Ethical advice needed for a new grad...

Nurses New Nurse

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What would YOU do?

Say, hypothetically, that you are a new graduate RN at your first job. During morning med pass at a SNF, you witness another RN entering incorrect times for med administration on multiple patients in order to seem like everyone received their medication within the designated time frame. When you asked this nurse about the times, she states that she "guesses every nurse has to make a judgement call on how to chart."

Would you take it further? Would you ignore it?

Specializes in LTC, Psych, M/S.
I guess most everyone is using Emars or some such thing now?? The last two LTCs I worked at were paper MARs and there is no charting what time you gave a med-only that you gave them. Only things you had to put a time in for were PRNs. My current LTC ( I'm no longer on the floor) does the same.

Wouldn't that be nice if all health care was using EMARS. There is another thread on this and it sounds like they make the med pass alot easier and accurate in the LTCs. However LTCs are not required to use them as hospitals are ( by next year I believe).

the nurse is risking her license and allowing management to get away with creating an impossible situation. As long as she does it, management has no incentive to correct anything. If she gets caught, they just find someone else.

exactly. most employers are leaning to the fact that there are thousands of people out there looking for a job. so they can easily replace that nurse

imho its no big deal. new grad nurse is going to be all about doing everything by the books. thats every new grad in every field of everything. you'll realize, what this hypothetical nurse realized already hopefully from practical experience and not from simply laziness/bad work ethic is that, this can more or less be negligible and overall harmless. However, this is definitely something to keep in mind and report immediately should it become an issue, to the point where patients are actually being harmed and suffering real consequences as a result of such negligence. if a pt suffers as a result, you should definitely be the first to mention that you witnessed these falsified logs. But if nothing comes of it, then its something to put in the back of your mind. My two cents

Specializes in Behavioral health.

Hi AnnaleaRN:

I'm a new grad myself. We a had similar situation happen in one of my clinicals. The professor gave the sage advice "Worry about your practice" when you see things like this. A new grad is in a vulnerable status and may not be aware of all the politics behind closed doors. The administration maybe knows and doesn't care. The nurse in question might be the administrator's favorite and can do no wrong. If it was me, I would approach management like a rookie seeking clarification 'I want to make sure I'm doing this right. I learned it in school like this. How do we do it here?'

Specializes in Medical Surgical.

The time that the pts receive their medication in a SNF is RARELY if ever dictated by the physician, the nurses who take the order decide the time when they transfer it into the MAR. I used to alternately put in 7am and 8am and even 830am into the MAR as I took new orders based on how I actually gave them, that way with my 1hr time frame for before or after the time, I could start at 6am, and give meds till 930 like I usually did, and they would be getting their meds within the time frame. The trick is to make sure if you change the time on one morning med, you have to change the time on ALL the morning meds(except insulin's, which you don't usually do with med pass anyway). I wouldn't even care if state showed up because I really could do the med pass like the times said. Well, mostly.

What would YOU do?

Say, hypothetically, that you are a new graduate RN at your first job. During morning med pass at a SNF, you witness another RN entering incorrect times for med administration on multiple patients in order to seem like everyone received their medication within the designated time frame. When you asked this nurse about the times, she states that she "guesses every nurse has to make a judgement call on how to chart."

Would you take it further? Would you ignore it?

As a new grad I'd worry about "MY" nursing practice 1rst and foremost. And then it boils down to, "if I have enough time to police another nurse's work, is there anything that I could do to help this nurse?"

Then the next following questions should become relevant. 1. Was a patient hurt or has the potential to be fatally hurt by these late occurrences? 2. What type of medicines are being given late? 3. Are all other nurses commonly this late with their med admin? 4. As a new grad, why am I able to pass my meds on time and why does my skill-set appear to be superior?

Find out the answers to these questions first and then this should give you an answer to the next justified action to take. Take care.....

