HI all. I'm working in home health doing infusion therapy and share a case with another nurse. We are to take notes q @ hours per agency policy and with this pt doing so is easy as we are changing infusion bottles q 45 minutes. Its albumin so we do vs and assessment each bottle change. Its an 8 hours shift, 4 hours of infusion. My fellow Rn did not do his charting for 2 days straight and wouldn't you know when I came on we had an emergency situation and I had no data for the the previous shift. I was able to keep pt stabilized until EMS arrived and fortunately the pt will be ok.
However my fellow Rn he became extremely defensive when I asked about his lack of notes . He told me he left a note that everything had been routine both days and his laptop had broken therefore he wasn't able to print his notes. I was flabbergasted as he could have left handwritten notes but I didn't even go that far w/ him since he was so nasty to me. I know he s going to type up the notes and insert them into the pts chart when he has the next shift. So the agency wont know about this since we turn in paperwork weekly. This is fraudulent to me.
My question is how should I approach this w./ the agency? They already know he he leaves shifts early and seem ok w/ him doing so. I'm afraid I'm going to be blacklisted for speaking up so its been 2 days that my mouths shut. Any ideas?
Jun 29, '10
Can you take the notes to the office where they will see that his are not there? You don't have to say a word. Then the office will have to ask him for his notes. Let them manage him. If they don't do anything, then you know know he is favored for whatever reason. He will probably type up the notes just as you say but can you really prove that? That's why I say take your notes in. His notes will probably be written using yours as a guide. Yes it is fraudulent and you were left without possible key info that could have made a difference in the patient's emergency. You can call in report to the office after every shift you work. Let them know that you are unaware of the previous shift because there is no data available. He may straighten up because you have then very silently but strongly shown the level of professionalism you have and that you expect. People love to argue but when you say little to nothing, they become uncomfortable and either change what they do or leave. Then you win either way.
Jun 30, '10
This is a common happening in home health. What is really hilarious, is the person who rarely leaves their notes calling the office and tattling on anyone else who does not leave a note. Back and forth. Most of the time the agency will jump on certain people about this, just like anything else, but the big offenders never are confronted and made to conform. Any of the previous suggestions would be good if you feel the agency needs to know. When I see this, I keep my mouth shut, unless the topic comes up from the agency, then I speak. I do not feel it is my place to be running herd on the others, I just make certain I do my own job the way it should be done. If the nursing supervisor was on the ball, they would catch a lot of this stuff, but they are normally the first to look the other way.
Jun 30, '10
Thank God your patient was OK! What might guide your future actions with respect to this--- you already know they are aware of his unprofessional and fraudulent behavior (leaving early), and they didn't do anything about it. If the management is OK with this guy being paid for not working, they probably won't get all wound up about the notes he didn't complete.
Agencies often have their pets. They literally can do no wrong. Had a nurse that reported for duty, stayed for an hour, left for 5 or 6 hours, and back at the home for the last hour. Time sheet= 1500--2300. In the first 4 months of "nurse of the month", he was nurse of the month for 2. These people have the ability to sabotage you, so letting it go will be the best thing to do if you want to stay at the job.
Jun 30, '10
Thank you to the three of you, I really appreciate the suggestions. You're confirming what I'm starting to see in HH- unfortunately. This is whats going on now.
I gave report to the agency, as required w/ an admission, and did say the previous shift data was unavailable. They didn't say anything. I have turned in my paperwork for the week as usual, no mention of his lack of charting.
He must be their pet- has never had pt sign timesheet, and from speaking w/ pt caretaker, never stays the whole shift. I found this out because the night this happened she offered to let me go 3 hrs early since pt was asleep. She told me he always leaves early and she wanted to go to bed as well. I refused and stayed by pts bed, just watching her sleep. At shift end I got a funny feeling, took VS and her temp was 103.9, BP 62/47. The hour previous- final required VS check- all was wnl.
Pt is immuno compromised ped, w/ central line. Imagine if I had left when caretaker offered?
Anyway that was 3 days ago., pt still hospitalized, septicemic and unresponsive to antipyretics. Caretaker called me last night to thank me for staying on the job and to tell me she has reviewed nursing notes in the agency binder. She overheard me telling paramedics VS data was not available and so knows about lack of notes. She is taking it upon herself to bring this up w/ the agency. I simply said I didnt know what his story was and left it at that.
So it looks as if this problem will be addressed w/o my having to get into it. I get the feeling nothing will be done since the agency has indicated to me several times they are looking for the bottom line. I'm not sure how I can be proactive about this particular RN and I'm open to more suggestions. I'm going to see what they do about this situation, if he's taken off the case or if notes just mysteriously appear in the binder. If they reprimand him I'm sure I'll hear about it from him. If they do nothing then I 've got to get out. Till then I'm going to practice CYA even more defensively . I just hate feeling like a wuzzy.
Jun 30, '10
We the caca hits the fan. You never want to be the one catching it. If management is putting the entire business at risk for a chosen few, so be it. Now I must say when an unethical or illegal practice continues, crying ignorant to the fact becomes more difficult. Take care of yourself first.
Jun 30, '10
Thank you. I do smell a lawsuit brewing over a string of incidents on this case before me. i consider it on the record that I gave them info they needed to know but did it w/o calling him out. I need the income, dont want to be dismissed for bringing up "problems". I just hope I don't get splattered w/ this mess.
Jun 30, '10
Start looking for another job. But I would not necessarily leave this job early over the poor job performance of one nurse. Why should he dictate your ability to pay your bills? Practice good defensive nursing. Make certain that anything you report to the agency is done in writing. Write a logical, non-threatening statement in your nurses notes to document for the record: "Previous vital signs, assessment not available" or words to that effect. That way you are recording, on the record, that his documentation was not there when you needed it. You are covered.
Jun 30, '10
Hope things work out, Jen. Home health, if nothing else causes us to see on a daily basis the horrible results of slack care and the "go along to get along" atmosphere that sickens some agencies. They aren't all like that, though. Best wishes!
Jul 2, '10
Thank you ladies for your replies. I will email my reports to keep a record instead of calling in- as appropriate of course. I'm still new and learning the cya ropes and this is a good experience for now. I enjoy the autonomy of HH and don't want to leave it or this particular job sorely over this incident but I am looking into working for other home care infusion companies. Can anyone recommend any? Thanks again
Must Read Topics