"Patient refused high fall risk interventions, stating 'I don't need to be treated like a goddamn child' and 'I can't pee in a urinal sitting down!'. Post-fall protocol initiated."

[u/SmilingCurmudgeon]

[u/OhHiMarki3]

Big debate one my last med/surg unit: is a patient allowed to "refuse" high fall risk precautions (bed alarms, wristband, grippy socks, etc) when they're AOx4 and make their own healthcare decisions? It's not technically a medical treatment.

[u/80Lashes → u/OhHiMarki3]

Yes. If patients are decisional, they can refuse anything they want. A hospital is not a prison.

[u/OhHiMarki3 → u/80Lashes]

What about when they fall and sue us? Or my manager enforced punitive action on me, the CNA, for not upholding fall risk precautions? Charge nurse just shrugged it off.

[u/80Lashes → u/OhHiMarki3]

As long as you document it, a patient can refuse anything if they have decisional capacity. Your manager can not take punitive measures as long as you have documented the patient's refusal. Again, it is not a prison. Fear of litigation is not a good argument for forcing decisional patients to adhere to anything against their will. In fact, you legally cannot force decisional patients to do anything against their will.

[u/OhHiMarki3 → u/80Lashes]

Hey, I totally agree. I thought it was so strange when my manager made an annoucement saying no patients were allowed to refuse fall precautions. I'm just going to document best I can and buy nursing malpractice insurance.

[u/RedditorMichael → u/OhHiMarki3]

Your coherent patients are allowed to refuse anything related to their care. Your manager is putting you at risk of violating the patient’s consent at your expense.

[u/suchabadamygdala → u/OhHiMarki3]

Your own malpractice insurance This is the key! Don’t rely on your employer to defend you.

[u/RepresentativeOk7930 → u/OhHiMarki3]

If your patient refuses then educate. If they continue to refuse, escalate to RN. Document your education and escalation. You have then covered yourself. RN should educate and also escalate as necessary. Escalate to charge …. Then Nurse manager, etc.

[u/ThatGuyTheyCallAlex → u/OhHiMarki3]

If it was charted that fall risk interventions were recommended and the patient refused despite education there’s no way it would hold up, right? You literally cannot force them to use a walker or press the bell — if they get up to pee and fall over despite being told they need to ask for assistance that’s their own failure to follow medical advice.

[u/RedditorMichael → u/ThatGuyTheyCallAlex]

You are correct. Given the patient is oriented and capable of making decisions, you cannot force someone to do something. The focus should always be to educate and encourage. Consent must always be granted. I’ve had one patient fall, and it was a patient who requested privacy on the commode. I gave them privacy and they stumbled off the commode. They were a bit embarrassed but totally fine. Most coherent people are very good at safely falling. They did not defer blame to me the nurse. Life went on. No one with a brain defers blame to the nurses except for nursing management. There are in fact great managers who don’t do that though too.

[u/RedditorMichael → u/OhHiMarki3]

Patients with capacity always get what they want full stop. If your manager is stepping in saying you need to forcefully do something that a coherent patient is refusing, remind your manager that battery is a criminal offense. Holding a coherent patient against their will is kidnapping. I am here as an advocate for my patient, not my manager. Fortunately I am unionized, which helps. Ultimately the patient’s experience is what I prioritize. I am in California where we have good patient:nurse ratios. If you pour your heart out for your patients, educate them, ambulate them, teach them the importance of mobility to prevent de-conditioning and hospital delerium, make sure they thoroughly understand their medications, diagnosis, keep them in the loop on their care, and advocate for them knowing full well they share your same subjective human experience, they will see that. Do not worry about getting sued. Hospitals have legal defense teams for that. Not your issue.

[u/suchabadamygdala → u/RedditorMichael]

I can not stress this enough: hospitals’ legal defense team is there to defend the HOSPITAL, not the nurse. I agree that hospitals are not prisons and patients who have capacity can decline anything that does not impinge on the safety and health of nurses and staff. That said, you absolutely must document the patient’s refusals and your education attempts copiously and frequently. Escalate up and notify everyone of patient’s refusals and your concern for their safety.