Being asked to sign on treatments not done

[puppypower]

I work in assisted living and it is my first job. The nursing supervisor is asking us to sign off on treatments we didn't do because we are understaffed and can't get to them in a shift. Most of the nurses do this. I won't do it. Not only is it illegal, but making it seem like everything is being done means there is no evidence for the need for more staff. In one case, an order for hourly rounding on a resident was written in the MAR. No way I can see this person more than once in a shift. I signed for one hour. But every other nurse signs off on all eight during their shift. I'm not neglecting this person, I'm prioritizing the one who fell, the one who is having trouble breathing and the one with chest pain. I can't take care of these emergencies and hourly round for something non-emergent. The supervisor puts a lot of pressure on because the "state requires that we're doing all the treatments." Not sure how to proceed to get what I want: better staffing. I've begun documenting with HR that I don't get lunches. Other nurses don't bother. It's additional paperwork to ask for your lunch time in pay. In the end I leave feeling like I wasn't able to do a good job for all the residents. Census is FULL and yet no additional staffing has been added to take care of the increase. Good caregivers are quitting due to the strain. Is there a solution? Or should I just quit before something bad happens?

[JuliaRNMSN]

I have experienced the scenario you describe. It is stressful and chips away at your spirit. It is a shame when peers are doing wrong. You know what is expected of your professional licensure and have a clear understanding of your ethics. Still, when the organization is demonstrating a lack of committment to attend to these issues, one person can do nothing. You could blow the whistle but you could face so much stress. You would need a plan and need to understand how your state supports this. In the meantime, voice all concerns to your supervisor diplomatically, explaining the shared interests in quality client outcomes through better staffing. If your supervisor does not act or go up the chain of command within a reasonable time, you must consider going to the next level. This activity shows you are trying to solve these problems for everyone's interest. Stay true to your beliefs and values, don't falsify like everyone else is, keep a personal journal of what happened, what you did, and the outcomes. Keep it at home and remember HIPPA. Consider what you will do in the event that voicing your concerns results in for example being "pushed out." These things resemble being written up for refusing to document the hourly checks for example and thereby "the RN failed to -----resulting in ----(something that could affect your future jobs, your license etc.

My experience was being written up by non nursing HR folks who composed a simplistic reason out of an unusual and very complex situation. I did not sign it. I ended up voting with my feet but the financial consequences have been awful. It was the lesser of two evils and I preserved my 25 year unencumbered license. I am still trying to write about this employment so I can appeal the fact finding decision for unemployment in the state I live in. It is difficult but I believe there is a way to do this and it is a work in progress.

[Esme12, ASN, BSN, RN]

• Quit
  
• Advocate for better staffing
  
• Contact the State Nursing Board
  

[sallyrnrrt, ADN, RN]

esme12, said it best that is the priority for me

[SeattleJess]

I would add only that you may want to make a written report to your employer on the conditions and ask them to remedy it. Also, report to your state BON and any other relevant oversight agency. Then, when your employer doesn't remedy conditions (or retaliates), quit immediately. Your paper trail will help you with unemployment and other claims.

I know it's tough but personally I could not walk away from an unethical situation just to save myself. I think we have an obligation to report, tough as it can be.

[classicdame, MSN, EdD]

quitting is not enough. Your BON may consider this type of documentation fraud

[caliotter3]

Only you can decide how much you want to deal with, concerning this. Being odd man out is no picnic. I would continue charting the truth and reporting what you feel necessary, but I would not waste any time. Look for a new job. And be prepared to encounter this kind of attitude often.

[nurseprnRN, BSN, RN]

Esme's got my priorities too. "All of the above" except put it in the MAR as done.

I review a lot of charts for a living, and when I find myself looking at a treatment flow sheet that indicates treatments were done hourly all day for someone who died hours (or a day or two) before, my clients hear about it. Bear in mind that these cases are already in litigation because something happened. This really, really looks bad. Or you see, "Turned q2h, skin dry and intact" for days and days on end, and then a new nurse comes in or the patient transfers to another unit, and lo and behold, there's a stage 2 or 3 pressure ulcer. Uh, HUH.

If your supervisor cannot be brought to understand that she is putting your facility at risk for encouraging this policy, then you have to go over her head. Document your efforts in a journal or emails, cc'd widely, s they can't blame it on you later.

Call your own malpractice insurer and get advice from the atty there-- you have paid for it already and they can help.

And you do have to report it to the state or other accrediting body for your institution.

This can also be construed as Medicare and/or Medicaid fraud, because reimbursement is based on care delivered, there are mandatory reports made quarterly to the state Medicaid office for this. and if they are billing for a certain level of care but not giving it, then that constitutes fraudulent billing. A call to the state Medicaid office, yeah, THAT should get their attention. Of course, riling up these waters means you should have another job lined up, because they will want to get rid of you. But then you can really report them.

As to your charts, the standard convention for charting omitted doses/treatments is to draw a circle around that square and initial it. Do that and nobody will be able to falsify your charts over your signature.

[OCNRN63, RN]

I had a job like this, but it was working for a physician. I quit although I should add that my supervisor fired me the day I quit. There was a lot of wrongdoing going on, and I felt compelled to report it to the appropriate authorities. It was one of the most stressful times in my life. I also worked for a facility where the stuff going on there would make your skin crawl. I kept a journal and eventually called the state. I was asked to come to the state capitol to review my journal with representatives from the Dept. of Health. That facility closed not long afterward. (I remember getting a phone call from an aide saying "The State's here! Did you talk to someone?" I never gave any indication that I had done so...talk about having to do some fast talking to distract her.)

Get out now with your license intact.

[Junebug903, LPN]

Good for you!

[ponymom]

I can't get my head around those advocating for signing the MAR anyway.

I was a new nurse at a NH, and they tried pressuring me to sign for hourly rounding, even after I worked the algorythm that showed it was physically impossible to do so. Instead I would circle in the MAR where needed and also document in the chart why I could not hourly round. I also explained to the family why I could not hourly round (I told them we didn't have enough staff to hourly round, although they knew it anyway). I put a fat stop on that pressure for me to sign for things not accomplished real quick. I suffered no repercussions.

[TriciaJ, RN]

Your employer won't staff appropriately, but tells you flat-out to falsify charting. Get out now. If any of your charting is found to have been falsified, the facility will hang you out to dry. They will deny any wrong-doing on their part.

Get a new job and as soon as you're out the door report them to everyone. BON, Adult Protective Services, Medicare (the facility is likely billing Medicare for the hourly rounds that aren't happening), the state regulatory agencies, etc. Shame on your coworkers for being part of the problem. Yes, I know they have families to feed, but what they're doing is about as honourable as shop-lifting groceries. Deplorable situation.