"I'm in absolute state of panic" UPDATE

[NurseCard, ADN]

Hi folks!

This past Wednesday morning I made a post about my TOTAL state of despair after a horrendous incident at work that morning, and the fact that I wanted to quit my job, RIGHT THEN. You guys gave me LOTS of great advice regarding my post, and I really thank you all!!! :kiss

Just wanted to post an update and let you all know I am feeling a LOT better. I have decided to actually keep doing what I am doing, because overall I really do love being a nurse. I love using the knowledge that I have to help my patients, and also educate them. I love HAVING all of the knowledge that I keep accumulating every day. Also, I have learned that I really need to take steps to reduce the stress that I let myself feel OUTSIDE of work, and that means, for me, letting my husband know, loud and clear, that he needs to help out around this house. (I'm going to start making lists of errands that he can run for me, on days that I need to sleep!) Also, that means not worrying so much about things that are really kinda petty, like home repairs and such. Plus, I'm going to look into maybe doing some agency work, to make more money. That will help with our financial situation and ease THOSE worries a bit. I know, agency can be VERY stressful and agency nurses can get the crap end of the stick sometimes. But, I've learned to embrace the stress of my job, and then LEAVE it there.

Also... I wanted to share with you all exactly WHAT happened that morning to make me so upset. Some of you may read this and say "Uh yeah, you screwed up pretty bad, hope you learned from it", and some of you may say "Is that ALL??" :wink2:

Anyway... my hospital has, in the past couple of months, implemented a tighter "fall risk" protocol. In addition to putting orange bracelets on "fall risk" patients, putting up little "leaf" signs outside their doors, bed alarms for some, and checking on them regularly... we NOW have q 30 minute checks on all of them. We have a piece of paper that hangs just inside their rooms that we have to fill out every thirty minutes. Anyway, in order to be considered a definate "fall risk", the patients are supposed to meet certain criteria.

When I came on shift at 7pm, I was going to have five patients with no tech. Okay, fine. Would RATHER have a tech, but I can usually handle five with no tech, fairly well. The nurse that I was taking over for, had also not had a tech, had had admissions, and had been VERY busy. She therefore had not been able to hang signs, put bracelets on, or really fully and accurately chart Fall Risk assessments. When she gave me report she basically said "Oh ALL these people need to be fall risks!" But, in my opinion, two of them were somewhat iffy. One of them was a 35 year old who was currently getting up and down pretty well. The other one was an 81 year old who, to the best of my knowledge, had been getting up and down by herself all day, was perfectly "with it", and had not fallen any time in the recent past, if at all. HOWEVER, the woman did have a high INR. So maybe the high INR should have made her a fall risk ALONE, and I did consider that. But she was very steady on her feet, or had been. At 11pm, we actually got one tech for the floor; she was going to have 15 patients all by herself. Of my five patients I decided that three of them were definate fall risks, and the two did not need to be, including the one with high INR.

WELL..... guess who decided to get up and go to the bathroom, go wash her hands at the sink... and FALL, and hit her HEAD on the SINK. You guessed it.

The 81 year old, with the high INR. Well actually, it had been high the day before, but she had gotten FFP, and that morning it apparently was much better because the lab had not called me with a critical INR on her.

Still... I was VERY VERY upset for several reasons. 1) Even though she had been steady on her feet, I feel like I should have went ahead and made her a fall risk for the high INR ALONE. 2) I know that I didn't accurately and completely chart that the reason I didn't make her a Fall Risk was because she was steady on her feet, or even that she had BEEN steady on her feet. My charting is usually pretty good, so why in the world I dropped the ball so badly there, I really don't know. 3) Today was this WOMAN"S BIRTHDAY.

Oh, and this happened when I had a grand total of 10 minutes left in my shift.

And I DID do everything that I was supposed to do afterwards. I called the supervisor, called the family, called the doctor, assessed the lady (she appeared to have a nice bump on her head but that was it; we put ice on it), and did the appropriate charting. I really hoped that I would come back to work and find out that she ended up being fine. I did however find out that she had went to ICU, but it supposedly had nothing to do with the fall or a bleed or anything like that; someone said it was cardiac related.

So.... I guess from now on, when in doubt, make them a fall risk. But it's frustrating because MOST of our patients are fall risks, and we have to do so much extra charting and paperwork. And, I guess maybe I was trying to make things a little easier on my tech or something, since she had fifteen patients. But it isn't like I couldn't have helped her WATCH this one patient.

