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

Music in My Heart · Mar 24, 2013

...at this point i seriously think I deserve to be fired since I know the consequences of the mistake I had made.

I challenge this thinking.

You do *NOT* deserve to be fired. I am sick of how our society's immediate response to a mistake or an error in judgement is to try to destroy somebody's livelihood.

If you had a history of cutting corners, OK, termination might be appropriate. In your case, you made a stupid decision and have apparently recognized you error.

You may be terminated, I don't know.

However, you do not *deserve* termination - you deserve remedial training and... yes, grace.

Fiona59 · Mar 24, 2013

Are you in a union? If so, seek their assistance.

She won't get much support from a union. I mean, they might quibble over the short shift turn, but if the OP consented to it, well that's her issue.

Falsification is lying. Not telling truth. Unions don't back liars.

They might be able to make sure she gets a slap on the wrist but they aren't going to hold her hand and pat her on the head and sing kumbaya.

I'd be more worried about it being reported to the nurse's registry.

sharpeimom · Mar 24, 2013

You falsified records and that's a pretty big mistake, but since you're a new nurse, you're also still learning. You know what you did was wrong and why, and deserve a chance to show that you have learned why it is wrong and will never do it again.

A nurse learns never ever to chart even five minutes ahead. Too much that is unexpected can happen. Seemingly stable patients can crump at a moment's notice. Orders can change or be discontinued... patients can switch rooms and floors...

SleeepyRN · Mar 24, 2013

Best of luck to you. I love hearing that you're taking full responsibility and not making excuses. People are way more likely to be a little lenient when you own up to it and offer on your own ways in which you can improve. I think you've gotten great advice so far. If you had tried making excuses, the responses would probably not have been so kind.

That being said it's messed up that we are even put in positions where we are even tempted to cut such a huge corner. I've said before, no nurse I know goes into work thinking "I'm going to be lazy and cut corners today." When it happens it's not because we want to do it, its because either 1: we are new and still slow without help from a charge nurse or 2: nurse to patient ratios are simply unrealistic. I'm confident that without a doubt, if I had stayed at my first LTC position, I would have eventually been suspended, fired, or reported to the BON because the facility set us up to fail to save money. I hate admitting it, but the truth is, yes, there were times I falsified documentation by signing off the MAR when I wasn't finished passing meds (because my 2 hour window was up.) I'm really not trying to make excuses. The facility was just that awful. So I'm still in the process of looking for a job, but am scared to death that the next facility will be just as bad. I don't want to job hop, but I don't want to be in a position where I am DAILY forced into deciding between signing the MAR early, or being honest and always "being in the red" on the MAR because I'm passing my last meds late. I feel like its damned if you do, damned if you don't. So I'm going to try to find a mentor in my next job. Good luck with everything.

gcupid · Mar 24, 2013

What if you we're unable to make it to the next scheduled shift bc of a car crash or etc. There is no such thing as short cuts when it comes to documentation in nursing...... And that's why many short cut on the patient care side of nursing. Always think in legal aspects. Cover your self

SleeepyRN · Mar 24, 2013

I actually have a good example of how charting early screwed me. I was working 3-11. It was a particularly bad day (my last day before I quit actually.) I was majorly behind on my med pass. At 1900 one of my residents fell out of bed and had hit his head. I did a neuro check. His BP was around 200/120. When I looked in the MAR, I saw he had had a BP med that had been due about an hour earlier. I'm shameful to say that I had already signed the MAR that I had given him his med, when I really hadn't gotten to him yet. So I didn't know if his BP was high due to the fall, or because he hadn't received his BP med yet. Quite the predicament I put myself in legally and ethically. What I ended up doing was, when I called the NP, I told her his BP along with the rest of my assessments which were normal, and admitted to her that I had not given him his BP med yet, so that could be the cause of his elevated BP. I was ready to be reamed, but she was luckily nice with me about it and told me to go ahead and give him his BP med. But my documentation was false :/ I learned a HUGE lesson. I put my patient in potential danger because of my false documentation. The incident could have turned out way differently. The NP or MD could have looked at his high BP, and thinking I had already given him his BP med, assume that the high BP was a symptom and base their treatment on that false documentation.

With my next job, I'm going to first see who of my patients are on BP meds, and get them their meds first. And of course prioritize other patients as well.

