False documentation... more common than you think. - page 4
by OnlybyHisgraceRN 24,693 Views | 94 Comments
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... Read More
- 4Apr 26, '12 by OnlybyHisgraceRNQuote from woohi agree. i worked at a facility where me and another nurse fought hard to make changes. we both became targets. we were bullied every day. finally i quit, and the other nurse got fired. the nurses that didn't say anything, still got jobs.[/font][/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 heard nurses say, " its no bother, i need this job"
- 0Apr 27, '12 by dirtyhippiegirlQuote from palmsofvictoryHas this actually happened to you or to anyone that you know of?"Leadership has decided to make a couple of minor changes on our unit that you need to be aware of and that you will be expected to abide by.
1. Due to budget shortfall, unfortunately we have been forced to let go of our unit secretary and all of our PCTs effective immediately.
2. Your shift patient load will increase by 2 patients.
3. You will now be required to have each patient fill out a "shift feedback survey". You will turn these in to the unit manager at the end of every shift. Both the diligent completion and content of these surveys will be considered when your performance reports are written.
We regret having to make these changes, but I can assure you they are necessary. You, of course, will be expected to continue to perform at the highest level."
- 11Apr 27, '12 by palmsofvictoryNo. This is an exaggerated example of the fact that many ppl (not just nurses) are being asked to do too much these days. (Saw it in the teaching field, see it with my wife and friends in their careers... speech therapists, PTs, etc.) But we can't just keep pretending that it's not happening. I think the OP understands this and is looking for others who are thinking the same thing and willing to say it.
We are reaching a breaking point, like the founders with the tyrannical British king.
As pertaining to workloads (nursing and otherwise), time is not magical. It is a limited resource. You can only do so many tasks in a set amount of time.
If you are a personal assistant to someone and they give you a shopping list and $100, you can only buy so many things for $100. No matter how much they want you to or threaten to fire you, you can't keep adding items to the list and still come in under $100. You either have to start buying really cheap goods (reduce quality/time of care for each pt), take some items off the list (reduce case workload / # of pts), buy only some of the items on the list and lie to the boss (if they will not listen to reason and keep on demanding everything on the list) and hope they don't notice some items are missing (get "efficient" with documentation), buy all the items on the list but use your own credit card (clock out and finish paperwork on your free time til 2 hours after your shift is over), or tell them to shove their job up their #%$ and find a new place to work.
It is an allegory. or whatever that would qualify as.
If someone gives you a hairbrush, a 2-liter of Dr. Pepper, and a pack of gum and says "You have 3 hours to build me a Corvette or you're fired"... well, they deserve a kick in the nuts at that point, don't they?
Good day, friend.
- 11Apr 27, '12 by jlynn2303The first ltc facility I worked in, right out of nursing school, it was universal practice for all the nurses to get report, count, and then sign the treatment book, before they ever went out on the floor. I, new nurse that I was, said "but I haven't done them yet!" "you won't have time to come back and sign them later" I was told. They just laughed at me.They were right. You were in trouble if you stayed overtime to do it, you were in trouble if you clocked out and worked to do it, you were in trouble no matter what you did. I am not saying I approve, but that is the way it was.
