Can I get fired from signing the MARS a night before my next shift

Guest343211 · Mar 25, 2013

Wow. I feel for you, being tired and all. I can relate, but wow. I don't understand this. You did this on purpose? ???

Legally it's as bad..actually worse, than writing a bad check...you know...on purpose.

If someone notifies the BON, you are in trouble. I know you say you've learned your lesson. But I don't understand your thinking process in the first place. I would have you take a course on the legalities of documentation. It's like you didn't understand that you can't attest to something that hasn't happened yet. In short, you lied, and it's documented. Besides, what if you signed that you gave something at 0300, and your pt had a problem, or coded at 0100? How would you explain the signing of the meds two hours later? You don't think anyone would question this? It does not matter if it's amended. People would wonder why things are signed for 3, when pt coded or had some significant problem at 1, which would have affected the pts taking of meds at 2 and 3.

Guest343211 · Mar 25, 2013

“If we judge ourselves only by our aspirations and everyone else only by their conduct we shall soon reach a very false conclusion.”
― Calvin Coolidge
In other words, we tend to overlook our own transgressions while seeing nothing but when it comes to others.
The OP made a bad judgement call, but is not a "bad" nurse. We've all, every one of us, done something we're not proud of in our nursing career. The anonymity of the Internet just makes it easier for the self righteous to stay firmly on their high horses......

No offense,but who signs out meds a whole shift or day before the shift? That's like a doc writing a surgical procedure note 24 hours before the operation. It doesn't make any sense.

CodeteamB · Mar 25, 2013

Ok, I am ignorant having never worked LTC but I'm having a hard time understanding how this saved time... Anyone?

BrandonLPN, LPN · Mar 25, 2013

I'll admit, I don't understand the logic of signing out meds a day in advance. The OP should have realized at least two more nurses would be using the med books between now and then.

But initialing meds at the beginning of your shift for meds to be given later isn't unheard of. In corrections we pre poured all meds. And we signed them out in the MAR hours before giving them. If an inmate refused or even died in the intervening time, well, you just circled your initials. I can't do this in LTC but, frankly, I don't see why not. It's a MUCH safer way to pass meds.

pinkdustmagic28 · Mar 25, 2013

Hello guys wow thanks for all the posts. well I just wanted to add a little more about the job I do, I work in a long term care psychiatric facility, the unit where I was working at the day I made the stupid decisions of signing the MARS the night before has patients where the majority of them are aware of all the medications they take on a daily basis so they will tell you something is missing or if you are giving them something extra, I DID USED THE MARS TO PULL OUT MY MEDS, also the facility where I work is sad to say but is a very corrupt facility by corrupt I mean that since I've been working there I have seen Medication that are due at 1800 being pass @ 1600 and that ones due at 2100 get pass at 1800-1820 of course I have never said anything because besides being new I'M THE MINORITY. Since I started working here as an LVN (was a CNA here before) I HAVE ALWAYS TRIED REAL HARD TO BE ONE OF THE "GOOD NURSES" AND DO THINGS THE RIGHT WAY, so the mistake I have made has really affect me :down: because I felt that I have let down the residents I care so much for, and I have probably made the DON think that I'm careless and like to take short cuts, and like I said before I HAD ALREADY TAKEN RESPONSIBILITY for what I have done, I have not denied it, and I DO NOT THAT WHAT I DID WAS REALLY STUPID, AND I WOULD NEVER DO IT AGAIN, but besides being worry about getting fired I'm really concern about the facility reporting to the state I don't know what I would do if that happens

pinkdustmagic28 · Mar 25, 2013

thanks for the post, i have not tried to justify what I did in anyway, I was really honest with the DON, I told her that no I wasn't thinking and that yes I did sign the MARS the night before and that indeed I felt like I deserve to be suspended and yes I have always learned from my mistakes and this will be one of the ones that I WOULD NEVER DO, and yes so far this has been the worst and the only mistake I have made since I have been a LVN and I will make sure this will be the last one thanks for your post :up:

I am glad you seem to grasp the seriousness of your decision to pre chart. Now comes the really difficult part of dealing with the fallout from your decision. You need to use the lesson learned from this situation the next time you are faced with a choice of deviating from standard practice or facility policy because you will face those choices many times over in your career regardless of the practice setting. Remember the feelings that ran through you when your bad decision was discovered and the anxiety over possibly losing your job or having to go before your BON and attempt to justify or defend your decision. In other words please take this entire thing to heart and remember how even the seemingly simplest thing can turn around and bite you in the posterior and shoot your career right down the drain.
Move on, learn, remember and let this incident make you a better nurse in the future. We have all made bad choices in our careers; hopefully this will be the worst one you ever make.

pinkdustmagic28 · Mar 25, 2013

YES I was kind of influence by how my place of work is, I mean all their "HOUSE RULES" get broken on a daily basis but this doesn't justify for me to do what I did, since I started working here I had always tried really hard to be one of the "good nurses" which is not really many at the facility where I worked they all cover their backs unless you are not one of their race then they throw you under the bus quick, I feel really ashamed of myself because I did exactly what I told myself I would never do, be like the rest of my Co-Workers :no:

I still say she must have been influenced by the culture in that place, to presign all those meds. Ten months post LPN school is not enough distance (time) to have lost the paranoia of doing anything wrong, to check every med 16 or 20 times before giving it, or to even think about doing anything off kilter. I think she ought to claim temporary insanity, and also to name names of everyone else who is operating on the sly- sort of like receiving immunity from prosecution? Worth a shot, after all- she did infer that a fellow nurse instigated her disciplinary process.

