What happens now? Am I in trouble?

[DayDreamin ER CRNP]

I am working as a tech (CNA) while I'm in nursing school. I'm working on a family practice floor where I do my clinicals. The other night I was at the station and a bed alarm went off in the room across the hall. I ran in there to find the patient (young male) hanging on to the side of the bed with his right hand and hanging on to the IV pole with his left. His left leg was out to his side, completely straight and he had his right knee bent. Yes, he was about to hit the floor but his butt was just barely below the level of the bed mattress. With me so far.

I ran in there and tried to brace his leg and hold him up with my arm under his right arm and I hollered "help" and hit the bed alarm again so it would go off so everyone's pager would go off and the light outside his room would blink.

Two RNs came running in and were helping me to get him back in the bed. One nurse asked, "What's his problem?" but not in a rude or hateful way. The other nurse said something I can't recall right this second but it wasn't unprofessional or inappropriate.

We got him back in his bed and settled with the bed alarm back on. Apparently, he had just taken his pain meds he'd been asking for and tried to go to the bathroom. Now, this is a pretty fit looking young guy. As I left the room he asked to speak to the charge nurse and I told her everything that happened and so did the other 2 nurses.

A few hours later I went in to do vitals and I asked him how he was, did he need anything, etc. I left with, "I'm so glad you are ok tonight. Let me know if you need anything."

Fast forward to last night. I had to call my charge nurse and she asked me about that incident again. Apparently, he is now claiming that he completely fell out of the bed, flat on his abdomen and that it took us 20 minutes to get to his room. His mom is threatening to sue, etc.

Needless to say, I am totally shocked that he has lied like this. I had this guy as my patient 2 or 3 times over the past 2 weeks and he was always so cordial and appreciative toward me it seemed. I cannot figure out why he has lied like this.

Apparently, the other two nurses got their butts chewed on their next shift and so did the charge nurse until she as able to tell her full story. I'm just wondering what is in store for me when I work again and what usually happens in these instances. I'm not scared or anything because I didn't do anything wrong but I am worried that it reflects badly on us as a floor, etc.

Anyone have any experience like this?

[Argo]

you sure you didn't go in the room as he was picking himself off the floor?

[DayDreamin ER CRNP]

I'm sure. I asked him what happened and he said he was getting up to go to the bathroom and felt himself slip.

[caliotter3]

When the time comes, just continue to tell the truth. That is all you can do. Don't know what the guy's problem is, or that of his relatives, but there seems to be a lack of money in the family. It is a common ailment.

[Lizzy88]

I don't know the answer to this, but let us know what comes out of this. Good luck.

[rn/writer, RN]

You don't mention filling out an incident report. If no one did this, learn for next time. Any time there is something out of the ordinary that has the potential for further problems, fill one out. Then your side of the story is on record.

It may not be too late to fill an IR out now, but the longer the time between the incident and the report, the more difficult it becomes to recall all the details.

Even as a CNA, you should be able to file a report, or, at the very least, have a nurse or supervisor fill one out with you.

Some people are just born trouble-makers. I hope this goes away without a lot of fuss.

[Katie5]

This doesn't seem to me like an incident for sure..but thorough documentation would be in order.

[nursesherses]

See if the nurses or anyone involved documented that the patient was not harmed. If they did this, incident report or not, it proves that there was no harm and I would not worry about the mother having any grounds for sueing. Even though you answered the call, if he claims there was a breach of duty (not answering in time or whatever), their still must be harm or their is nothing to sue over.

[shiccy]

Even if you didn't fill out an incident report, something like that should be documented by the RN or even yourself in the long notes. At least where I'm from aids are allowed to chart in long notes if they need or want to. (they are actually SUPPOSE to, but sometimes aren't able to).

You have a few things. He just got pain meds and obviously was narcotic naive. If this is the case, it messes with perception and mental time. Also, you have YOUR first hand account. Thirdly if something like this happens it's not NEGLIGENCE, it's an accident. Accidents happen. If he's a 23yo and fit then he probably wasn't deemed a fall risk for any reason other than receiving a pain med. If someone has been educated on the call light system, they know how to use it pain med or not. Also if they are receiving a med for the first time, pain med education should have been given (can't say if it was or not) to tell him to not get up unless someone is present, at least for the first time he gets up... That unfortunately is and should be a standard of care. If a bed alarm was going off, I'm assuming this DID happen and he wasn't being the most compliant patient in the world / the RN (or whoever) did the right thing and put EXTRA precautions to prevent a fall by turning on the bed alarm.

Finally there's a little thing in MY state that if no harm came to the patient, then it's not an issue other than the fact that they want to complain, wine, and moan about it. If nothing is broken, no hematoma, no tests, no pain, etc., then you're A-OK. No harm no foul. In my state you have to prove negligence (pyrulent drainage, s/s of sepsis, not alerting someone to critical vitals/labs, etc), which is EXCEPTIONALLY hard to do. This means you have to prove that not only that happened, but that the person taking care of the patient KNEW about it, and refused to do anything about it.

The only thing you can do is say, "We apologize you feel this way" and leave it at that. There's not much else you can do at this point.

[Chico David, BSN, RN]

Several thoughts:

1. ditto to the above comment on an incident report.

2. I'm a union steward at our hospital and one of the things I encourage nurses to do is to just make some quick private notes for themselves about any incident that might come up later as a problem. This seems like you may not have thought much of it at the time, but you were all obviously concerned enough to want to talk to the charge nurse about it, so even though you did not expect the patient to lie, you obviously thought it was fairly significant - that should trigger the need for documentation in your mind.

3. Isn't it amazing how quick hospital managers are to always take the word of a patient or family member about some supposed event without even taking the time to ask the nurse what happened?

[shiccy]

Several thoughts:

1. ditto to the above comment on an incident report.

2. I'm a union steward at our hospital and one of the things I encourage nurses to do is to just make some quick private notes for themselves about any incident that might come up later as a problem. This seems like you may not have thought much of it at the time, but you were all obviously concerned enough to want to talk to the charge nurse about it, so even though you did not expect the patient to lie, you obviously thought it was fairly significant - that should trigger the need for documentation in your mind.

3. Isn't it amazing how quick hospital managers are to always take the word of a patient or family member about some supposed event without even taking the time to ask the nurse what happened?

The crap thing is that she had already went to talk to the manager / supervisor that night so this shouldn't be an issue.

[HollyHobby]

I'm so sorry you're involved in a mess like this. Fortunately for you, the liability, if any, will fall on the RN. I hope she documented the heck out of the incident. I've learned over the years that in cases like this, it's best to assume the patient/family will attack like a pack of dogs. Usually they won't, but it happens.

If I'd been the RN in this case, I'd have written a lengthy note detailing the events. I'd have filed an incident report. I'd have notified the house supervisor AND left a voicemail for my manager. I'd have notified the physician about the incident because the patient's pain meds might need to be changed. I'd have put the patient on full fall precautions.

The patient may not be intentionally lying; the narcotics may have altered his perception of reality to the point where he really believes he was neglected. Then his mom comes along and believes every word he says.

Document, document, document, any time something like this happens. And document as soon as it happens; don't wait for the family to threaten you or your words will be less convincing. In most cases, this kind of event wouldn't lead to legal action, but it's best to plan for the worst.