OnlybyHisgraceRN 12,067 Views
Joined Mar 29, '12.
Posts: 755 (52% Liked)
why does everybody come to an and ***and moan about staffing in snfs and ltc and i don't ever see anyone saying what they did about this? is there anybody out there who has promulgated some sort of action to effect change in these situations? please, i wanna hear about it! everyone wants to hear about it!
you know, when you make out a variance report ("meds for south wing given two and one half hours late due to new admission assessment," "no weights done on first of the month, insufficient staff," "mds done 4 days early as i will be away on vacation and there is no one to cover me," "foley catheter care on five residents not done this shift, no time due to extended med pass.") it goes to your risk manager. if you are part of a corporate structure, it goes to the corporate risk manager.
risk managers get very cranky about this sort of thing, because they realize that when there are a lot of these, they indicate system-wide risk exposure, and that means money (fines, judgments), and that gets management's attention. if everyone does them, especially if you are in touch with colleagues from the other facilities in your network, you could <gasp> have an effect for the better.
if you are really ripped about the situation you're in, and you get no response from the risk manager maneuver, you could make anonymous reports to the state. but do something. act like professionals, the professional advocates you are. it's for the residents, see.
At the onset, when administrative bureaucracy came up with the requirement to document :
Q 15' checks for ANYTHING
Q 2 hour checks for restrained patients... checking the restraint site, checking the toileting needs, checking the need for continued restraints, checking the vital signs...
We unanimously agreed...
They are MAKING us lie! The very act of initialing all of their precious little boxes .. makes it too time consuming to perform the tasks!
This is not just LTC... it is everywhere.
Any one that doesn't see that .. has their head buried in the sand.
Kudos to you for having the guts to bring this issue into the real world.
Just because some nurses assert that they do not falsely document does NOT in any way imply that they are saying they are "perfect" and it is unfair and misleading to suggest that they do.
OK I am going to disagree. A proper slow code is an art. How to make it look like you are doing something when not really trying to save the patient. As far as I am concerned the slow code will be needed as a self defence mechanisim for health care providers so long as our society maintains it's irrational refusal to talk openly about end of life issues and accept that dying is part of life.
I am a full time rapid response nurse. I am the code administrator for my hospital and the alternate code team leader until / if the "code chief" (usually a senior med or surg resident) arrives on the scene. Occasionaly I will run the entire code like the few times there have been two codes going on at the same time or the code chief doesn't show up for some other reason.
ON several occasions I have refused to code a patient at all. Other times I will let the team know this is going to be a a "show" or "slow" code. In every instance I had reason to know the patients wishes and knew that being coded was aginst their wishes. For example one man with severe necrotic bowel, literaly rotting from the inside out did not wish to be coded. When he was alert and oriented early in his hospitalization he made the informed decision to be a DNR. Later, when he could no longer make his wishes known, his estranged wife changed his code status to full code. The real problem is that she would be allowed to do that at all. That his weak kneeded-fearful-of-a-lawsuit physicians agreed to the change in his code status is another major problem that needs to be adressed. However all that is water under the bridge when "code blue" is called on him.
If the patient has made an informed decision to be full code I will code the heck out of him. I will not go aginst a patient's informed decision and wishes. I hope it doesn't cost me my job (so far not an issue) but if i does it does.
I have seen something similiar in my 3 years of nursing. An elderly man coded, and initially everything was being done, but then the the doc decided to verbally end the code, but everyone involved kept documenting as if the code was still happening. Needless to say, I was shock but apparently it happens.
Disclaimer: This is my personal opinion and I hope we can agree to disagree if need be. If you are a perfect nurse, please do not read.
I have seen many threads on AN about false documentation and while most replies to these threads have been helpful many members feel the need to judge the OP for false documentation.
In my opinion, many floor nurses are guilty of false documentation, so what gives some of you the audacity to judge and berate another nurse.
How many times have you given a medication outside of that "one hour" window but charted it was given on time?
How many times have you documented your assessment at the time it was supposed to be done, when in reality it was done much later or even much earlier.
