A legal Q

Editorial Team / Admin · Jan 30, 2006

The other night I worked at a nusing home (thru agency). Upon my arrival I learned that i will be the only licnesed staff in house, for my shift 6pm-6am. I was to care for 85 residents. I was told that it is legal b/c this wasn't a "skilled" facility.
I didn't get done with my HS med pass until 12:30 am, guys. I also came thisclose to running out of insulin syringes.
I called the DON about the insulin syringes, and she called me back (1.5 hours later) to tell me that she called a hospital, and proceeded gave me the method on how to calculate how much insulin to draw up on a TB syringe. Luckily, my last accu check for the shift didn't need insulin. If she had, I would have not felt comfortable enough administering it thru a TB syringe, especially by a heresay way of measurement!
With the insulin matter - if I would have needed to give more insulin and didn't have the syringes, what should I have done that wouldn't get me in legal trouble. I want the pt's to get their insulin, but not by risking my license!
Also, treatments did NOT get done this shift. A few of them did, but 4 or 5 of them didn't. I didn't have time and their were a few supplies missing for a couple of them. Would I have to make a nurses note as to why they didn't get done, or is simply circling my initials in the treatment book, which means "not done", enough to keep me covered? If I should have made a NN, what should I have wrote (examples please)? If I had enough time to make a NN, wouldn't I get Questioned by the BON, that if have had enough time to make a NN why didn't I have anough time to do the treatment (if supplies were there.) No, I have not heard from the BON or anything, I'm just asking.

Hello, ilovebuster,

I have no stats for anything close to this. You need to check out your states' BON take on this.

As for being the only licensed nurse in the building? Yes, that happens in my area as well. But, many many CNAs are there at the same time. I've often wondered how the nurse was able to do all the treatments and pass meds and chart. True, treatments are not common on nights but, I know some need to be done. As for the insulin? All I can say is please be sure you have insulin syringes readily available.

What to place in the NN? Not sure what you mean there. An explanation of why you didn't get things done? You don't chart there??????

ilovebuster · Jan 30, 2006

Once again, thanx Siri!

Ok, this place was a zoo. Not my fault that they were down to the last insulin syringe. I'm not even an employee there, just agency. I don't know what I would have done had I needed to give insulin to someone and I had no insulin syringes! I couldn't allow the Pt not to get his/her insulin, but on the same token, what on earth could I have done, legally?

As far as the treatments and Nurses Notes....

I didn't get a few treatments done. I didn't make a nurses not explaining why I didn't get them done. Instead, I just cirlcled my initials in the treatment book which (in my state) is a symbol that it wasn't done. Anytime you circle your initials, it wasn't done. Sooo, lets say that State comes in sometime and starts looking thru the Tx book, and they see that I cirlcled my initials for a treatment. They go to the NN and I don't have a not in there as to *why* I didn't do the treatment. Will I be held accountable?

I'm thinking that if a Tx isn't done, I need to make a nurses not about why it didn't get done. I just don't know what to write. "Residents W-D dressing change not completed this shift due to writer not having enough time and no other licnesed staff available to help?"

Editorial Team / Admin · Jan 30, 2006

Once again, thanx Siri!
Ok, this place was a zoo. Not my fault that they were down to the last insulin syringe. I'm not even an employee there, just agency. I don't know what I would have done had I needed to give insulin to someone and I had no insulin syringes! I couldn't allow the Pt not to get his/her insulin, but on the same token, what on earth could I have done, legally?
As far as the treatments and Nurses Notes....
I didn't get a few treatments done. I didn't make a nurses not explaining why I didn't get them done. Instead, I just cirlcled my initials in the treatment book which (in my state) is a symbol that it wasn't done. Anytime you circle your initials, it wasn't done. Sooo, lets say that State comes in sometime and starts looking thru the Tx book, and they see that I cirlcled my initials for a treatment. They go to the NN and I don't have a not in there as to *why* I didn't do the treatment. Will I be held accountable?
I'm thinking that if a Tx isn't done, I need to make a nurses not about why it didn't get done. I just don't know what to write. "Residents W-D dressing change not completed this shift due to writer not having enough time and no other licnesed staff available to help?"

O.K., let me reflect the question this way....

Are you required to document in the MR on all residents on your shift?

Are you required to make an entry outlining why you did not do a treatment or just circle the treatment time?

By the same token, are you required when you do not give a medication to document in the MR why or just circle the time?

JKDON · Jan 31, 2006

I would not think you'd want to explain in the record about not having time. Not a good idea. Yes it may be questioned why had time to write it down etc. Also, you could circle and pass on in report that some of them may be done on the next shift (say the monthly foley change) You don't want to draw attention to yourself in the record by saying you didn't have time.

I agree with Siri, it does happen and even in skilled facilities. If you have Med aides and nurse aides some items like vitals can be delegated if the pt is stable and it is routine checking. It probably won't be like that after you've been there a few times.

We almost ran out of insulin syringes once and had many TB syringes. Ours were single unit like the insulin syringes and 1cc with .1cc increments. We did not have to use, but would have if needed. It was the next safest thing we had and a temporary situation. Would have followed doses with HHG checks and made sure the doc was informed so he could advise if need. We asked our medical director and she said in a pinch (like a snowstorm) could be done, but not the best practice.

Bird2 · Feb 1, 2006

The DON should have got out of bed and gone to the nearest 24 hour store and bought insulin syringes or borrowed some from the Hospital. I have done this when I was on call when the facility I work for ran out of a certain supply that was needed. As far as the tx's are concerned I would not write in the clinical record that you did not have time. If it was that bad you could write an incident report that includes missing supplies etc. That way the info would not be in the clinical records and would give the facility a chance to fix the problems.