Patient “fall”? No neuro checks?

[thenursebabe25]

So I worked at a LTC facility (memory care unit) for the first time with one of my agencies. I had a patient complaining of pain to her side. After assessing patient, my CNA let me know that her son told staff that she had a fall a day or two ago which was not reported to me during shift change. Patient didn't remember if she fell or not. I didn't think much of it, and figured she was experiencing some soreness from the fall. She had no other complaints and refuse pain meds. I also did not think to check if neuro checks were done.... Shame on me, I know. I passed along the info of the alleged fall to day shift, and the day shift nurse then said she would start the patient on neuro checks. I don't know why I didn't think to start them myself.  God forbid if the patient was to sustain a serious injury from the fall, could I face any repercussions for not initiating neuro checks? Im sure it would fall more so on the shift in which she allegedly fell, but still. So tired of working in a field where I'm constantly paranoid about losing my license or worse. I try to give the absolute best care to my patients, but I'm still learning and don't always remember every single thing. 

[DavidFR, BSN, MSN, RN]

The staff on duty at the time of the fall should have done neuro obs, filled in the appropriate paperwork and informed the appropriate people.

You inherited a two day old problem. The likelihood of there being any potential neurological degeneration that hadn't already manifested itself is extremely minimal. You had the good sense to pass on the info you discovered to the oncoming day nurse who I'm assuming has easier access to doctors and admin staff than you do at night - two days later when the patient had evidently been neurologically alright, this wasn't an acute emergency that you had to go all out for. Neuro obs might have been a good idea and next time I'm sure you'll do them  - but I don't think it was a major oversight. Don't beat yourself up.

If you lack confidence and /or experience is it an ideal situation for you to be doing agency? Would you not be better in a fixed post where you'd have an orientation period and over time come to master your speciality? Agency is brutally demanding in that you're constantly adapting to different environments and specialities. There is no way you can be as performant as a permanent nurse who knows the unit well and works there all the time.

[Been there,done that, ASN, RN]

Could not agree with DavidFR more. It was not your responsibility to institute neuro checks for an incident 2 days prior. LTC is a difficult role for a newer nurse, especially in an agency role. 

[BeatsPerMinute, BSN, RN]

Agree with the the replies above. 

[thenursebabe25]

DavidFR said:

The staff on duty at the time of the fall should have done neuro obs, filled in the appropriate paperwork and informed the appropriate people.

You inherited a two day old problem. The likelihood of there being any potential neurological degeneration that hadn't already manifested itself is extremely minimal. You had the good sense to pass on the info you discovered to the oncoming day nurse who I'm assuming has easier access to doctors and admin staff than you do at night - two days later when the patient had evidently been neurologically alright, this wasn't an acute emergency that you had to go all out for. Neuro obs might have been a good idea and next time I'm sure you'll do them  - but I don't think it was a major oversight. Don't beat yourself up.

If you lack confidence and /or experience is it an ideal situation for you to be doing agency? Would you not be better in a fixed post where you'd have an orientation period and over time come to master your speciality? Agency is brutally demanding in that you're constantly adapting to different environments and specialities. There is no way you can be as performant as a permanent nurse who knows the unit well and works there all the time.

Hi, I really appreciate your feedback! All very true. As far as agency; I've been a nurse for 2 years now and in healthcare for about 5. I would say my lack of confidence at times comes from paranoia with everything going on in healthcare on the legal side. Hearing about all the cases that end up being blamed on nurses really gets in my head. My background in healthcare and foundation in nursing was in ALF (assisted living) which is super low acuity, so everything I know really came from on the job experiences at other places. We all know nursing school doesn't really prepare you for the real world. So sometimes, I feel like I just don't know enough in certain situations. Again, thank you!