My Mother (an LPN) is in need of advice!

Nurses General Nursing

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Hi, everyone. I'm new here but I have a serious concern. Or rather, my family does.

My mother has been an LPN for 33 years and has never had a single blemish on her record or a complaint regarding her conduct. She's always worked hard to provide the best patient care she could.

Several months ago, she found herself swamped by workloads that were simply too much for a single nurse to complete in a single shift and they had cut everyone's overtime to ensure that no one stayed over unless it was at their own expense. She worked nights and there was always a lot of work to do. They rotated her halls randomly though, so there was no chance of her setting things up to make it easier on her the following night.

In order to make things easier for her, she made what she called "Cheat Sheets" for her patients. It was a nursing chart with their names and unchanging conditions pre-recorded. She would make copies of these, check the patients each night, fill in any changing conditions and sign the page. She'd also write a summary of the check on the back, as was standard procedure. In the event that an unchanging condition did change, she'd simply shred the documents and make new ones excluding that condition. Her signature was always in fresh ink, as were the summaries and changing conditions.

She kept these "cheat sheets" in her locker at work. This came to light and she was fired and her actions were reported to the board of nursing.

Her hearing was the other day and they gave her three choices: 1) Have a full formal hearing which may be better or worse for her, 2) Plead the Mercy of the Court (they never elaborated upon what this means) and 3) Sign a paper accepting an official reprimand for Nevada Revised Statues 632.320 (7) unprofessional conduct, and Nevada Administrative Code 632.890 (20) inaccurate recording, falsifying records and (27) failing to perform nursing functions in a manner consistent with established or customary standards.

The problem is with (20). She never falsified anything, nor did she inaccurately record anything. The case-manager insisted that her actions constitute this... but I don't see how. We're moving across the country in a year or so and she'll be looking for a job again. We don't want her record reflecting that she did something neglectful or malicious when she was, in fact, simply trying to save time to get all of her work done.

She hasn't signed the papers yet, as we're still weighing our options. I was hoping that perhaps some of you would have some insight that you could offer.

Thank you.

Specializes in Community Health, Med-Surg, Home Health.

i am horribly confused...it seems that she created notes for herself in order to better keep up with what is happening with her patients under an overwhelming, confusing situation. if she wrote down the chronic conditions, maybe she did it in order to know that there was, in fact, a change in the basic condition of the patient? an example i can think of is if a patient has a history of chf, and you come in and see that the patient has not voided, hearing rales and has pitting edema, etc...she would have a hint of what is wrong, or interventions, maybe?

or were these things documented on official continuation records and were documented later on on another sheet? or was it that she had an individual sheet for each patient and decided to turn them in at the end of the day if there were no changes? it seems to me that the op's mother was in a horrendous situation and tried to keep up with as much as she can to the best of her ability and got seriously caught out there. does she have ? i would hope that situations like these would be covered in regard to representation.

Specializes in LTC, Acute Care.

What is going down makes me sad for your mother. It's a symptom of what the real problem is, and that's that her employer treated her like crud and kept pushing the limits of what she had to do on the job until she felt she had to do something like this. I know that wasn't a particularly helpful statement I made, but still...I hope it works out for her.

Specializes in Rehab, Infection, LTC.

the way i read it, i thought she was using these cheat sheets to chart on and put in the record. you cant do that.

i am horribly confused...it seems that she created notes for herself in order to better keep up with what is happening with her patients under an overwhelming, confusing situation. if she wrote down the chronic conditions, maybe she did it in order to know that there was, in fact, a change in the basic condition of the patient? an example i can think of is if a patient has a history of chf, and you come in and see that the patient has not voided, hearing rales and has pitting edema, etc...she would have a hint of what is wrong, or interventions, maybe?

or were these things documented on official continuation records and were documented later on on another sheet? or was it that she had an individual sheet for each patient and decided to turn them in at the end of the day if there were no changes? it seems to me that the op's mother was in a horrendous situation and tried to keep up with as much as she can to the best of her ability and got seriously caught out there. does she have malpractice insurance? i would hope that situations like these would be covered in regard to representation.

what is going down makes me sad for your mother. it's a symptom of what the real problem is, and that's that her employer treated her like crud and kept pushing the limits of what she had to do on the job until she felt she had to do something like this. i know that wasn't a particularly helpful statement i made, but still...i hope it works out for her.