pinkdustmagic28 · Mar 25, 2013

I'm not going to pile on and chastise you for doing this. You know you did wrong, and you seem willing to take responsibility for it even if it does cost you. However, you should also be aware that you shouldn't sign the narc count book ahead of time, not even for the end of the shift like a lot of nurses do. Honestly, how do you KNOW for certain that you'll be there at the end of the shift? As the saying goes, defecation eventuates, and careless nurses sometimes find that it eventuates all over them!
I learned this the hard way myself years ago, when I fainted at work and had to be taken to the ER in the middle of a night shift. Like most of the other staff with the same bad habit, I'd already signed in both 11-7 spaces and was still at the hospital when day shift came on at 0700. Obviously, I wasn't there to count narcotics in the morning (the other night shift nurse had taken over for me) so when I went back to work a couple of days later I was called into the DON's office. Luckily, I received only a verbal warning, and of course have never done it again; but over the years I've noticed a lot of people do it out of habit, and I'm always cautioning nursing staff members not to. The time saved isn't worth one's license!
Off my soapbox now. OP, I wish you well.

Hello there thanks for your post I did not sign the NARC count the night before, you don't know how bad I feel by doing what I did, I do not have a habit of taking short cuts when working I seriously don't understand why I did this I have never done it before and certainly I won't do it again.

BSNbeauty, BSN, RN · Mar 25, 2013

Samadam- I'm going to go out on the limb here and assume you have never worked in a LTC facility. If so you would understand why this is done. However, understanding and condoning are two different things. I have seen a few nurses pre-sign MARS. I don't condone this however I understand that they are doing to save time. I think the OP learned her lesson and will most likely NEVER do this again. I agree with Brandon, that it is so easy to stay on a high horse when on the internet.

Wow. I feel for you, being tired and all. I can relate, but wow. I don't understand this. You did this on purpose? ???
Legally it's as bad..actually worse, than writing a bad check...you know...on purpose.
If someone notifies the BON, you are in trouble. I know you say you've learned your lesson. But I don't understand your thinking process in the first place. I would have you take a course on the legalities of documentation. It's like you didn't understand that you can't attest to something that hasn't happened yet. In short, you lied, and it's documented. Besides, what if you signed that you gave something at 0300, and your pt had a problem, or coded at 0100? How would you explain the signing of the meds two hours later? You don't think anyone would question this? It does not matter if it's amended. People would wonder why things are signed for 3, when pt coded or had some significant problem at 1, which would have affected the pts taking of meds at 2 and 3.

SuzieVN · Mar 26, 2013

Ok, I am ignorant having never worked LTC but I'm having a hard time understanding how this saved time... Anyone?

Imagine having 25, 30 patients. Each has possibly 3,5, or more med sheets. Most receive over 10 meds. The med book can be several inches thick, with possibly 100, 150 pages of meds. Each med needs an inital in the box- maybe 1000 boxes on one shift. One blank box, whether or not the med was given, can cause a write up, or worse. With a med pass that can last 2-4 hours, the pressure not to miss a single box, meaning to cause a med error- is intense. For some nurses, they feel that if they first go through the book, focused soley on filling in boxes, down the line, page after page- that they will save time, rather than signing one box at a time, over and over. Then they can focus on pulling the meds from the cart and giving them. Despite the risks, and despite the fact it makes no sense, the urge to presign is too great for some nurses to resist. It's quite a strange phenemenon. But it happens in every nursing home, to some extent.

BrandonLPN, LPN · Mar 26, 2013

Imagine having 25, 30 patients. Each has possibly 3,5, or more med sheets. Most receive over 10 meds. The med book can be several inches thick, with possibly 100, 150 pages of meds. Each med needs an inital in the box- maybe 1000 boxes on one shift. One blank box, whether or not the med was given, can cause a write up, or worse. With a med pass that can last 2-4 hours, the pressure not to miss a single box, meaning to cause a med error- is intense. For some nurses, they feel that if they first go through the book, focused soley on filling in boxes, down the line, page after page- that they will save time, rather than signing one box at a time, over and over. Then they can focus on pulling the meds from the cart and giving them. Despite the risks, and despite the fact it makes no sense, the urge to presign is too great for some nurses to resist. It's quite a strange phenemenon. But it happens in every nursing home, to some extent.

Exactly.

I can always tell which posters here have dealt with a LTC paper MAR and it's thousands of tiny little boxes..... and those who haven't.

Yes, it's clearly illogical and risky to initial meds in advance. But everything about a LTC med pass is illogical and risky. You have a system that's over regulated and facilities that are over punitive, stuff like this will happen.

wyogypsy, RN · Mar 26, 2013

STOP beating yourself up. Yes what you did was wrong, but nobody died over it. You have taken responsibility (and believe me, not all do), you have learned your lesson, you are still a nurse, and able to practice in that facility even if it is not passing meds but doing wound care. I doubt they are going to turn you into the BON or they would have already done it.

Is there a nurse there that you really respect? Maybe you could shadow her for a med pass. Ask the DON if you could do this, and ask if there is a nurse she could recommend that you shadow. I realize you would have had orientation, but there is only so much we can grasp during that stressful time. Now you would have other questions for that nurse on how and why she does things the way she does. This could be a huge benefit. Every nurse comes up with their own routine and some are much better at it than others. We can always learn from each other.

We have all made mistakes, some we don't even know we have made. Long-term care nursing is wonderful in the fact that we get to take care of the best patients in the world, however, it is certainly a very difficult specialty.

With the way that you have accepted responsibility you will do just fine in nursing - it is good to see someone not trying to place the blame elsewhere!