The Shift: One Nurse, Twelve Hours, Four Patients' Lives by Theresa Brown

a patient’s risk of falling is probably a good idea. It needs to be quicker, though, because the irony right now is, the time I spend on the computer carefully documenting a patient’s fall risk is time I could physically spend in the patient’s room talking about how we can work together to keep him upright and on his feet. Designers of electronic charting systems don’t seem to understand that checklists themselves are not the innovation, because checklists are not substitutes for care. The real innovation is having staff use lists to consistently create the safest and highest-quality clinical environment possible.
    Mr. Hampton is a true fall risk. He’s older, on oxygen, and appears confused. He’s been asleep so far this shift, but he could wake up needing to go to the bathroom at any time, feel uncertain about where he is, get tangled up in his sheets or oxygen tubing, and fall simply getting out of bed.
    Thinking of that I feel a sudden sense of urgency and go and knock softly on Mr. Hampton’s door. He’s asleep again and I step over to the bed and tap his shoulder.
    He opens his eyes and I pick up the plastic urinal on the shelf next to his bed. “Mr. Hampton,” I say quietly, holding up the urinal with a gloved hand so that he can see it. “Do you need to go to the bathroom?” He nods and I help him sit up in bed by sliding one arm behind his back. Then I disentangle his legs from his heap of covers until he can dangle them over the edge of the bed, ultimately resting his feet on the floor. He is very tall.
    “Do you need my help?”
    He shakes his head no and reaches out for the urinal. With his other hand he reaches under the edge of his hospital gown and prepares to urinate. I turn sideways so that my back is to him, but I keep my right hand on his shoulder to prop him up and so that I’ll feel it if he starts to lean forward precipitously.
    I hear the sound of a urine stream and then it stops. I wait a few seconds, then ask if he’s done.
    “Hunh,” he says. It’s the first sound I’ve heard him make! I turn around to face him, pleased that he’s verbalizing something, and with my other gloved hand take the urinal from him and set it aside. I grab a wet wipe from the packet in his room and hand it to him. He takes it and slowly and carefully wipes both hands, afterward handing the used wipe to me.
    I look at the urinal. He really needed to pee. I bend down to put myself at eye level with him. “Better?”
    “Better,” he says, almost as if he’s talking to himself, but his voice is strong with none of the quaverings of old age. I look at him, wrinkling my eyebrows together as I adjust the two plastic prongs that send oxygen into his nose. Already he’s trying to get back under the covers and I help him slide his legs in and fall back on the bed.
    His eyes start to close. I use the pulse-oxygen machine to check his oxygen saturation and heart rate. All normal. Guess he’s tired, I think, frowning to myself. All this sleeping is somewhat unusual but, of course, he’s also sick with lymphoma.
    In his bathroom I empty the urinal, measuring the amount so that I can record it later. All fluid that goes into and out of a patient gets charted, too.
    I’ve now helped to keep Mr. Hampton safe, but the scary thing is that patients will fall no matter what hospitals do. They fall because they lunge for cell phones. They fall because their blood pressure drops too quickly too soon after they stand up. They fall because cancer is clouding their brain and messing with their cerebellum. They fall because they don’t want to ask for help in the bathroom.
    Humans are bipeds—it’s easy for us to fall. My husband and I have both had bad falls walking the dog in sketchy weather. I would like to be encouraged to physically
observe
my patients rather than simply record that I
have
observed them. Today at least I documented that I kept Mr. Hampton safe from falling and I also had time to actually do