baby.nurse123

I am a new RN, still within my first year of practice. The other day, one of my patients had a fall and this is the first patient fall I've had to deal with. We set the patient up in a chair with his table over the chair, call button/personal items in reach, nonskid socks on etc.... One of the therapists working with the patient earlier offered to move his chair closer to the doorway so he could be seen by staff passing by, but I told her he would be okay, he was watching tv at the time and had been using the call button all day if we weren't in his room at that moment. Then I had about a thousand things going on with my other patients at the same time. When the aide came to round on him 20 minutes later, she found him in the bathroom sitting on the floor. I assessed him--the vitals were fine, he hadn't hit is head, orientation was at his baseline, and had only a small bruise on his knee with no pain. We assisted him back to his chair and moved him to the closest room to the nurses station that was available. We did apply a bed alarm, though my experience has been that you can't always rely on it (because sometimes it doesn't always go off or the patient just moves so fast). I notified the doctor, did my documentation to address all the formalities that come with it. I just feel so bad about this and honestly very stupid :smackingf because thinking back on it, I know this probably could have been prevented if I had just let her move his chair closer to the doorway. And maybe this sounds silly, but can I get fired for stuff like this? I'm so afraid to lose my job and/or license because this was such a huge lapse in my judgement and totally my fault...

The MD does discuss the plan with the patient and help set the limits, but what I find is that the patients behave differently with different members of the healthcare team. Like when they are talking to the doctor, they act like they're on board with the plan. With the RN (the person who controls the administration of the med), the patient acts out and tries to manipulate enforcement of the plan.

thanks for all the responses! I think I've discovered my petpeeve in nursing and I've always been irritated with these kinds of behaviors in general. Recently, I was glad to learn a few things being done about this at my hospital: - The ER, specialty clinics, and hospitalists will not be prescribing narcs for long term pain management. They may prescribe for a set amount of time post-op (like if it's a major ortho case or something), but otherwise this will be done almost exclusively by the PCP now - the hospital has recently started offering conferences for long term pain management for the doctors - the patients who were violent toward staff despite the multi-disciplinary team meetings with the patient, etc actually will not be admitted to our hospital anymore...but I do wonder how they will be at the hospital in the next town 20 minutes away? I hate to pass along the problem for someone else to deal with. I wish there was more community support for this issue so that these patients can be better managed outside the hospital.

I am a new nurse with only about 6 months of acute care nursing experience. I am learning a lot every day, but the one thing that I am struggling with is dealing with manipulative patients. I love my job and what I do, but the one thing that really gets me worked up is a manipulative patient (particularly the ones with drug seeking behaviors). I work in a tiny hospital in a small town, so we see our share of very familiar frequent flyers.... I swear some of these patients must literally sit in their rooms and watch the clock count down until EXACTLY the earliest second they can get their next dose. They like to test the waters at the beginning of each shift with their oncoming nurse to see what they can get (i.e. getting their dose earlier when they KNOW it is waaay to early). Then, when I tell them it's not time yet and offer some form of non-pharmacological intervention, they claim to "know how the system works" because they've been here so often and then eventually agree to wait for the next available dose. I've had those patients who request that I just push the med fast, which I have not and will not do (I will only push it over the recommended rate). I've even had patients tell me to medicate them even while they're asleep, to which I have replied that I can't medicate them until I've assessed their pain, and I can't assess their pain if they're sleeping...therefore I will not be medicating them while they're asleep (plus I would NEVER want to be put in a situation where a patient is medicated unbeknownst to them and then they try to claim that they never got the dose). I've seen patients who are extremely resistant to limit setting (and the nurses on my unit are very good about clearly communicating the medication plan to the next shift), and if they don't get just their way, they refuse the nurse's care and demand a new nurse. I even saw patients get violent on multiple occasions (throwing items around the room) and making threats to staff because the medication administration orders/schedule was not to their liking. Now I know there are many many medical conditions out there that cause a lot of physical pain, and I'm not in the patient's shoes experiencing it....but I'm in need of advice on how to deal with these kinds of patients. and I know it's only a matter of time before I see them again in very similar circumstances...