Safety issue: 2 high risk pt's: one fell during shift

[LonghornChic, BSN]

I am currently a nursing student working as a CNA in an internal multi-hospital float agency. Occasionally, I am assigned to be a patient sitter rather than a CNA. I am always assigned 1 patient to sit for. Never 2. Furthermore, when I signed on to this job 6 month ago I was never informed (both verbally or in written fashion) that I could be given 2 patients as a sitter.

A couple of weeks ago I was assigned 2 patients with rooms side by side. One of the patients was impulsive (had a TBI) and had a tendency to want to get out of bed. He had a C-collar due to extensive neck surgery, was at times experiencing altered mental status, had some limb weakness that was being addressed by PT, was supposed to be NPO (the glasses of cold water I found in the room indicated otherwise) and was very adamantly demanding we give him something to eat/drink. The second patient had brain surgery a couple of weeks back, was not oriented to person/place/time, was having visual hallucinations most of the time and also had a tendency to get out of bed. Both of these patients have had a history of aggression per report. In all honesty, they each needed their own sitter and not have to share a sitter.

After verifying the orders on the computer (there were 1:1 orders for both patients), I confirmed with the charge nurse that she approved this arrangement, called my float agency to verify that this could be done, and mentioned to the assigned nurses that it was going to be difficult to try and keep both patients safe at the same time given the circumstances. They were under the impression that each patient had their own sitter, not a shared sitter, and told me to just ask for help if needed. I relieved the 2 night sitters for both patients. I am assuming that staff shortage could not allow for 2 day sitters, only one.

Later that morning, one of the patients was agitated and out of bed. At the same time, the other patient had also quickly jump out of bed. I called out for help and one of the nurses came. I redirected one patient back to bed while the nurse attempted to take the other patient back to bed (the patient had made it clear across the room by the time the nurse arrived). At some point and out of my visual field, the other patient the nurse was helping fell to the floor. I heard the fall to the floor and I called for more help while still putting the other patient back in bed. Help arrived.

I could tell that the charge nurse was agitated that the patient fell and asked me "what happened?" I told her exactly what happened and she proceeded to tell me that I would be assigned to only one patient. They put the patient who fell in a safety net enclosure.

4 hours later (only 6 hours into my 12 hour shift) another sitter comes to "relieve" me form my duties. I was confused and assumed that this had something to do with the earlier incident so I obliged. Before leaving, I asked the charge nurse why I was dismissed. She stated that I was done, my services were no longer needed and I could head home. She was curt with her response to my question. Upon leaving, I made sure to email my supervisor about what happened.

Fast forward to the following week and I now see that schedule shows that I "Left without permission" on that day. This reflects negatively on my record and affects my year end review. I have sent several follow up emails to my agency with no response. I've also left about 2 voice mails. I am thinking that my next step in this is to just show up.

Yesterday, I called to get my assignment and was again given 2 patients. After what happened and still no response, I refused to take the assignment and the agency reluctantly gave me one patient but said that I was going to be reported to my supervisor. They also said that this is going to be the norm because the main hospitals are now doubling up on all their sitters. Patient safety is not something I am willing to compromise, am at the end of my rope with these people and considering quitting. I like what I do but this is too much. Also, how would you as an RN handle a situation like this (you have a 1:1 order but instead got a sitter for 2).

[CalArmy]

That is awful!! The whole point of being a sitter is that you are watching them because they are impulsive or unsafe. How can you do that with rooms side by side?? I'm sorry you are getting blamed for something that sounds like you had no control over.

[oceanblue52]

Wow. I'm sorry this happened to you. Can you find a different job? They are allowing very unsafe practices. Totally unacceptable to put you in that position; the Charge RN should have pulled another staff member off the floor and used good teamwork to cover for the higher ratio. At least, that's how I've always seen it done.

Hard to say what I would do as an R.N. since I'm a new grad. If I was dealing with that particular Charge R.N. I probably would have called the House Supervisor doing scheduling to see about calling someone in or tried to work with my colleagues to redistribute the load so one of us could watch the second patient (if no aides were available). Clearly staffing was already tight though since this place was using agency nurses. Ideally, if an extra aide is available, best option is to pull them off the floor and have the nurses do total cares. VERY un ideal situation but sometimes it's possible with good staff. Barring that I'd document like crazy, submit and incident report, and speak with the manager ASAP.

Please keep us posted on your decision, and don't feel bad if you decide to quit. Any hiring manager that's worth working for would understand that situation, as long as you can explain it tactfully in an interview.

[xoemmylouox, ASN, RN]

Well that is a new one for me. I don't get it, but you know hospitals will come up with new means to scrape every penny of profit out.

[BuckyBadgerRN, ASN, RN]

1:1 means just that. If each pt had orders for that, then that is what they needed to be provided. Maybe I read the post wrong, but I got the impression that pt 2 fell WHILE the nurse was with him?

[Here.I.Stand, BSN, RN]

If "the house" can't give us another CNA for 1:1, our charge nurses pulls our floor CNA to do it. 1:1 does not mean in CNA in one room with another pt unattended. This is not anywhere near your fault.

[ontnursec]

I was put in this situation as a health care assistant while in school. Both patients got out of bed at the same time. It was stressful. Neither fell luckily but it was not a situation I'd want to repeat. No advice but good luck sorting this out with the agency

[LonghornChic, BSN]

1:1 means just that. If each pt had orders for that, then that is what they needed to be provided. Maybe I read the post wrong, but I got the impression that pt 2 fell WHILE the nurse was with him?

Yes, the nurse was already in the room with them but the patient had already made it to the door by the time she got there. I think that this could have been prevented if there was someone there with them to redirect as soon as they made an attempt to get up.

[LonghornChic, BSN]

Update: I ended up resigning because the agency 1.) refused to remove the absence from my record even if I wasn't at fault and 2.) informed me that I would be required to sit for 2 patients due to staff shortage whether I liked it or not.

I really got the feeling that the profit margin was the priority here and not so much patient safety.

[crazin01]

sorry you had such an atrocious series of issues with management in regards to this issue. Sounds like you're better off leaving them in your dust, but I'd be fuming if in your position. And patient safety is most definitely not the priority in this instance. Seems more places are going this way, the almighty buck is the bottom line.

Sorry again, but kudos to you for standing up for your principles & placing your patients' safety as #1.