I'm just curious if anyone else is seeing this where they work. The healthcare system for which I work for has instituted new guidelines related to patient falls. According to the higher-ups, there has been an intolerable number of patient falls throughout the system. We received an email notification this past week that if one of our patients is involved in a fall that our nurse manager and department director will be meeting with us to review the patient's chart and to determine why the fall occurred and what we could have done to prevent it. If we have a second patient involved in a fall we are being threatened that we will be disciplined and that it will be reflected in our yearly evaluation.
Is anyone else seeing anything similar to this? I can't believe that they are threatening us with this. Do they think we're pushing our patients down to the floor? Do they think we're just sitting outside of the room twiddling our thumbs? Do they not realize how much of a patient's care revolves around the computer and that paper chart? Forget even having enough time to spend just 5 minutes in the patient's room. Why does it take almost 24 hours after an order for a low bed is placed to actually get it? Automated orders are being put in through our system to avoid administering sedatives and placing restraints. Physicians are being directed not to allow their patients to be sedated or restrained. Can't possibly have a sitter for the patient because there just isn't enough staff in the hospital. Staffing always seems to be an issue. I often have 3 patients in one corner and 2 down the hall. How can I be in two places at once?
The people making these rules and guidelines are so far from bedside nursing it isn't even funny. I thought safe staffing is what helped save lives and prevent falls? Guess I was wrong.
Has anyone heard of the new "nurse monitor" concept? Yes, someone is going to stay in the room with the very confused, agitated, often combatative patient. They will not attempt to intervene with patient care but will put on the light when the nurse is needed. The nurse is given so much time to get to the room and take care of the patient. If the nurse is not there in so many minutes(???) she will be given a reprimand, after 3 reprimands, she is given a day off and must undergo safety training. If a second incident occurs then she will be fired. I swear I am not making this up, I spoke with a girl yesterday and she told me the place where she works is going to this system. These monitors are paid minimum wage, have little to no CNA or other training, but are going to be an extra pair of eyes for administration. I know my mouth dropped open when she told me this. She said it is some new way to keep costs down and meet new JCAHO standards. ??????
Instead of paying multiple someones $6/hr with no training to sit in a room doing absolutely nothing except tattling on the staff with one patient, how about paying for 1 or 2 extra nurses, or how about paying for 3 or 4 extra aides.
Every single patient that is even a moderate fall risk put in a request for a sitter. Document that you did this. If there is a fall then its because management didn't provide a sitter. If they ask why your sitter requests have gone up by 500% explain the effect of the new policy. Sit back and watch management's head spin. Not a nurse, but that's what I would do. Usually when management figures out that the unintended consequences of a policy are going to interfere with their country club membership then they come to some sort of accommodation.
David Carpenter, PA-C
I agree wholeheartedly with David. When the patient is admitted, we are supposed to do a fall risk assessment. If they are identified as a fall risk at admission, be proactive and request a sitter. When a patient falls, it is perfectly reasonable for administration and whoever to come by and look at the situation and determine how and why it happened as you described in your OP. Then if your patient falls, they can see that you identified the patient as a risk and you took steps to protect the patient and thus yourself. If there is another fall and it is documented that you took steps to protect the patient the first time and they came by and looked at the patient and STILL did not provide you the tools necessary to protect the patient, they will look even worse. So they can try to "discipline" the nurse but it will only look bad for them.
I think working conditions for nurses keep getting worse and worse.
The hospital I work at doesn't want physical restraints, chemical restraints or sitters. And OF COURSE they don't want any pts falling either. They even have a special nurse rounding to tell you everything you should be doing instead of sitters and restraints, all of which would all be possible in an alternate universe with 1:1 nurse to pt ratios. It just kills me, one of these days I am really going to lose my temper with them.
And of course you will be talked to if you have a pt fall.
And the nurse moniter concept is god aweful. I can barely believe it exists.
