NYCHikerRN

This is what happened: The patient again made an effort to get up. I told him to stay in bed and that he is at a high risk for falling due to his condition and the medications he recently took. He ignored me, got up aggressively, and marched from the hospital bed beside the window toward the door. Before he could get to the door, I blocked him with my body and he shoved me aside and continued walking. I yelled out for the nurse who was sitting at the mobile computer station a couple of doors away (not following him any longer). He went forward a few steps and ended up on his hands and knees by the doorway. If I did something wrong by doing this, then I don't know what to tell you. I was NOT going to keep pursuing him until he flat-out punched me in the face (which is something I was fearing he would do at any time, given his violent social history).

I agree with you. It was the primary RN's responsibility to maintain the safety of the patient, and she failed to do so by 1. delegate 1:1 duties to a volunteer (regardless of my status as an RN - she did not know this upon assigning the patient to me), and 2. not contacting the physician to modify the plan of care. Surely there must be some protocols in place to deal with such patients. Restraints, while they are made out to be the devil himself when you're studying for the NCLEX, definitely are necessary in many situations where less invasive interventions fail to work (and believe me, I tried every method of distraction I could come up with). Perhaps the patient's nurse didn't want to have to deal with the extra work associated with maintaining a restraint, such as extra paperwork and assessments. In retrospect, in makes me so angry...

From my understanding, you ARE responsible for persons under the good samaritan law if you decide to initiate the patient-nurse relationship. I.e.; if you actively stop and help, you are right there responsible for the care of that individual until emergency services arrive to take over the situation. However, if you do NOT engage the person, you are not responsible as an RN, even if you have your scrubs and ID badge on you.

I never left him alone. He shoved me and marched forward as I was calling out for help in the hallway. I didn't explicitly leave him. He was steps away from me. I was overpowered...

Dudette, I don't recall them explicitly mentioning that volunteers are not to do 1-to-1's. Of course, warned us that even if we are SN's, GN's, or RN's, we are NOT allowed to practice any sort of invasive procedures or administer medications under volunteer duties. This was common sense to me. However, given how commonplace 1-to-1 volunteers are, I figured nobody really cared. And it's true, nobody really does care. It is just brought up as a technicality when something wrong happens. The RN responsible for the patient only then is reminded and possibly admonished. ChristineN, Thank you for the reassurance. I will definitely speak to somebody about it in the volunteer office. However, truth be told, I DO like doing 1-to-1's, as they are excellent learning opportunities for my future practice. It's just that I'm kicking myself in the butt because I should have known better, and I feel so much more mortal and at risk for termination, had this happened under my own care (for instance, if I didn't know how to deal with my ETOH patient). However, if I was in charge of care, I would definitely have sought out the physician and explained to him that the tranquilizers aren't effective, in hopes of modifying the plan of care. I just feel very vulnerable is what I'm saying. I really don't want to lose my license, ever. Gah...

Hello everyone, I'm a brand new RN. , just passed my NCLEX last week. :) I have been volunteering at my local hospital as a "patient care companion" since February of this year, just to get that extra experience outside of my clinical curriculum and to increase my marketability as a new grad RN coming on to the workforce. As a companion, I often do 1-to-1's with acutely confused patients who are major fall risks (although, RN's are NOT supposed to assign volunteers to do 1-to-1... however, this occurs very regularly). Today, I had a patient unlike any that I had to deal with as both a volunteer or as a student nurse. The patient was a middle-aged alcoholic who was admitted in DT's. He was completely delirious, and only oriented to himself. Alcoholics, as many of you know, get very aggressive and agitated in withdrawal. I was assigned to him as a 1-to-1. All through the day, this highly tolerant gentleman kept trying to get up despite respectable doses of librium and PRN ativan. I haven't been volunteering for a few weeks, so I felt a little timid today, especially with such a patient. The patient kept getting up, and instead of using an effective amount of force to hold him down and keep him in bed, I was simply following him and redirecting him, asking him to please get back into bed. His gait was extremely unsteady, and in multiple instances I had to prop him back up into alignment so he wouldnt drop down. In this middle of this day, He aggressively got up and said he had to go somewhere, in his hallucinatory state. I tried redirecting him, but he shoved me aside and marched forward. I was asking the nurse for help as he walked forward. Next thing you know, he was on his hands and knees on the floor. An incident report was filed. I felt like I should have known better, as a new graduate RN whose sole purpose in life should be the safety of the patient, no matter how many times they tell you to go ".... yourself". It made me question myself and my abilities. I knew what I should have done differently (be more aggressive in demanding he stay in bed), but at the same time I couldn't help but feel that the responsible nurse should have followed a hospital algorithm and put this extremely volatile patient on, at least, 2-point restraints or heavier chemical sedation. Eventually, a high-level nurse came to interview the responsible RN on the details of the incident. I overheard her say something about "penalizing" someone. I'm not sure if she was referring to me, but I feel like she was (the RN downplayed it and said I wouldn't get in trouble). My stomach churned. At this moment, I felt like these 110 hours of volunteering would go down the drain as I would get terminated. In addition, I felt incompetent and felt like my job or license would be so vulnerable to termination if this had happened to me as a new hire RN. So what do you guys think? Am I justified in feeling the way I do? Does this happen all the time and is it "no big deal" for the sake of your job security (so long as it doesnt happen in a consitent pattern)? I know falls are HUUUUGE things for hospitals, and they can get in trouble and lose JCAHO money and general prestige. It's really eating me up inside... Please share your thoughts and advice. Thank you.

