What are my rights..

Nurse Ratched, RN · Jul 6, 2005

First, you need to fill out an incident report for employee health (whomever carries your worker's comp) in case this turns into something.

Second, you shouldn't refuse a pt because he/she is difficult to move - you just get more help when the time comes to move them. Knowing now that this person is max assist, the pt will just have to live with you getting more help (I understand that other staff may feel comfortable moving you independently, but I am not, so for your safety, I am getting some standby help."

Final suggestion: if you are partway through a lift and there are problems, and you can safely return the pt to his starting position until you can get more help, do so.

unknown99, BSN, RN · Jul 6, 2005

Yes, you can refuse. If therapy are the ones getting this patient up for strength and training, they would need to be the ones to clear it so nursing can do it. Sonds to me that this patient is not ready to be cleared yet. I would talk to the P.T person and have the PT person explain to the client why PT are the only ones to get the patient up. If nursing is allowed, then have another staff member with you to assist. Use a gait belt, even if it is just for sitting on the side of the bed. That gives an extra base of support. The family member should not be assisting with this unless it is PT educating them on proper technique.

meownsmile, BSN, RN · Jul 6, 2005

If the patient is known to have BLE flacidity why would you even contemplate trying to get them up by yourself? I doubt PT got her up with one person. Sorry your back is sore but what do you expect.

Yes you have the right to say "I need to wait for assistance" or "let me find the hoyer lift to get you up" or "im sorry you will have to be patient until there is staff that can help with your transfer, but for now lets change your position in bed to make you more comfortable".

I dont know that you need a legal opinion. You attempted to work beyond your capability in lifting/transferring this person without help. I think you should be lucky she didnt end up on the floor with a broken hip, then you would need legal opinions.

Sorry to be so harsh, but using some analysis of the situation should have told you not to do what you did. Be glad your back is just sore, and the patient isnt injured.

Nurse Ratched, RN · Jul 6, 2005

I re-read the original post - clarifiying my answer - my brain read "Should I refuse (to take) this pt" not "should I refuse this (request by the patient)" - sagarcia is of course correct that there should be an order for the pt's activity level. If only to be up with PT, then only up with PT.

lsyorke, RN · Jul 6, 2005

If the patient is known to have BLE flacidity why would you even contemplate trying to get them up by yourself? I doubt PT got her up with one person. Sorry your back is sore but what do you expect.
Yes you have the right to say "I need to wait for assistance" or "let me find the hoyer lift to get you up" or "im sorry you will have to be patient until there is staff that can help with your transfer, but for now lets change your position in bed to make you more comfortable".
I dont know that you need a legal opinion. You attempted to work beyond your capability in lifting/transferring this person without help. I think you should be lucky she didnt end up on the floor with a broken hip, then you would need legal opinions.
Sorry to be so harsh, but using some analysis of the situation should have told you not to do what you did. Be glad your back is just sore, and the patient isnt injured.

OP said that she had assistance.

BittyBabyGrower, MSN, RN · Jul 6, 2005

No, not at first she didn't....and I know it is hard to refuse someone, but sometimes you have to do it and get help. I am sure that this patient understands that. I used to work ortho while in school and if the PT's were working with a patient, we had to clear it with them to get them up and use the same strategies as they did. No one's back is worth it. If we lifted without help and then wrote an incident report, you can bet your booty we got a talking to.

Hope your back feels better!

Luv2BAnurse · Jul 6, 2005

so the nice person i am i go and help the pt out w/ assistance from another staff member.

anyhow, we got the pt up to the side of bed safely without incident

So, get MORE assistance next time. Fill out the incident report, and take care of yourself.

lsyorke, RN · Jul 6, 2005

No, not at first she didn't....and I know it is hard to refuse someone, but sometimes you have to do it and get help. I am sure that this patient understands that. I used to work ortho while in school and if the PT's were working with a patient, we had to clear it with them to get them up and use the same strategies as they did. No one's back is worth it. If we lifted without help and then wrote an incident report, you can bet your booty we got a talking to.
Hope your back feels better!

" so the nice person i am i go and help the pt out w/ assistance from another staff member"

She did get help. This is an ongoing problem with nursing. PT clears patients to get up and they come and get them up to a chair. THEN when it's time to go back to bed(much harder than getting someone up) PT is not there. I don't know the answer. When it takes 4 people to get someone out of bed and the facility doesn't have a hoyer lift nurses have to have some say in the safety issue.

beausud · Jul 7, 2005

hey everyone, thx for all your inputs. to further clarify my original post: the pt wanted us to get him up at the side of the bed... just to have his feet touch the floor according to him. ofcourse when we got him up to the edge of the bed, he would have a tendency to fall back due to his lack of upper body strength. we basically held this pt up for about 10 minutes while he sat at the edge of the bed. i dont recall seeing an order/recomendation from PT, nor from the docs, to clear him so that nursing can try to replicate what activity PT did w/ this patiet; i will review the PT notes....

Unfortunately there are no "PT" people around on NOC, so the rn's just have to get more people to have this pt sit up at the side of the bed. i will also look for an available hoyer lift... if PT says its ok for us to do it, can some of the nurses still "legally" refuse to help if other safety devices are not available?

my back feels ok now, thank goodness. thx again for everyone's input.

meownsmile, BSN, RN · Jul 7, 2005

I am glad your back feels better,, be careful. Always use any safety devices you have available (with orders) to save your back.

cursenurse · Jul 7, 2005

Yes, you can refuse. If therapy are the ones getting this patient up for strength and training, they would need to be the ones to clear it so nursing can do it. Sonds to me that this patient is not ready to be cleared yet. I would talk to the P.T person and have the PT person explain to the client why PT are the only ones to get the patient up. If nursing is allowed, then have another staff member with you to assist. Use a gait belt, even if it is just for sitting on the side of the bed. That gives an extra base of support. The family member should not be assisting with this unless it is PT educating them on proper technique.

I totally agree with this. if that pt is being followed by PT, then you need to find out if she is suppossed to get up only with PT, or if nursing can do it. if nursing can get her up, PT has to let you know what kind of assistance she needs. and i don't care if the pt wants to get up or not, i would not put myself or colleages in a position to be harmed. definitely find out how much help you need before you transfer. do not let a pt guilt trip you into doing something you are not comfortable with.