Jul 2 by [COLOR=#003366]S.G. Jul 2 by [COLOR=#003366]S.G. A member since Jun '13. Posts: 5 Likes: 4

I always chart accurate times. I worked in LTC for only a month and left because I didn't like the staffing and the poor patient care as a result. I didn't like that people saw no problem with inaccurate charting. I chart accurately for the safety of my patient. I don't chart in order to save my license. If it comes to me being afraid of disciplinary action against my license, I'd rather it be for passing meds late than for lying in a legal document.

This is an interesting question.

First off, I'd like to say that it is completely unrealistic to safely medicate 30 patients in the 2 hour window and NO, this is not the nurse's fault. It is bad staffing. Unsafe staffing actually.

Now, the more important issue is that nurses who document that the meds were given on time are aiding to perpetuate the problem. If all nurses start documenting the actual time they were able to accomplish the task, management would have to deal with the fact that they are understaffing. By not documenting reality, nurses continue to set themselves up for failure.

Sent from my iPhone using allnurses.com

Glad to see when I came here this morning that there were more posts like these two. I thought for a while there I was outnumbered.

I'm a patient advocate first but not far behind is caring about the license I worked so hard to attain.

Saying that this is the way things are done and you can't do anything about it is what enables facilities to get away with short-staffing. We were given the options to chose from that told why we might be late. If one didn't fit, I'd write my own. I'm not going to lie - I've seen that come back to bite you in the tush too many times.

I'm really glad and want to give kudos to my first awesome mentor, the DON of the hospital where I got my first job. She always had the nurses best interests at heart, listened to our concerns, and taught us never to chart something you didn't do or to chart that you did it at a different time than when you actually did it. I'm so glad she was there for me as a newbie.

Specializes in Wilderness Medicine, ICU, Adult Ed..

I chart the time accurately so that, if there is an emergency, the time since last administration will be reflected in the record. It is impossible to give even as few as ten patients multiple meds at the same time, and would be dangerous to try! As other posters have mentioned, it is very rare for the orders to specify a specific time, just AM, PM, HS, PC, etc., so there is no need to falsify the record to suggest that I did something at a different time than I did. This kind of "little white lie" is the kind that might bite you in the butt in the very unlikely, but possible, case in which the patient has a problem and the doctor needs to know exactly when they were medicated. Not likely, by why endure the stress of worrying about it? Pass meds efficiently, chart accurately, and have a good day.

As a DON in a 68 bed facility-I feel the generalization of Nursing Home staffing offensive. I have been here 20 years. We continue to be a 5 star facility, and our staffing is ABOVE the industry norm. We have 28 Nurses, 24 of them RNs. We have had surrounding facilities tell us we "over staff" and make it bad for the rest of them. I AM management. I set the staffing. We have 4 nurses on days and evening shift. We have concentrated on DECREASING the number of medications our residents receive, because polypharmacy is the actual issue, not staffing. If I am 97 years old, DO NOT put me on a cholesterol medication, multiple blood pressure medications, antidepressants and multiple vitamins. Please do not color all Nursing Homes with the same pen, we are not the same.

LCPHrn - :up:

I agree - we should not color all Nursing Homes with the same pen. There are two associated with where I work who have DON's like you. We are lucky. So is your facility.

Specializes in LTC, OR.
As a DON in a 68 bed facility-I feel the generalization of Nursing Home staffing offensive. I have been here 20 years. We continue to be a 5 star facility, and our staffing is ABOVE the industry norm. We have 28 Nurses, 24 of them RNs. We have had surrounding facilities tell us we "over staff" and make it bad for the rest of them. I AM management. I set the staffing. We have 4 nurses on days and evening shift. We have concentrated on DECREASING the number of medications our residents receive, because polypharmacy is the actual issue, not staffing. If I am 97 years old, DO NOT put me on a cholesterol medication, multiple blood pressure medications, antidepressants and multiple vitamins. Please do not color all Nursing Homes with the same pen, we are not the same.

I'd like to work in your facility, seems like your patients receive an adequate nursing care with this staffing level. How many aids work on AM and PM shifts?

Specializes in LTC, Psych, M/S.

Are the doctors in agreement with taking patients off certain medications?

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