being framed?

[leslie :-D]

it's been awhile seen i've been here but good to know my collegues are here in time of need...so in advance, i am grateful and thank you.

i received a very serious written warning from my don re: writing disparaging remarks about another nurse in the nurse's notes. one of my pt's whose on duragesic has poorly controlled pain, is alert & oriented, frail, elderly but whose autonomy is key in any interventions applied. i've worked w/this pt. re: her poorly controlled pain and she agreed to try prn vicodin, an order i obtained for her. when i came onto my shift, this pt. shared concerns about the nurse on duty the noc before, and how she had awoken this pt. and said "here, take your pain pill". this pt. was suspicious but did take it, could not get back to sleep and told me that if it was vicodin that was given, it didn't feel like it. it is notable that i reported this nurse to my don 1 month earlier for being incoherent with unintelligible speech, w/ an inability to give or write report. other nurses have shared concerns about this nurse and narcotics but of course, cannot say anything w/o evidence. i've gone through my nurse practice act and cannot find anything about documentation. what i wrote in the nurse's notes reflected my patients' concerns. i had told my don that i was mandated to document any and all pt. concerns that could potentially jeopardize their therapeutic regimen. my question is does anyone have any resources or links re: nursing documentation? i did find one blurb from rnweb.com but would like to access something more tangible to present to my don. this warning contained my disparaging this nurse, then a couple of incidents' that were extremely distorted and half-truths....i have gone to corporate asking for a thorough and objective investigation. i have been at this facility close to 7 years full time with an excellent reputation amongst my pts and their families.

please, and thank you.

[EastCoast]

We just had a similar incident of narc. diversion in my facility. The nurses took the patients complaints once they became suspicious and filled out occurrence/incident reports that said ' pt recieved 2 tyenol #3 at 3pm signed off by so and so. In this case the patient sometimes wasn't even getting the med or just getting 1 of the 2 pills. " Documentation further included whether the patient had pain relief which was really the issue. I would be like a dog with a bone about reporting this to the DON. If no reponse pursue it with BON. THey should have some type of resource.

I would caution you about documenting in the record except for the true complaints...don't throw in your own feeling/thoughts. Too subjective. I do not think you should have been formally reprimanded. A simple 'be careful' type of thing and listening to your stated issues and follow up on that aspect to me would seem wise and geared to caring for the patient...not protecting the nurse.

[leslie :-D]

that's exactly what i did was document the patient's concerns; completely objective. and this blurb that i found from rnweb "complaints, abusive remarks, or other statements that you judge to be pertinent to a patient's condition and care-including that person's mental state or competence-should be documented. Any such statements should be charted verbatim to avoid subjective interpretations and vagueness." I just wish I could find more complete materials re: documentation. Thanks very much for your response.

[rpbear]

I thought that charting anything about another person other than the patient was not allowed. Also, isn't charting about another nurse in either a good or bad way slander. Maybe this is what your DON is referring to. I would research the laws and practices in your state to make sure.

I am not saying that is it right wrong what you did. I think that if you suspect that another nurse is doing something wrong it should be reported. I just am not sure it is legal to put it in the pts chart.

Good Luck!

[Agnus]

I would document this. However, I do not think is wise to do so on the patient record. Most facilities have a patient concern form where I would document this. If there is no such form I would write it on a plain piece of paper. Ask, as I find it hard to believe that your facility does not have a form or means of documenting things of this nature.

To put it in the patient record is risky as this is a document that is subject to being called into court.

You recorded a derogatory remark about a nurse. It was not your remark but that will not matter when the patient record is called into court. Either the patient or the nurse could file a suit. Or both.

This was a patient concern which needed to be addressed but this was not the place to document it. Just like an incident report. You don't put in the chart that you filed and incident report. When there is an incident the only thing you put in the chart is the bare minimum facts. You don't say gave the wrong med. you say pt. recieved 10 mg. m. s. dr. smith notified and what ever you did as follow up. such as monitored vs or such.

It is in the incident report that you say it was the wrong med and give a bit more factual detail.

The chart is about the patient not about the staff nor what the patient says about the staff.

[leslie :-D]

agnus, i agree it certainly is not a desirable situation and one that creates much ambivalence and ambiguity. but according to my training and now, this blurb quoted above from rnweb, it is supposed to be documented as such. it is not a judgement on the nurse; i strictly documented what the patient told me and since that night, this patient has become more suspicious, ascertaining she's getting the meds that she is supposed to. i'm not really worried about the libel aspect of it because i recorded something accurately. it's certainly not a pleasant task though. if anyone can give me avenues to pursue re: nursing documentation, it would be much appreciated. thanks again.

[sjoe]

"isn't charting about another nurse in either a good or bad way slander."

Slander is spoken, libel is written. AND it has to be false, malicious, and/or creates $$$$ damages in order to qualify.

[-jt]

at the New York State Nurses Association's website:

Charting and Documentation: Know Your Professional Responsibility While Keeping Your Nursing License Safe

http://69.3.158.146/nurse/nysna/syllabus.cfm?CourseKey=2400

excerpt:

<........ should be related to the patient condition or chief complaint. it is not appropriate record staff conflicts in record. disputes among questions about another actions behaviors are legitimate care concerns and do belong alternatively you can document your a memo. while documenting mention an incident event report. facilities have special forms methods for incidents. these reports confidential handled differently than medical report internal used by facility>

[leslie :-D]

Thanks very much JT...although I am not going to use this specific link, I did come up with some promising results with a google search. As I am reading some of these threads, I smile at the diversity of brilliant, spunky minds.....what a garden.

[Agnus]

Perhaps you should talk to some one in your facilitie's risk management department. I don't believe lible is an issue liability is.

I agree document it. I do not agree that the place to document is in the patient record. There are policies in place for handling such a situation. Please, find out how your facility wants this type of thing documented.

This really is about the nurse not the patient. Go back to your facillity and learn their way of handling this. If this dosn't satisfy you consult an attorney (ideally a nurse attorney) because bottom line it is an attorney that will use this document. You can always talk to your hospital's legal department. Just follow thier policies and you should be safe.

This is not a unique situation listen to what your facility tells you.

[BadBird, BSN, RN]

Without reading what you charted it is difficult to comment. However, you could have stated "patient stated no relief of pain from vicodin given at ---- time." And a seperate statement of concern or incident report if you suspect a nurse of narcotic diversion. What if your suspicions are incorrect and you are setting up a nurse who could possible lose their job and their license. This is a very sticky situation, report your suspicions and let management and HR deal with it. To be falsely accused is a terrible thing and if the nurse is guilty they will be found out eventually.

[MandyInMS]

Had this happen many years ago with an alert/oriented pt..nurse X came into her room and gave her a shot for pain..although she han't asked for one..but said she was having a little pain and took the shot..which was supposed to be Demerol..couple of hours later the pt called saying her pain had increased..the pts nurse went to assess her, and told her about the other nurse giving her a shot and that she was sure it wasn't Demerol..that she had had Demerol before and what she got wasn't it..pt's nurse had to fill out an incident report..and call the MD for "another" shot of Demerol..seeing how it was too soon according to the records..this nurse apparently has several reports filed on her and was eventually drug tested and fired.

We were told never to document such things in the pt chart..always to file an incident report and report to DON.