they were indeed individual sheets and she was certainly checking each resident thoroughly. if a condition had changed in one of them, her "cheat sheets" would not have been submitted. instead, she would've used a fresh sheet and made note of the change. when asked how this was inaccurate recording or falsifying documents, the case-manager dodged the question by bringing up a breach of patient confidentiality... even though the records were kept in her locker under lock and key. at work no less.

they dropped that complaint entirely as there was no basis for a confidentiality breach, but they kept the inaccurate recording, falsifying bit for some reason and i don't know what we can do. that's why i'm asking for advice here.

you're quite correct in stating that it's a symptom of the real problem and i thank you for saying so. my mother is a single parent and i watched her work herself into illness on several occasions to make ends meet. she is so burned out because the nurses she used to work with generally dismiss their duties in favor of gossiping in the break room and their work falls on her shoulders. she could offer no proof of this, as cell phones or recording devices were prohibited, but she shouldered the burden anyway.

the problem came when her employer heaped more onto her and demanded that she take on additional workloads after firing several employees that had, in the past, helped her when she was in a tight situation by taking on some of the paper work.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Condition change or not, you must chart on a patient every shift.

This is not the case in all healthcare settings.

Most LTCFs and nursing homes utilize a "charting by exception" method of documentation, where nursing staff is not required to chart on patients unless something out of the ordinary happens. Many nursing home patients are in stable condition with rather predictable outcomes; therefore, many of them might receive a nurses note entry perhaps once a month or so.

:cry: I am sorry to hear this about your mother, she sounds like a Nurse who like most of us are overwhelmed at times with patient case loads. Unfortunately, I have to agree with most of the advise. It is difficult for her to prove that she didn't shred any documents and that she did assessments on her shift. I agree that her best option is to get a lawyer that would be willing to work with her in regard to payment. I wish there was something else I could do for her but I suggest that she not sign anything until she talks to a lawyer. She could try to find one that may give her a free legal consultation first. There are a few lawyers out there that advertise for free consultation. Tell her to hang in there and to think before she signs anything!!! :no:

Keep us informed.

Doris Nesiba RN

Specializes in Community Health, Med-Surg, Home Health.

Does your mother have ?

Specializes in Community Health, Med-Surg, Home Health.
What is going down makes me sad for your mother. It's a symptom of what the real problem is, and that's that her employer treated her like crud and kept pushing the limits of what she had to do on the job until she felt she had to do something like this. I know that wasn't a particularly helpful statement I made, but still...I hope it works out for her.

Agreed. What disturbs me is that I know for a fact that many caring nurses have their backs against the wall and have had to come up with creative ways to try and provide safe patient care and accurate charting...doing both cannot be done effectively within a given shift. The OP's mother just got caught by uncaring people. Think of the many other incidents that I am SURE continue to happen at that same facility (and others) right under their nose while they try and make an example of this one person.

Sometimes, I notice that these things are subjective...it can depend on WHO discovered it and WHAT they decide to do about it. I am wondering how the powers that be found out about this to begin with. I have to be honest...if I were a supervisor that had an employee that was really trying to do the best they can to comply with the rules, care for patients, etc...and found this, I would have spoken to her privately, gotten rid of it and told her never to do this again.

As I was wondering how much of her near retirement years came into play as well.

This is too bad because it sounds like she meant well, trying to organize her work to promote organized care for her patients.

Specializes in Community Health, Med-Surg, Home Health.
This is too bad because it sounds like she meant well, trying to organize her work to promote organized care for her patients.

I agree with this! What a shame...these people do this to her and then, throw her to the wolves this way. I am sure that plenty of the other nurses working there have resorted to throwing away meds, skipping treatments and barely writing notes in order to survive. The entire system SUCKS! This is why people leave bedside nursing so quickly.

Update: My mother refused to sign the agreement and stood her ground, stating that she would go to trial if need be, as she falsified nothing.

She had no money for a lawyer, but refused to admit to something she didn't do.

She was offered a new agreement days before the hearing that omitted the inaccurate recording, falsifying bit.

She gladly signed it and has to take a couple of courses next year as penance.

Everything worked out in the end, but apparently they wanted her to buckle under the pressure and sign something that would've been worse for her rather than simply admitting that they had nothing to suggest she inaccurately recorded or falsified from the start. I have no clue why they wanted to punish her so badly, but end the end, holding out and seeing it through proved the right thing to do.

Thank you for all the advice you gave, it was quite valuable to us in this matter.

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