Edmia, My *ultimate* goal is to get masters and specialize. Perhaps even anaesthesist but we'll see where that goes. First, after obtaining a BSN, I want to work hospital bedsides for at least a few years. That's the plan anyway. MD is a nice thought (I was extraordinarily fascinated with physiology and biochemical processes in the various systems of the body in a/p) but it's ridiculously competitive. Everyone and their mother is a pre-med apparently. My mistake was that I didn't have a goal in mind in high school, and slacked in my first year of college. After I got my stuff together, I got A's in both semesters of inorganic chemistry and both semesters of general biology. I probably could have gotten accepted to a New York-area med school if I was focused from the beginning though. But don't get me wrong, I didn't "settle" with nursing at all. Nursing was my initial goal entering college, and I would feel much more comfortable with the responsibilities of a nurse. I feel like specializing would be a great niche for me though, as it combines nursing and all the other stuff I'd be interested in learning.

Excellent posts, thanks everyone! As for the "dire need" comment, I do realize that Nursing field was not immune to the tanked economy. But I still believe, and I think many can attest, that in relation to many other fields Nursing is still an easier field to find employment in. There is still a national shortage, but largely depends on geographical location within the US. In New York City, there's no shortage because we have closed a few hospitals in the past decade while the amount of new nurses being pumped out of our schools remained the same, or even grew with increasing demand to enter the field. Simultaneously, as others have mentioned, veteran nurses on the brink of retirement have to hold off on that because their 401k's went down the drain. It's a pretty horrible combination, and I seriously hope I'm not forced to move outside of the city for employment. Many new nurses who are having trouble finding jobs at hospitals often have to settle with physician's offices and nursing homes, until they can find an opportunity to work in a hospital. It definitely sucks. My school offers some internships/externships at several highly respected hospitals around the city, so I'll definitely try to get at least one of those as it would give me a great edge. Getting those depends highly upon GPA so I'm ready to work hard for it.

It won't change my goals is all. I'm just curious why the lot of you feel the way you do.

...wow @ all the negativity in this thread. Those of you who would dissuade anyone from entering nursing, would you please explain your personal reasons for doing so? At this point it does NOT matter to me. Upon entering college, I wasn't sure why I wanted to do nursing exactly and I pretty much got 2 C's in the psychology pre-requisite courses, and completely FAILED anatomy/physiology 1. I kind of got my stuff together and started over, re-took the class, and pumped out almost all A's and a few B+'s to obtain an associates degree in Biology. I transferred to a respected 4-year school and continued my hard work; I was one of 14 people (out of a lecture hall of a total of 440) to recieve an A in anatomy/physiology 2. Same story with Orgo and Microbiology. I also scored high above the 99th percentile in the nursing school entrance exam through rigorous study. I have worked SO hard to get accepted into this program (one of the most respected in the country), and nothing brought happiness to me more than seeing that acceptance email for the first time. It's truly a dream come true, and I'm not willing to let anything stand in my way from making nursing my life-long career.

Lovely_RN, I agree. She also tried to scare me with the NCLEX, claiming she failed it three times, and knew somebody who was in the top third of his class in a good program who failed it six times then gave up...

So I went to my GP's private clinic today to get blood work, a PPD round, and antibody titers done for nursing school which I'll be starting this coming Fall. Upon meeting with his nurse, I told her I needed all of this done for nursing school. She blankly stared at me for a good three seconds and then asked: "Why in the world are you going to nursing school?". I wasn't sure what she meant by that, so I asked her to clarify. She said "Well, you're a young guy with flawless English skills. What the heck are you getting yourself in to?" (This Nurse is a Russian immigrant, whose English skills are not perfect. I'm Russian too, but came here at a very young age unlike her. I guess a lot of Nurses in New York City are immigrants that lack great language skills so they choose nursing as a "last resort" profession apparently?). She went on to explain to me how nobody is hiring right now, and that hospitals are closing. She assumed I was going for an Associates degree, but the program I'm entering is for the BSN. I told her this, and then she questioned why I didn't go for PA or PT instead. I told her Nursing is what I truly wanted to do, and she smirked and said "Okay, you don't understand the situation yet. You'll see." Not that I was discouraged by this, but I found it interesting how bitter some people can be against their own profession. Especially a nurse, who knows that there is a dire need for people to enter the profession, especially as many baby-boomer nurses are going to retire in the coming years. Have you ever had people try to discourage you when you told them you were going into nursing? And do you regret not taking their advice? I think I know what I'm getting myself into (hopefully), and I'm mentally prepared. I just hope that at some point in the future I won't end up hating my job like she does...

You had a physical done by the school? We don't have that option. I'm gonna go to my GP.

Thank you for your answer KelRN215, you have allayed my fears. I'm still at a loss to see why they would need (or request, rather) information on a history of things that will have absolutely no bearing on your ability to perform your duties. Seems suspicious, that's why I feared it would be a disqualifying factor...

Thanks for all the info guys. I think my school actually requires you sign a waiver to release your health info... or am I wrong? This is on the health form: " Present this document to your professor indicating that you have been cleared for Clinical placement: I _________ undеrstand thе agеncy to which I am assigned may requirе more hеalth data than listed abovе.I hеreby authorize the nursing school to rеlease my hеalth clеarance information and all associatеd documеnts, including laboratory rеports and immunization waivеrs, to any health care providеr, which may require it in connection with my participation in a clinical course. I also understand that it is my responsibility to update my H&P and PPD required by either the Undergraduate or Graduate Programs." Additionally: "Establishmеnt of a hеalth rеcord on all studеnts еntering thе nursing program is required. The purposе of this health requiremеnt and clinical practice clearancе is to protеct studеnts as wеll as the cliеnts with whom they will be working. It is also important to dеtermine that thе studеnt is able to fulfill the objectivеs of the еducational programs." There is a section that a student must fill out regarding past/present conditions.. and theres a section the doc fills out that includes a short statement of past medical history. Will I really be able to withhold the information? What do you guys think? Is this standard?