*sigh* This incident was just a huge wake up call. I need to work harder, accept the fact that my job is hard work and a LOT of stress, WATCH my charting more carefully... AND, take care of myself at HOME so that I can do my job more effectively.

Thanks for listening!

[stidget99]

It's a terrible thing for our pts and for us when we have a big incident like this happen. But, there are sometimes we cannot be "seers" and know what will happen and when. If we had that ability, there would never be a need for implementing protocols like falls risks.

Take this as a learning experience. Also, as you said, as a wake up call. There are changes that are needed in your life and because of this once incident, you have now become enlightened. Maybe this was supposed to happen? Esp since the pt didn't suffer any dire consequences.

Good luck to you. Please know that we are always here for each other. That's one of the reasons why this site is so important to so many of us. Thanks Brian for having this idea and putting it into action.

[talaxandra]

You poor thing - that's so distressing. I'm glad that you're feeling better about it now, and have come up with ways of reducing your stress :)

It took me a minute - Fall here is Autumn - but I really like the leaves idea!

I just have a question - if you had made her a high falls risk, how would your management of her changed? I know that you would have formally checked on her every half hour, but it doesn't sound as though she was lying on the floor for half the shift...

This absolutely isn't a criticism of you, just a concern about system changes. We've introduced new falls assessment and notification policies (orange bands etc), and I think that an increased awareness of fall potential is valuable, especially when staff unfamiliar with the patient are involved. But having to sign off a sheet every half hour sounds like admin make work to me, unless there's an aspect I'm missing (which is certainly possible).

[lady_jezebel]

What you describe is not neglect or a "grave error" at all. You have been much to hard on yourself. All patients are a potential fall risk, so sometimes we don't identify those who need special signs or conditions (ex. bed alarm). Things happen. Sometimes even when we have the signs on the door or bed alarms or whatever, people STILL fall. Even on their birthdays.

I've made much more serious mistakes than that, as have most nurses I know. We learn from them & are more aware the next time, that's all.

Anyway, it sounds like your floor is way too understaffed, which would make this a "systems error" rather than a nursing error. The best solution would be for the hospital to provide a sitter (someone to just watch the patient) as they do where I work, but it's a more expensive cost for the institution. What you describe is just another example of how hospitals often sacrifice safety to save a few bucks, thereby dumping unreasonable responsibility on the nursing staff. It's your administration that should carry the burden of guilt, not one poor overworked nurse. Seriously.

[NurseCard, ADN]

Honestly, a lot of it is myself, and the facilty, CYA'ing. "Covering our butts". The f q30 minute checks, the extra charting, the extra work... it's so that if a patient DOES fall, it at least appears as if we did EVERYTHING possible to avoid it.

I felt like I didn't really do much to avoid this one. And like I said, the woman had been steady on her feet, to the best of my knowledge. But I didn't do the greatest job of CHARTING that, and that's what made me the most upset of all.

[NurseCard, ADN]

They come down pretty hard on us when a patient falls. There have actually been some rather ridiculous measures taken at my hospital, at times. The manager of the other med/surge unit at my hospital (there are two), at one time was making the techs set bed alarms on *EVERY* patient. NO ONE was allowed to get up by themselves. I think also, that that same manager made the techs put up all four rails on everyone's beds. EVERY patient.

Later it was brought to her attention that four rails up is considered a restraint, even on patients that really NEED the four rails.

[Grace Oz]

It wouldn't matter how many checks are in place, or how thoroughly we chart, sometimes things just happen. Putting so many precautionary checks in place doesn't guarantee falls won't occur. It's a bit like carrying a hanky in our pocket, just IN CASE we might need to blow our nose!

You are human, you're a nurse. Nurses are HUMAN. Don't beat up on yourself. Take whatever lessons you need to learn from this experience, and move forward.

Best wishes to you.

[NurseyBaby'05, BSN, RN]

q30min pt checks?!?!?! That's insane. How are you able to do anything else?Im on a Neuro step-down and we get more falls than your average floor. Nobody likes to deal with them, but sometimes they cannot be prevented. We have had a huge decrease in falls and restraint use with the implementation of Fall Risk Care Plans (Every patient gets one) and widespread use of Lowboy beds. I think our falls have decreased by 2/3 or more. We also try to place the really squirrelly ones in the rooms right outside the nurses station. The other thing that has really helped is 24 hour sitters. Often these pts need to go to BR and get up w/o thinking. Their ST Memory is not intact and they forget that they're not steady on their feet until they get up. We're down to a few a falls a month & for a Neuro floor that's not too bad.It's ridiculous that you need to do fall documentation q30 min.