Incident Reports and Staff

[drknyko]

Hi guys, a newbie to RN World! Just graduated and making the world a little bit better one at a time! Anyway, caught in a bit of conundrum, I hope you guys can help. Here's the story:

I work nights at my hospital and yesterday morning a patient supposedly fell to the floor. Now the nurse, which is an LPN (very important part), asked me to help the patient get back to the bed, so of course i said yes. I went into the room, asked the LPN if he fell or not and he mumbled something and we went on to put the patient back to the bed. I told him you should tell the Charge and write an incident report. Then I went on my merry way to MY 6 patients. Then, working tonight, the charge confronts me, asking me if i knew about a patient who fell and I said yes. She proceeded to ask me if I had done anything else than help the LPN, and I said no. So, for 15 minutes I am being scolded for not making sure the LPN told her and for not making an incident report. She is making an incident report NOW including my name.

Now, when she scolded me, my mind was getting pain meds for a patient, but then when I had time to reflect on it, she basically was telling me that since I am an RN, I should have been on top of the situation just because he is an LPN. She was asking me if anything was done, vital signs, paging the MD, and I am wide-eyed. I do not remember reading as one of my responsibilities as an RN to babysit an LPN. It's not like he is new, he has been working for a few years now and I just got off orientation a month ago. I'm not syaing he's a bad nurse either; he's helped me a couple times.

So, we probably would have to speak to the RN manager tomorrow, what should I do? Say? Am I liable for anything that happened to the patient? Any advice? Thanks!

[litbitblack, ASN, RN]

ok so what happened?

[diane227, LPN, RN]

Do not think of an "incident report" getting someone into trouble. The report is used to keep track of incidents that occur to see if there is a trend or to document problems that may need corrective action. I document anything that is outside normal working conditions/ procedures for the floor. (falls, medication errors, physician errors, incorrect transcription of orders, failure to give medications as ordered, injuries to visitors, deviations from the standard of care). This way, my manager can know what problem areas we need to focus on. For example, we were having lots of falls. This became known to her due to the number of reports that she received. We made a corrective plan of action for the entire floor to follow and now our falls are down to nothing.

People cannot make corrections in defective systems unless they know about it. Another example. When we have patients that are on swallow precautions I insist that they have suction set up in the room. There were not enough suction devices in the hospital to maintain that standard. My documentation of each time this occurred resulted in the hospital purchase of these necessary suction devices. I spend a lot of my time documenting problems, but if I want corrections made, I have to be part of the solution.

[drknyko]

I spoke to the LPN and he said because his other pt was in a risk of having a HTN Urgency, and numerous other bad things happening at the same time with his pts, he forgot to make/tell the charge. Well, anyway, they reprimanded both of us and I was being assertive that his actions were not MY responsibility. But, they sidewined it in a way that I maybe PARTLY responsible since my license says RN. What should I do now? Should I call my lawyer about this?

[Iheartadvice]

I'm really surprised you got reprimanded. The LPN should be held accountable for not reporting that... it appears to me that they conveniently forgot... which has actually happened to me too, but I mentioned it to the charge RN. We've had so many falls in the last few months, and I've filled out an incident report on any that I found or was in charge of... I had a day nurse actually leave a fall on her shift and say she was going to fill out an incident report, but then asked me to notify the md, which is required at my work... I realized that nothing was ever documented, and since I had notified the doctor, I felt like I was involved enough to fill out the incident report. From what was explained to me, the incident report is where to list details that you could forget later on in case it becomes a legal situation or if there was an injury. I write as much as I can and list everyone who witnessed. I feel like the few times I've gone to my manager to explain situations/patient safety issues/falls due to understaffing, instead of directly filling out the incident report or sending an email, the tables get turned on me wishing later I would've said because I get emotional. Its patient safety, its a basic in nursing, and when a patient's safety is compromised, its really hard for me to get emotions involved. Also, its the best form of documentation for your records too.