I am currently in a facility where there are meds, and breathing treatments etc all due at 5pm, I'm supposed to pass trays, hang an IV, supervise the dining room, pass meds simultaneously every night. I have 26 patients, 5 gtubes, 7 diabetics, a trach, 6 breathing treatments (multiple times a day) one man whose chair needs repositioned every hour( and only nursing can do it), another woman whose brace needs to come off or go on every two hours, p cleaning someone's eyes, vitals, lotions, bandage changes, wound care.....next week I am supposed to get a woundvac/gtube added. Speech therapy told me she is going to turn the pleasure feeding of one of my gtube patients over to nursing, three times a day - I said "I don't have time." I am already in there, pouring the food, dropping the eye drops, for 12 minutes each time. Therapeutic feeding takes 20 minutes, at least. Add that to the trach care and just one of the other gtubes (just one of them) and there's an hour already - at med pass time. And I've got 24, count 'em, 24 more patients to go. I am supposed to be off at 10pm and it's not unusual for me to stay until 2am. Nurses in this facility stay for hours after their shift ends to get treatments done, meds passed, etc. It would be impossible to fill out an incident report every time a med was late. None of us would ever be able to leave. This is universal at this facility. I focus on the meds that are time critical - insulin, heart meds, antibiotics, etc - if someone gets their colace with their bedtime meds, they'll live. God forbid a patient actually wants to TALK to me, or needs a hug, or a family member calls, or a doctor's office, or pharmacy shows up. I go without dinner, without breaks. This is true on every shift and every hall in this facility. God forbid you find a rash - it's 45 minutes of paperwork. Skin tear? same thing. If you get a fall and skin tear in one night, don't bother crying, there isn't time. I come in repeatedly to the first shift nurse in tears trying to keep up with it (she's been there 13 years and has resigned, as has the adon, the unit manager, the 2nd shift manager etc) Management doesn't give a damn and I hope there's another level of hell for the people who admit these patients and just stack them up on these halls without any consideration for acuity and adequate staffing. I talked to our medical director about it one night - I said it's my license and yours, not the guy in the admissions office - why don't you have a say in who is admitted here? You are the medical director?! Not the aide who was promoted to admissions director, or the aide who is now facility director. He is going over the facility director's head to corporate, I think. Nurses are quitting right and left and I am looking because I hate working this way. Apparently, the facility director gets a bigger bonus the less staff he uses to run the facility. How he sleeps at night, I do not know. When I've worked outside of ltc this stuff hasn't been an issue. I was transferred here because census was low at another company venture (hospice) where none of this was an issue. There was sufficient staff, sufficient time, etc. Sure, it was crazy sometimes, but not like this. In the midst of it all, there are real people, real patients, real nurses....and I try to hold onto that, to the human contact, and try to make a difference to at least some of them.
- 5Apr 27, '12 by thelema13I have filled out many risk masters with no action taken. I have gone to multiple meetings, requested by myself, to speak with the ED director or manager about a nurse/incident/labs lost/yadda yadda.
The sad thing about all of the previous posts is that it happens all too often. Under staffing, pressed for time, and increased patient loads make us cut corners from time to time. Yea, I have falsified a patients vitals that was in my ED for a toothache or a stubbed toe. I document estimated weights all the time because I cannot get every EMS or straight-back patient on the scale. I am supposed to do hourly rounding AND hourly clinical notes, but in all honesty, when does that happen? On a slow night perhaps. If I am lucky.
Some genius thought it would be a good idea to scan all meds when giving them. Yes, accurate charting and another fail-safe for patient safety, but also yes to time consuming, frustrating when the scanner/badge/med doesn't work properly and not really appropriate for the ED. And then I get chewed out for not complying with policy. How about some of the higher-ups come down and work a shift and scan ALL the meds? Half the time the COWS battery is dead from day shift.
Our scope of practice as nurses is continually widening, yet staffing seems to dwindle, tech positions disappear, and shifts feel like they get longer. There is always an exception to the rule, but knowingly fraudulently documenting that you did something when you did not is wrong. Slap my hand for documenting the tooth ache has a pulse ox of 100%, but I am not charting an assessment that I did not really do. I simply won't document, and if my charge or manager or director wants to ask questions or moan and complain, I will tell them the truth. Yes, the reason the Baker Act ran out of the ED is because the psych rooms were already full, the ED was full, and I had 7 patients to care for and I even pulled a CNA from the floor to be a sitter. I am not going to tackle a patient, that is what the sheriff's office is for. It is not my fault that we are understaffed and overworked. The truth hurts sometime.
To the LTC and nursing home nurses, I give you kudos for what you are able to do. That has to be a depressing job. I know you guys are so understaffed, it is ridiculous. Blame capitalism and greed for these situations. Just one request before you package up a patient and send them my way: an accurate, concise report would be nice, handwritten on paper even, and not 'the patient doesn't look good"; empty the foley bag! Vent over.
I say to each their own. After all, it is your name and license number that is on the line when the attorney's start sniffing.
- 0Apr 27, '12 by HorseshoeQuote from LadybluebellOf course it is. If it's not true, it by definition must be false.I think everyone does some "creative' charting once in a wile with the workload we have, and manager's breathing down your neck. I would never make up vital signs or anything, but sometimes you need to get creative. I will document hourly rounds because i am expected to, but sometimes i might not really get in to the room that often. I don't consider this as false documentation. If i am in the room q2 instead of hourly and the patient is ok, whats the harm.
There may be no harm in a q 2h check. If you can justify it due to the patient's condition/status, by all means chart a q 2h check.