Thing is, where I work, we are usually well staffed. RN to Pt ratio about
4-5/1 and PCT to Pt ratio averages 5-7/1.
Our nurse manager chewed out one of the other techs because a patient fell and she was designated as his. She was mobile, not confused, and had been going to the bathroom back and forth fine on her own, NEVER put her light on or asked for assistance. He was IN the bathroom with another elderly pt who NEEDED assistance to ambulate. Apparently he was supposed to be psychic and know the completely ambulatory patient was going to take a header and just leave the elderly woman in the bathroom by herself to fall too.
This whole subject gets under my skin. None of us want patients to fall! It isn't like we just sit around the nurses station betting on who is going down next!:angryfire
We can only do what we can do. Bed in low position, clear path to ambulate, call light in reach, pt knows how to use call light, pt knows to call when they need to get out of bed, and bed alarm on loud. We even have our pt's room programmed to our phones and when the bed alarm is triggered our phone beeps a special way and says bed exit in room #whatever. All of that does NO good when you are already knee deep in it with another pt who cannot be left. You can not just run out of the room and leave one for another.
Combative pt's, pt's with dementia or confusion, Alzheimer's, or any kind of AMS.......that is one thing. That pt needs a sitter, or a room close to the nurses station........A sitter is the ONLY way you can just sit and stare at a pt 24/7.
It is very frustrating because you have to have a really good reason to get a sitter, and that usually only happens when someone has suicidal ideation or is pulling at tubes.
We are only people and just cannot be in 2 places at once. Often, as I described before, the ones who do fall are walkie/talkies who don't call for help, don't put the light on, take a mis-step or trip.
Please don't think I am downplaying the situation, pt falls are horrible and they should not have to go thru that and I certainly don't want anyone to fall..............but being reprimanded for a patient falling while you were assisting another patient is just nonsense.
Instead of paying multiple someones $6/hr with no training to sit in a room doing absolutely nothing except tattling on the staff with one patient, how about paying for 1 or 2 extra nurses, or how about paying for 3 or 4 extra aides.
You are making too much sense. Can't have that in hospitals. It scares them.
If they had one brain cell combined of course they would hire extra nurses but they tallied up their brain cells and only came up with half of one.
Every single patient that is even a moderate fall risk put in a request for a sitter. Document that you did this. If there is a fall then its because management didn't provide a sitter. If they ask why your sitter requests have gone up by 500% explain the effect of the new policy. Sit back and watch management's head spin. Not a nurse, but that's what I would do. Usually when management figures out that the unintended consequences of a policy are going to interfere with their country club membership then they come to some sort of accommodation.
David Carpenter, PA-C
That's what I would do too. You are in essence putting the ball back in their court where it belongs. I hope all the nurses in your facility follow suit. They should.
Specializes in Tele, Home Health, MICU, CTICU, LTC.
Nurses should not be blamed for falls. I'm sure most of us that have had a patient fault have felt bad enough about it, not need to reprimand and possibly fire us over it. I don't see a problem with management and administration sitting down with the nurse to review the chart and try to determine why the patient fell, but to potentially fire a nurse over a fall, I don't think so.
Seeing this where I work as well. Thanks to Joint Commision adopting this zero tolerance of falls, pressure ulcers, and nosocomial infections our administration has turned up the heat on the nurse managers and staff nurses on preventing these things.
Needless to say in reality, patients are going to fall, some patients are going to have skin breakdown no matter what you do, and some nosocomial infections are bound to happen. That however isn't a good enough defense in Joint Commision's eyes. How can I prevent every patient from falling when we have 7 patients a piece and no CNA?
On top of this administration has decided we're OVERstaffed. I've decided I'm going to have to find a way to make 6 clones of myself that way I can accomplish all that I need to please administration. Trust me, I feel your pain.
I think I used to work at the same hospital. One of the nurses was disciplined for a patient falling. Patient was alert & oriented x3, had a total knee replacement , bed was in low position, call light in reach, etc. The nurse had rounded on the patient maybe 10-20 minutes before he fell.
