politics there but if your unit is so supportive they shouldn't be gossiping about whose patient fell and why, and passing judgement on nurses whose patients fell. That doesn't sit right with me.

Agreed. Falls will happen even if you have the best technology available to prevent. Don't be hard on yourself. It happens.

[amoLucia]

A supervisor on my very first job eons ago was very realistic & understanding about pts' falling. She said, "pts fall - you can't sit on top of them all the time and you can't tie them all down" That says it all to me.

But like you, I still feel guilty and am disappointed that someone falls despite all my interventions. But them I remember that I can't sit on them and I can't tie them down.

[sallyrnrrt, ADN, RN]

we try responsible fall prevention methods, empty bladder before bed, fall bed alarms,low bed, fall mats, freq. incont. rounds, pt. education re use of call light, etcetcetc...... but with dementia lack appreciation of safety boundaries in adls. and with too independent pts. as MYSELF, i got the right to fall ....... seriously when the day comes, just leave a stack of incident rpts at my bedside !

[SwansonRN]

After my first fall I cried and cried. I wanted to quit. I thought I was going to get sued or that the patient's family would complain about me to management. My manager bought me a donut and said, "patients are people and nursing is not a perfect science. We can't completely stop these things from happening, just do our best to prevent them." The next day I transferred the patient to a lower level of care. The daughter called me and was so thankful and she wished that I could keep taking care of her family member. Basically, I learned that not every mistake or adverse event is going to be the end of the world and now I am very vigilant about fall prevention and safety. It's made me a better nurse. If your coworkers or higher ups make you feel horrible about this, then they are in the wrong.