I'm really not clear on patient safety issues beyond falls... There are unsafe nurses I've wanted to report. I just don't want to have a conflict with my coworkers I'm working 24 - 36 hours a week with. I am emotional and work with a lot of very unprofessional experienced nurses. My supervisor immediately suggests a sit down with the three of us to work it out... last thing I'd ever want on weekend nights with the same 3-4 nurses... I could never thrive in an environment that had compromised their trust in me... we are all we have. Then it always is gossip, I'm not sure how word spreads so fast, but it always does if a situation is addressed by our manager on the floor for a good week following the incident... I really am starting to hate floor gossip more than anything else. And then even if something happened that was worth reporting, the last thing I need is an enemy with my few coworkers I see every shift...

Please, can anyone say the best way to handle reporting unsafe nursing/incidents without becoming floor gossip or making enemies? Its been my biggest struggle... As far as an unsafe nurse, and I see/hear about a lot of them unfortunately, and I feel as though I'm always walking on shift to patients who have half of their orders done from 3 weeks ago or info lost in reports... I spend half of my night going through orders to make sure I won't be accountable for things undone. How is this fair? How can I fix it without tattling, as it feels like I am when I go to my manager? Its been eating at me.

[litbitblack, ASN, RN]

You can't fix it without someone else knowing about it and the other staff being held accountable. Don't think of it as tattling, think of it as making the best environment for your present and future patients

[2BSure]

I spoke to the LPN and he said because his other pt was in a risk of having a HTN Urgency, and numerous other bad things happening at the same time with his pts, he forgot to make/tell the charge. Well, anyway, they reprimanded both of us and I was being assertive that his actions were not MY responsibility. But, they sidewined it in a way that I maybe PARTLY responsible since my license says RN. What should I do now? Should I call my lawyer about this?

Steady on! First you sound quite upset and I understand that. This stuff can be very distressing. Make sure they are clear about what they think you are responsible for. The fall? Clearly not. The documentation? Clearly not (as you were not a witness nor were you the first to come upon the patient). Essentially they are saying that you, the RN, were responsible for ensuring that he, the LPN, did an incident report. Hmmmm. Perhaps, RNs, in the most general way are all responsible for ensuring that incidents reporting is done -- but in a collaborative way. OK so LPN is a lesser license that RN (sorry I know no politically correct way to put that and I mean no disrespect to LPNs) -- but if the guy was not a direct report I see no issue. Did they ask you for your report in writing? Were you reprimanded in writing? If so you can simply make a calm appeal in writing.

Sadly, no facility goes without patients falling. Because you are newly minted as an RN try to use this experience to reflect calmly on wether you would have done something different. I you do this and decide you acted to the best of your ability...take a deep breathe and get specifics from your employer as to exactly what they wanted you to do. I don't mean aggressively or plaintively -- just remind them you are a new RN and you want a long and successful career with them and you see this as an opportunity to learn. I know this sounds a bit like fluff but you want to come out of this still looking like a pro...which you are.

I cannot see why you would want a lawyer unless I misread something.

[Luv Nursing]

I'm dying to know how things turned out. As a Nurse Manager, my first thing would be to remind everyone "involved" that incident reports are not punitive, but a way to evaluate for possibly a system proccess flaw. (Of course, if you have one person repeating the same thing over and over and over...then you have an individual issue, still not punitive.)

I also agree with the others. If you came to me with the facts as noted above...I would in no way have any issue with your actions. It sounds as you did exactly what you should have.

If you don't mind, will you let us know how you made out? I hope well.

[sasha2lady]

I just had a similar thing happen to me....Im an LPN and so are the other 2 nurses I work with....well....I was in the med room faxing some med orders to the pharmacy and when I came out I saw 2aides taking off to the other nurses hall....I go around the corner to see what it was...and a pt had slid out of his w/c....on the floor...I helped the 2 aides get him up and to my knowledge...that nurse did not fill out an incident report..she didnt assess him...she did nothing....it wasnt my pt....So far no one has said anything to me about it....but if they do...Im prepared. I have 30 residents of my own to tend to...I cant do another nurses 20 something pts too. She knew to do that report....shes been a nurse longer than Ive been alive.

[diane227, LPN, RN]

It is the responsibility of everyone, cna, nurse, etc to document events that occur. Anyone can fill out a report. Even if you do not know how to fill out the actual form, use a blank piece of paper. The important thing is to get the event on paper and reported to the manager.