False Charting

angelbear · Sep 30, 2003

Ok so lets say you have 10 pts and you have to assess them all and then do vs Q2 on 5 of them and Q4 on 5 of them and neuro checks Q2 on a couple of them. So you dont have time to get it all done and you dont chart falsley what do you do?

Rapheal · Sep 30, 2003

Oh angelbear I know exactly what you mean. It is so hard to get everything done and charted. I think I could get so much more done if not for the IMHO unnecessary charting. Also there are so many patients who were admitted with q 2-4 hour vitals who are improved but still we are doing these frequent vitals. Then the patient complains because they cannot get any sleep or even rest.

Too often hospitals try to save money by not providing aides. When you have an aide who can do vitals at least on most of your patients- it frees up your time for more detailed assessments, more time to check orders and more time to evaluate labs. But many times you are so rushed to get these vitals, I&O's and chart them--that you are not getting to these things as often or as detailed as you like.

Also it really stinks when nurses see a slight change in a patient or something that they would like to evaluate further - but forgo it because it is time for blood sugars, weights, ect. If you haven't gotten to these tasks and charted them - it is an incident and you may get written up. So the nurse must weigh which is more important to the hospital and what is going to keep him or her employed versus acceptable patient care. Not fair to the patient or the nurse but unless you can split into more than one person you are not going to get everything done. I DO NOT advocate false charting but I DO UNDERSTAND why nurses feel they have to do it.

jjjoy, LPN · Oct 2, 2003

I DO NOT advocate false charting but I DO UNDERSTAND why nurses feel they have to do it.

Exactly. It's a dilemma, not just a matter of doing it right or wrong. Because doing EVERYTHING, including all the charting, is simply impossible some places, but if you don't play along, you are accused of just not being good enough and might jeopardize your job. Of course, jeopardizing your license and patient safety isn't a wise choice either, but as employees bound by management's decisions, the choice is often "take it or leave it" and, for some, the temporary loss of income would be a real hardship. As more and more nurses leave bedside nursing, LTC especially, the ones left are the ones who have fewer options and are thus less likely to demand better conditions for fear of loss of their job. Others are working at several different facilities and just do what they need to do to get through the shift without incidence and then rush off to another job. Everyone's so busy trying to just get by that there's no time to really share what works and what doesn't at a facility. Then there's a crisis, a new policy written up, extra steps to take and less time for nurses to work together and so on. That's what it looks like from my perspective. I certainly don't know it all.

cannoli · Oct 2, 2003

I would rather stay late and hear it from management about incidental overtime, etc.

They also don't like narrative note charting which a lot of times I consider CYA charting (and that takes time).

I think CYA is the most important thing. Inaccuracies in the charting may come back to bite one in the butt if there is an adverse outcome and legal action.

tonchitoRN · Oct 2, 2003

nursie30 wrote "false charting is like faking an orgasim". i guess that means it happens a lot more then people care to admit.

i am one of those who do the work and then stay late to chart. so of course i got called into the manager's office to find out how come everyone else is leaving on time and i am not. i told her point blank because they are not really doing what they are supposed to do and even gave examples: meds not given told her to look in the med drawer, meds left at the bedside and these were all charted as given. my favorite is the 11-7 nurse who charts they did neuro checks every 2 hours. if that were true the patient would be so tired the next day. iv sites that never were changed only the date was rewritten on the covering. the list goes on and on.

the saying goes "if it was not charted it was not done" also, "if it was charted it was done". from a legal standpoint charting you did it is just as good as it was done (unless there are witnesses to testify otherwise).

unfortunately everyone has bills to pay, families to support. and if you have to make a choice to feed your kids or heaven forbid chart falsely. many would choose to chart falsely than to quit and not feed the kids.

kbaker · Oct 2, 2003

I think that the best way for nurses to ensure that all nursing care is documented for is time management (prioritization), delegation, and communication. If something cannot be done and documented for, then it is up to the RN to ask for assistance (if possible) or to pass it on to someone who is able to complete the task. I for one do not like to pass things on to the next shift, but sometimes there is simply not enough time to get everything done (ex. during a code, during 5 admissions at once, crashing patient, etc..)

In the end, if nursing wants to gain the respect it deserves then each one of us has to do our part and take on the responsibility of patient care and be accountable for our actions. False documentation is a good way to lose trust and respect as nursing professionals. Remember that your nursing license says Registered PROFESSIONAL nurse.

cannoli · Oct 2, 2003

That certainly doesn't say much for the honesty and ethics of nurses does it?, if many others feel the same way.

Also, if people are false charting, what else are they doing? or not doing? in regard to patient care. Sounds like a real safe environment (not) for the patient.

cannoli · Oct 2, 2003

Management also likes to talk about the nurse's time management or lack of it. Sure you can ask for help, you don't get any. Sometimes there is no one to delegate to. Everyone is just as busy or busier. The problem is not the individual nurse's time management, the problem is that the assignment is overwhelmingly impossible in the first place, and that is the fault of the dollar is the bottom line hospital management. If assignments were according to acuity and were safe and were able to be accomplished within a shift, in the first place, false charting would not even be an issue.

kbaker · Oct 2, 2003

Originally posted by cannoli
Management also likes to talk about the nurse's time management or lack of it. Sure you can ask for help, you don't get any. Sometimes there is no one to delegate to. Everyone is just as busy or busier. The problem is not the individual nurse's time management, the problem is that the assignment is overwhelmingly impossible in the first place, and that is the fault of the dollar is the bottom line hospital management. If assignments were according to acuity and were safe and were able to be accomplished within a shift, in the first place, false charting would not even be an issue.

I totally understand where you are coming from, because at some institutions it is very difficult to get help from management when it comes to staffing and patient assignments. What I am saying to you is that when it comes down to it, the nurse is the one on that unit at that moment, putting her licence and health on the line. We can blame management (and we have every right to!) but we are the ones who actually take the unsafe assignments. We have a right to refuse assignments that are unsafe if we feel like our license is in jeopardy. I understand your point, but I feel that regardless of who is at blame (sometimes its the entire institution) we need to remember that we have to do the right thing for our patients and ourselves.

cannoli · Oct 2, 2003

One time, I did try to refuse an assignment, and I was threatened that I would never work in that hospital system again, I was also threatened that I would be reported to the BON for patient abandonment (the BON in my state does not consider that abandonment but an employment issue), I was ready to walk off, the manager then resolved the issue and I did not walk off. However, I was ready to walk. I had not signed in and I had not taken report on the patients.

The problem sometimes is that we do not know that the assignment is unsafe until AFTER we have heard the report, and then it does become abandonment.

Also, it is very easy to say just refuse an assignment. Sometimes the people that talk the most have never actually done it.

nurseygrrl, LPN · Oct 2, 2003

I had a little talk with my ADON today about charting. She was upset that a lot of nurses at the facility where I work are not charting in the pt's chart every time a PRN medication is given and everytime a treatment is done. I told her that we sign an MAR and treatment book daily, we do wound and treatment assessments weekly, we chart for pain scale and relief on a flow sheet in the MAR every time we give a PRN pain medication as well as charting effectiveness for other PRN meds on the back of the med sheets. It is all we can do to just get THAT mess of charting done amongst all of our other unsurmountable daily tasks!

My final sentence was: It's gotten to the point where either we can GIVE the meds and DO the treatments...or just chart on them all day long. With staff so short, doing both is impossible.