On top of that the nurse had 9 patients and the CNA was in another room at the time. Of course according to management the unit was overstaffed. It's a frustrating subject. It seems more and more responsibility is being placed on nurses while resources and staff are being taken away. Last staff meeting I went to was all about the budget and how we can cut down on staffing even more.
It's not like we want our patients to fall or get pressure ulcers, but please give us enough staff to properly care for our patients.
Another wonderful example of good ideas turned back by the Joint Commission. We have so much to be thankful for: especially TJC for making our lives soooo much better.
Yes, it is a good idea that falls should not happen. I'm totally in agreement with that, but there needs to be realistic and rational though that goes into it. People fall. Especially older folks with medical problems. It happens. No matter how much you round, how many staff you have, the loudest bed alarms or a psychic aide, the only way it's not going to happen is if they are sedated, paralyzed and intubated, and even then, it could...
Blaming the nurse ina situation like this only creates more division between administration and the bedside nurses. It's not like we encourage our patients to fall...that's too much paperwork to deal with! Should here be a review of the situation? Probably, we can always learn from our "mistakes" but taking it to the level of discipline and poor evaluations is counter-productive.
That's why I truly believe that members of TJC who make these rules should be required to spend time on the floor, doing bedside nursing in the current environment to gain a better understanding of the rules they want to enact. I think it would change their perspective.
Cheers,
Tom
There's another group of people who should be required to do bedside nursing, and that's Medicare folks who are the ones who drive reimbursement, and thus staffing. Not to speak of they are among the prime generators of the usually repetitive paperwork that continues to proliferate.
They live in a political bureaucracy, and it's only accidental that their goals coincide with good patient care. As Weber pointed out many decades ago, bureaucracy's prime motivation is its own survival and expansion.
Has anyone heard of the new "nurse monitor" concept? Yes, someone is going to stay in the room with the very confused, agitated, often combatative patient. They will not attempt to intervene with patient care but will put on the light when the nurse is needed. The nurse is given so much time to get to the room and take care of the patient. If the nurse is not there in so many minutes(???) she will be given a reprimand, after 3 reprimands, she is given a day off and must undergo safety training. If a second incident occurs then she will be fired. I swear I am not making this up, I spoke with a girl yesterday and she told me the place where she works is going to this system. These monitors are paid minimum wage, have little to no CNA or other training, but are going to be an extra pair of eyes for administration. I know my mouth dropped open when she told me this. She said it is some new way to keep costs down and meet new JCAHO standards. ??????
I guess David pretty well chipped in with the absolute right response to this. Put it back on them. When they get an automatic sitter request from every single patient who needs 24 hour eyes, they will see what they need to do. Staff adequately, or, as we know they will not, drop the discipline on falls (an unfortunate more likely position).
Document EVERYTHING. As a manager for a number of years, I learned that management only responds to documentation. Also, documentation is the only thing that will protect you. Correct, accurate and thorough documentation implies you are doing your job right in the eyes of authority. CYA ladies and gents. And this is not just a nursing thing, unfortunately.
They even have a special nurse rounding to tell you everything you should be doing instead of sitters and restraints, all of which would all be possible in an alternate universe with 1:1 nurse to pt ratios. It just kills me, one of these days I am really going to lose my temper with them. 
She was mobile, not confused, and had been going to the bathroom back and forth fine on her own, NEVER put her light on or asked for assistance. He was IN the bathroom with another elderly pt who NEEDED assistance to ambulate. Apparently he was supposed to be psychic and know the completely ambulatory patient was going to take a header and just leave the elderly woman in the bathroom by herself to fall too.
wooh, BSN, RN
1 Article; 4,383 Posts
Instead of paying multiple someones $6/hr with no training to sit in a room doing absolutely nothing except tattling on the staff with one patient, how about paying for 1 or 2 extra nurses, or how about paying for 3 or 4 extra aides.