I’m an LPN working in a skilled nursing facility, and I genuinely want to know if other nurses have experienced this because I recently got into an argument with an aide over this exact situation. When I arrived for my shift at 7 PM, I had a resident who was already sitting in his wheelchair near the nurses’ station. Fast-forward to approximately 1 AM, and this same resident was STILL sitting in his wheelchair. Mind you, this resident is an extremely high fall risk, has a history of falls, and already has multiple fall-prevention interventions in place, including fall mats, toileting, frequent rounding, bed in the lowest position, and other individualized interventions outlined in his care plan. The resident was visibly soiled, had a strong odor, and was actively attempting to get out of his wheelchair and ambulate independently despite being unable to do so safely. If he had managed to get up without assistance, he very likely would’ve ended up on the floor. When I questioned why he hadn’t been assisted back to bed, the aide explained that he had previously fallen because he was put back to bed “too early” and that she didn’t want to deal with another fall. This is where we got into an argument. I explained that this resident had been sitting in his wheelchair since BEFORE I arrived at 7 PM, and it was now approximately 1 AM. That’s over six hours of him sitting there during my shift alone, not including however long he had been up before I arrived. I understand that some residents are restless, wander, or have behaviors that make bedtime difficult. However, this resident wasn’t actively wandering around the unit. He was sitting in a wheelchair, soiled, uncomfortable, and repeatedly attempting to get up without assistance. How is leaving him in that situation safer than providing proper care and assisting him into bed with his fall precautions in place? The resident also had a PRN medication order, which I offered to administer if appropriate while the aide completed his care and got him settled. I even offered to personally help transfer him back to bed once I finished my medication pass and wound treatments because initially, I assumed the aide was simply having difficulty transferring him or needed additional assistance. What frustrated me the most was the comment about not wanting to “deal with a fall.” As licensed nurses, we’re the ones responsible for performing the post-fall assessments, completing the nursing documentation, notifying providers and families as indicated, initiating neurological checks when appropriate, reassessing fall interventions, and completing the necessary follow-up. CNAs absolutely have responsibilities when it comes to reporting falls and maintaining resident safety, but they aren’t the ones performing licensed nursing assessments or completing most of that paperwork. And here’s my other point: This resident already had numerous fall-prevention interventions in place. If a fall were to occur despite everyone following the care plan and implementing appropriate precautions, that doesn’t automatically mean someone was negligent or that the nurse’s license is on the line. Falls can still happen even when appropriate interventions have been followed. I’m not saying we should ignore a resident’s history of falling or put someone in bed simply because it’s nighttime. I’m saying that leaving a soiled, high-fall-risk resident sitting in a wheelchair for hours, while he’s actively attempting to stand up without assistance, doesn’t seem like an appropriate solution either. Being a fall risk does not mean someone should be denied assistance with toileting, hygiene, transfers, or getting into bed. I genuinely believe fall prevention should be a team effort, and we should be using clinical judgment and individualized care plans rather than allowing fear of a potential fall to prevent us from providing basic care. So I’m curious: Have any other nurses dealt with aides refusing to assist residents back to bed because they’re afraid of a fall? How did you handle it? And am I wrong for thinking that leaving this resident in his wheelchair for that long created additional safety concerns rather than preventing them?   submitted by   /u/Nass-1234 [link]   [comments]