SuzieVN · Mar 24, 2013

A union has nothing to say about a nurse that falsified documentation. What were you thinking, though- where did you get the idea to do that? Did you think "What if I'm in an accident, and can't go to work tomorrow?". Is there a widespread practice of other nurses doing it? You are in a very, very sad situation- ethically, your DON is obligated to report you to the BON. Is she doesn't, and all that happens is that you are fired, you better thank your lucky stars. Being an LPN only 10 months, I'd think you's still be full of fear about doing anything except by the book, that's what makes me think, maybe, that there are issues in your place, that you are picking up others' bad habits? Cross your fingers, be forthright and direct with the DON. Do not make excuses. Do not beg her to be lenient. Just look her in the eye, and tell her you accept whatever decision she hands down. But if you're into it, she doesn't report you- if that happens, naturally, you realize your nursing future will be bleak...Tell us what happens, eh?

SuzieVN · Mar 24, 2013

With my next job, I'm going to first see who of my patients are on BP meds, and get them their meds first. And of course prioritize other patients as well.

It is a great idea, that before that prior to starting the routine meds pass, to check sugars and BP and O2 sats and lab reports and other indicators that can cause you to have to alter the meds you give, call for new orders, call in extreme situations. I also make rounds to see if anyone needs pain med right off the bat, so they don't have to wait an hour or longer- it also cuts down the call lights, dramatically. It may seem like doing double the work- but you will actually save a lot of time by putting out all those little fires before you get caught up in a massive, neverending med pass.

BSNbeauty, BSN, RN · Mar 24, 2013

OP, you had a lapse in judgement and unfortunately there are consequences. I too, made a mistake and took a short cut in documentation which was falsification. I owned it and apologized and the DON was nice enough not to suspend of fire me. I'm still haunted to this day, thinking that one day I'll get a call from the BON because of this huge mistake. I did what all the other nurses do, which is to sign treatment MARS in the beginning of the shift, ofcourse I was the only one that got caught. It was a lessened learned and I never did THAT again. I hope it all works out.

SuzieVN · Mar 25, 2013

You falsified records and that's a pretty big mistake, but since you're a new nurse, you're also still learning. You know what you did was wrong and why, and deserve a chance to show that you have learned why it is wrong and will never do it again.
A nurse learns never ever to chart even five minutes ahead. Too much that is unexpected can happen. Seemingly stable patients can crump at a moment's notice. Orders can change or be discontinued... patients can switch rooms and floors...

And any nurse that has ever worked LTC also knows that it is a reality that there is always another nurse in that place, either before your shift, or after your shift, or wants your schedule, or wants your man, or is just personally miserable, or whatever that is always ready and EAGER to get other nurses in trouble. Obviously, the nurse that caught your error isn't your best friend. Also, I've signed off whole days worth of meds on the wrong date (like when medical records prints the wrong dates (such as February 30- it can happen when you're following the day shift, who also signed on a wrong date, before you notice), and had to go back and 'error' 100's of my initials, explaining 'med not given, signed in error, February 30 does not exist'...

allnurses Guide · Mar 25, 2013

Yes, you can get fired for that, but I doubt your DON would schedule a meeting for April 4 if she planned to fire you. I know you took responsibility for what happened, but I do think this is a little different from the usual scenario of "new and still learning", unless your school sort of glossed over the topic of documentation, it's really more an indication of how you react to stress and fatigue, disregarding a basic safeguard that is usually drilled into the heads of nursing students, and also different from pre-charting to avoid documenting outside the two-hour window during a shift because of the 8 hour interval between your two shifts.

I'm not trying to chastise you by that, just that maybe you should reconsider your rotating schedule or otherwise try and deal with a root problem, in case something else happens while you were in the same state of mind as that which caused you to falsify the record.

SleeepyRN · Mar 25, 2013

It is a great idea, that before that prior to starting the routine meds pass, to check sugars and BP and O2 sats and lab reports and other indicators that can cause you to have to alter the meds you give, call for new orders, call in extreme situations. I also make rounds to see if anyone needs pain med right off the bat, so they don't have to wait an hour or longer- it also cuts down the call lights, dramatically. It may seem like doing double the work- but you will actually save a lot of time by putting out all those little fires before you get caught up in a massive, neverending med pass.

Thank you for the advice. I used to, at the beginning of my shift, write down who needed BG and vitals. I only worked for 6 weeks on my own, so I was still trying to find the routine that worked best for me. So even though at start of shift, I knew so and so needed 02 sat checked, I may not have gotten to it til half way through my shift. Which as I'm learning, doesn't make sense, because as you stated, the assessment could change the course of care for that patient that shift. Thanks :)