Missed it

  1. I missed a wrist fracture.

    Kid came in, had fallen. We iced. ROM was fine, no swelling or bruising while he was in the clinic, grip strength was good. I sent him along. Never heard anything more, but it was close to the end of the day.

    Mom comes in yesterday afternoon upset I didn't contact her. I explain that I didn't see anything to report, he had no signs of a fracture. I offered to contact her every single time he crosses my threshold. He was playing while we talked, and I still didn't see anything out of the norm. Was grasping with both hands, turning and twisting his wrists. Then, the note came this morning it was indeed a fracture.

    Part of me feels like crap; I honestly didn't see anything and would have (and have called) if I saw anything to suspect an injury. I hate that I missed it. I keep trying to think of what I didn't check that might have clued me in.

    Part of me is a little pissed; mom comes in, mad at me. But, she waited all weekend to take him in to be examined. The office is the same one I use, and is open every day with extended hours. Not to mention all the Urgent Care clinics and two ERs in the area. If she was as concerned as she claims, why wait?

    How do you handle joint injuries? What else could I assess?

    TIA virtual co-workers!
  2. Visit BluebellRN profile page

    About BluebellRN, ADN, BSN, RN

    Joined: Feb '11; Posts: 25; Likes: 41
    from US
    Specialty: 10 year(s) of experience

    33 Comments

  3. by   OldDude
    OMG! You're the worst nurse EVER!! None of us have ever missed a fracture...maybe consider drying windows at the local car wash instead. Now, back to reality. This mom is raging at you to compensate for her own lack of intervention; the same type of parent that will rage at you if they get an x-ray and there is NO fracture.

    Forget about it...so what it's a fracture. You didn't "miss" a damn thing. I tire of such sensationalism and unreal expectations.

    You've already beat yourself up about it enough so put it behind you and continue to be the competent, compassionate, nurse you are.
  4. by   BunnyBunnyBSNRN
    Bluebell,

    We all miss things. Heck sometimes we see things that aren't there and insist a kid get seen for what turns out to be nothing. You don't have x-ray vision and you didn't see anything telling you there was a problem. By the sounds of it, you did the same assessment any of us would have done.

    I give you permission to have a small pity party as long as you promise to leave said party and go back to being the best school nurse you know how to be.

    Oh, and by the way, by the sound of it, if you did call mom and told her what happened and what the assessment findings were, she wouldn't have taken kiddlette in to the doctor's until Monday anyway.

    {{hugs}}

    Bunny
  5. by   jlrm50
    You did the assessment that any of us would have done. We do not have x-ray vision (but that would be cool). Even the mom didn't take the child to be seen right away. Don't beat yourself up. From here on out, I would contact her with any visits.
  6. by   Cas1in72
    Dont beat yourself up on this one. I would have handled it exactly the same way. Chances are Mom is unleashing on you because deep down she feels bad for not taking the kid in for days and needs to find someone to "blame" In reality, no one is to blame. It happens!
    If I had one superpower( as a school nurse) it would be x-ray vision- would make my work life so much easier. Ive even said that jokingly to a few parents.
    Take it easy on yourself. This is a much harder job than anyone outside of the field could ever imagine!!!!
  7. by   Wuzzie
  8. by   jhunting
    I worry about this all the time, and in this case, I wouldn't have done anything different! When you talked to the mother the first time, did you review any signs/symptoms to look out for? I always do this to cover my butt a little... Something along the lines of "based on what I see right here and now, I would not worry, however if Johnny starts to exhibit symptom A, B, C, etc... that would be cause for concern and further evaluation by their PCP/Urgent Care". I think this makes the parents aware that you know what you're talking about and then puts the responsibility on them to continue to monitor, makes it up to their judgement. They probably still will be mad, but they'll have less ammo to throw back at you since you adequately prepared them. And I ALWAYS document that I had that discussion with them.
  9. by   Farawyn
    Quote from OldDude
    OMG! You're the worst nurse EVER!! None of us have ever missed a fracture...maybe consider drying windows at the local car wash instead. Now, back to reality. This mom is raging at you to compensate for her own lack of intervention; the same type of parent that will rage at you if they get an x-ray and there is NO fracture.

    Forget about it...so what it's a fracture. You didn't "miss" a damn thing. I tire of such sensationalism and unreal expectations.

    You've already beat yourself up about it enough so put it behind you and continue to be the competent, compassionate, nurse you are.
    This is why I love you.
  10. by   Amethya
    We all miss things. You did an amazing job!

    I had a fracture lately, but I caught it because it actually looked swollen. Yours was invisible, so don't beat yourself up!
  11. by   NutmeggeRN
    Meh, not the first and probably not the last!!!

    It will all be ok!
  12. by   kidzcare
    I once sent a kid (FF BTW) back out to Field Day with a hairline fracture to his lower leg (he asked to return and per my assessment there was no obvious injury). He was seen bouncing in the bouncy castle and jump roping before and after he was in my office.

    His mom was not upset at all, she knew he often exaggerated and only took him to be seen when he complained of increasing pain. I did scour my charting to be sure I had everything documented but sh*t happens!
  13. by   MrNurse(x2)
    My wife drove my 11 year old 4 hours before being seen for his wrist that "hurt a little", sure enough broken. Same kid degloved his shin this weekend, and guess what? "It hurts a little". That pain reflex that protects us from further injury isn't that strong in everyone. Sorry you are dealing with the increasingly common irresponsible sorts that have to deflect their guilt on others. Move on, it will probably happen again if you do this for any length of time.
  14. by   kidzcare
    Also, every single medical professional (me, EMTs, ER doctors) who saw my daughter's displaced broken arm thought is was a dislocated shoulder because the deformity was up so high (just missed her growth plate). The xray proved us all wrong. You can see the xray (and all the support I got!) in this thread: My daughter's arm...

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