For my LTC, nurses are you 100 percent positive that your 20-60 residents were turned and repositioned every 2 hours, or that each one of them was toileted every two hours? Yet you will still initial those two initials in that square box.
When I was a nursing student I would often floor nurses "magically" come up with a patients weight, vital sign, or blood sugar and document, knowing that it was NEVER done. I was so quick to judge as a student and thought their license should be taken right away. After working as a nurse, I realized that while I don't condone that behavior I understand it.
If you answered NEVER to all my questions you are either a super nurse or either you work in a place that have perfect staffing, perfect patients, and perfect coworkers.
The purpose of this thread was for us to sit here and evaluate ourselves before we judge someone for false documentation.
I'm not talking about the nurse that is clearly negligent, lazy, and etc. I'm talking about the nurse like myself who provides competent and quality care to patients but faced with staffing issues that makes it nearly impossible to document every single thing as it is being done.
Unfortunately, some of us work in places where we no longer take care of patients but instead we are taking care of the higher ups in their effort to please the state.
Maybe if we can get rid of some of this customer service BS we can actually have more time for proper and precise documentation.
We are saving lives everyday. I rather give a calcium chew tablet 2 hours late than to ignore my patient that has CHF and having SOB.
So the moral of this story is that people in glass houses shouldn't throw stones.
For all of you nurses that never had to participate in "false documentation" I admire you, envy you and hope to be like you when I grow up.
This was is more of " mean things nurss say"
A coworker had a difficult patient. The patient was very sassy and sarcastic. The nurse asked the patient if he was in pain. The patient replied " are you in pain"?
The nurse stated: " Yes, I'm in pain but my pain leaves when I go home, yours will always be here"
Short version of my story is I accidentally told a pt I did not want her "to go down on me" when I really meant fall down on the floor. Oh I was dying trying to get out of that room I was so embarassed.
I'm going to pick on myself for a moment. I have to admit that sometimes I blurt things out without truly thinking about it. Today I said something ( without thinking) to a patient that was purely stupid.
Long story short: My patient had to drink a medication that did not taste so good. She had to drink a whole cup and the only thing I could do to make it bearable was to add a little ice.
Patient: "This taste horrible"
Me: "Just imagine it is a magarita on the rocks"
Patients' husband: " That is not a good idea, since we are both recovering alcoholics"
Me: " Oh you are right...bad idea, never mind.( then I proceed to use more therapeutic interventions)
Needless to say I learned my lesson, never assume anything.
I now except my award for blurting out the most stupid thing ever!
[/size]yup, get's management's attention, and they come up with an innovative solution, generally involving giving the nurses yet another form to fill out.
bahahaha! right. like nurses can get together on anything. there's always the few that will just suck it up and do whatever management tells them to do. and depend on the few vocal ones to get in trouble and change things. but because the quiet do gooders won't get behind them, the vocal ones get told, "well nobody else is complaining!"
if there's not time to chart accurately, there's sure not time to chart incident reports for every single thing.
I've been in Nursing for 25 years, and I can say without a doubt I have never falsified a patient record. I am not super nurse, but I am an ethical one. If I didn't do something, or did it late, I documented that and why. I have written things like: "could not turn patient due to her weight and lack of available assistance. Hoyer lift out of service."
Hell yes it upset people. But I'm not going to lie to protect them. I tell the truth, to protect myself and ultimately, the patients.
In my opinion the OP is just making excuses for bad practice; practice which is frankly, indefensible. I hope there isn't much support for it. Another reason nursing is in such a state, we cannot even trust our "colleagues."
It is a pull down assessment, you can do a comment though. But I don't see the point of writing that it is a late entry, I did the assessment at 12. It is not like I am making an assessment up, at which point I would consider false documentation coming into play.
yeah, since you ask, honey. get out in the real world. of course admin, don, and previous coworkers aren't going to do anything-- they'd have done it already if they were inclined to. all you've mentioned here is just in-house moaning.
i don't see the state inspection people in there, i don't see any corporate risk managers or corporate attorneys in that list. chapter and verse and why it matters (since they might not always know the medicare rules, etc.)
and it's gotta be more than just you.
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