Help! I need some advice!

[Shirl57]

Last week I had to lower a patient to the floor to avoid a fall. This patient is recovering from a fx hip and has severe dementia. The patient is also a 1:1 through out the evening shift (sundowners too). While I had her in my care, I had to turn to pull a narcotic PRN for another resident, while still looking back to watch her. When she stood up from her wheel chair I could tell she was about to fall and I caught her. She was pushing away the w/c so I had no choice but to lower her to the floor. Now - I also knew that if I used the Hoyer lift to pick her up from the floor she would not understand, be frightened, fight it, and possibly harming herself, me and another staff member whom I asked to help. But I also knew that guiding her to stand using her 'good leg' and the gait belt, we could safely place her back in her chair. She had the strength to stand up easily. Our facility is a 'No Lift' facility. However, she is a two assist transfer. Here is the question: Was I wrong in NOT using the Hoyer? I had just gotten written up for not doing so. Sorry this so lengthy - I really need some advice!

[caliotter3]

I don't know what to say. It seems a person is blank if they do, and blank if they don't, and blank if they just stand there with a quizzical look on their face. I am certain that no matter what action you take, the managers will find a way to criticize you for it.

[Iseeyou_RN, RN]

If she had the strength to "stand up easily" I don't understand how they could write you up for a lift. But I'm also not familiar with 'no lift' facilities.

[Shirl57]

The 'no lift' policy means that we are not to physically lift our patients/residents. If they cannot easily transfer on their own, they are to use a stand lift or Hoyer!!!

[Miller86]

I'm sorry to hear you got written up. I don't see the issue if the person was able to stand up on their own and transfer with minimal assist. However, we have a "no lift" policy in our facility as well and we always use the Hoyer lift whenever available just to watch our own butts. They even made a mobile Hoyer lift accessible now just so that we are following the "no lift" policy. It's really a neat thing to have and it does save our backs. Just follow whatever the policy is because at the end of the day that is what they consider and get you written up for. For patients that are able to stand up and help themselves, we are not required to use the Hoyer lift. So it depends on the mobility of that patient.

[Davey Do]

Shirl57:

In our Institution, a Patient on a 1:1 status is always kept within arm's reach. One Staff member to one Patient. The Staff Member should not have to deal with any other patient except the one to who they are assigned.

In a Perfect World.

Extenuating circumstances are always a variable, as in your case. One does the best they can with what they have to work with.

If you had to provide care for another Patient, then you were unable to fulfill the duties of your assignment. The priority was the 1:1. The other Patient could have waited until: another Nurse could pull the med or another Staff Member could relieve you so you could perform the task.

Administrators must identify and resolve situations. That's what Write Ups should be all about. It shouldn't be percieved as a personal thing. It's merely a methodical approach.

To your credit, I must give you some support, in that, you dealt with the situation and prevented further injury to Staff and Clients.

However, the rules of our Institutions need to be followed. Or we have to deal with the consequences. We don't have to like it. But we have to abide by them.

Dave

[Soulwindow42]

You have just done a good job to the best of your knowledge at that time, and you have greatly avoided a possible surgical post-operative morbidity (another Fracture or prosthesis dislocation should the patient falls down). However, this patient has dementia and can't comprehend all what you will say. There is a possibility he might stand up again and take most of your time for attention. Hoyer lift is good, but I don't conform with them having u written up. What is important is nothing worrisome happen to the patient. Keep up the good work.

[CoffeeRTC, BSN, RN]

Is this LTC? There is no such thing as 1:1 in ltc unless they actually bring in a sitter or have someone delegated to this and this task alone. I don't think the "fall" or "asssist to the floor" is the issue. It was the no lift policy.

If that was the policy, then yes...you broke it and technically I guess you should have been written up..but maybe only as a counseling session.

In reality...every situation is different and all rules don't apply.

[linearthinker, DNP, RN]

I think they are just protecting themselves. If you got hurt lifting in a place w/ a no lift policy, they don't have to pay workman's comp. Forget about this incident, and in the future for your own protection, follow the rule no matter how impractical they may seem in the moment.

[tyvin, BSN, RN]

Unfortunately she was a two person assist, you should have gone by your facilities policy regarding the no lift policy IMO.

I hear you and agree with your action completely but it sounds like your place of work is not standing behind you. Did someone report you for being unsafe or what happened?

You got to know at any time you leave a one on one to attempt to do something else Murphy's Law will prevail. It sounds like your place also needs to revisit what a one on one does. How can you be watching other people when you are on a 1:1 situation? Also what is an RN doing with being assigned a 1:1?

Let us know what happens.

[Shirl57]

Just to clarify some things: When she stood from her chair, she was no more than 5 feet from me. I was the only nurse on duty and had two med aides. The MA's were busy putting people to bed and giving baths. I guess my biggest issue, was that I knew it would be unsafe trying to get her in the lift jacket, let alone raise her into the air. I truely believe she then would have had an injury for sure!

[linearthinker, DNP, RN]

You may be right, but being right isn't going to help after the fact. You have to abide by policy or be prepared to accept come what may.