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

SuzieVN · Mar 26, 2013

Sorry to beat down the same old path, but again- I feel the customary routine in that place is for people to cut corners, and that the OP took the bait. OP was reported by another nurse, then she was suspended, and placed on a lower scale of work- pending the final outcome. Possibly, the DON was forced to realize that the place is a mess, that she is at risk, herself, and maybe that is why the end result hasn't yet been decided, if it hasn't. The DON may in fact be in jeapordy of BON action...or maybe the DON needs to sort things out, to make sure she is then not reported, herself? It's a tangled web, we weave- and too bad more nurse are not aware of the totality of the situation when they try to attack their peers...more so in this digital age: It might come back to bite you on the ***?

Welcome to nursing, especially LTC- somebody is ready, able, and EAGER to cut your throat, daily.

Guest343211 · Mar 26, 2013

Samadam- I'm going to go out on the limb here and assume you have never worked in a LTC facility. If so you would understand why this is done. However, understanding and condoning are two different things. I have seen a few nurses pre-sign MARS. I don't condone this however I understand that they are doing to save time. I think the OP learned her lesson and will most likely NEVER do this again. I agree with Brandon, that it is so easy to stay on a high horse when on the internet.

Whatever with the whole high horse comment. Unless there is an issue of safety for the nurse/s, as maybe Brandon implied, it's basically like purgoring yourself . There's a lack of understanding about legal documentation. Until you can understand the nature of what you are doing legally, all the back and forth won't matter. All the nasty comments about high horses won't matter. It's a freaking legal document. It is what it is.

Now, I have worked on telefloors prior to critical care, where we had 14 to 16 patients per night, and let me tell you. Those people were getting every kind of medication under the sun. On top of that you were bombarded with admits and codes, and IVs and runs of VT and all kinds of ****. The biggest difference to me would be 10 or more patients that may not have good swallowing in a nursing home. But people in the hospital can have problems taking many different kinds of meds as well. And then you can have all kinds of problems getting and keeping the IV is--and all the other acute care stuff that can hit you all at once, and/or patients that actually need to go to a unit bed, but there are none available, so, you are running your 14-16 patients and a mini-ICU on the tele floor. You had sure as hell hustle on these floors, b/c you don't know what the hell is going to hit your floor or come down.

On top of that, you have to be able to assess and document, at least on your own cheat sheet, what is going on with those patient before or at at the time of their first set of medications. There are zillions of labs to follow, and many medications that require certain assessment or signs directly prior to administration. It's not enough to have some tech or aid run all the signs and then when you get to the patient, you give the meds based on those signs. They are tele monitored and their are on meds and things that can change their data from minute to minute.

Maybe nursing homes need to invest in computer MAR programs. But pre-documenting administration 24 hours before giving a medication is totally insane, and no offense, but I have to wonder about the nursing judgment of a person that would think it may or may not be OK to do, and then goes ahead and does it.

Someone needs to available and problem solve on this issue, if this indeed is something prevalent within a facility.

Guest343211 · Mar 26, 2013

Exactly.
I can always tell which posters here have dealt with a LTC paper MAR and it's thousands of tiny little boxes..... and those who haven't.
Yes, it's clearly illogical and risky to initial meds in advance. But everything about a LTC med pass is illogical and risky. You have a system that's over regulated and facilities that are over punitive, stuff like this will happen.

OK, fine. People need to get involved and work to change these things, b/c clearly there is something wrong.

AT the same time, I take exception, b/c if anyone thinks a heavy load on a tele floor that carries ED admits as well as medical and post-op surgical patients is easier than a freaking nursing home, and that there is less acountability, I will say that you are dead wrong. People working these floors do not get breaks, and they run their azzes off all day or all night. I mean literally run their azzes of. On the tele floors where I worked, no one was fat. . .seriously, no one. They just burned too many calories. I worked in a few nursing homes as an aid as a teenager, and that was bad enough; but no way were the nurses busting their azzes like we were on a crazy, buzy, tele floor with 14-16 patients on night shift, or even an ICU with patients too sick to move away from for 1 minute.

So, yes, I have seen various sides of nursing in such places and on hospital floors and in nursing units in many hospital over > 20 years. I take exception to people indicating I am riding some high horse, when I know damn well what the standard of safe care should be.

I leave only the exception of the prison system, for I have not worked in a prison. But I have friends that have, and most of them tell me it's a cake walk compared to the floor or any number of sugical post-op units or the ED.

The only thing that I can possibly think of for justifying the pre-sign behavior in the prison system is maybe a safety issue with the inmates and nursing, in terms of logistics and how things are run.

Other than that, just sign when you have given the freaking medication for God's sake. It's a legal damn document. That's what people need to get through their heads.

Again I say, regardless of the situation, it's a LEGAL document. It's as good as a direct testimony on the stand in a court of law. I mean if a person is good with purjuring themselves, fine. I'm not, and your institution shouldn't be good with it either.

If you institution is set up so that you cannot follow the directed standard of practice or what is required by law, then calls need to be made to the board of nursing and other regulatory agencies.

Let me tell say this. I can tell you sure as daylight, people will get axed quicker than lightening for violating the legal requirements for documentation in the hospital, and the hospital will receive sanctions as well if violations have been found regarding documentation. Not to mention the trouble risk mgt will bring to you. They do NOT play with this kind of thing. You have to be as exacting and deliberate with the documenation as with any other kind of safe procedure--like following the protocol for direct, open chest tube suctioning or puting in an IV, or titrating vasoactive medications.

joanna73, BSN, RN · Mar 26, 2013

Ok, I am ignorant having never worked LTC but I'm having a hard time understanding how this saved time... Anyone?

I work LTC and this was an error in judgment, which, I'm sure the OP realizes in hindsight doesn't make sense.

Whether you sign the day of, or pre-sign a MAR, you aren't saving any time. Same amount of time either way. The other thing to consider is that patients go bad unexpectedly. The following shift, 2 or 3 residents might be dead, but you've signed that they took their meds.

Live and learn....

Guest343211 · Mar 26, 2013

Hello there thanks for your post I did not sign the NARC count the night before, you don't know how bad I feel by doing what I did, I do not have a habit of taking short cuts when working I seriously don't understand why I did this I have never done it before and certainly I won't do it again.

Pink, seriously. You need to sit down quietyly, once more and seroiusly consider whatever was your decision-making process in doing this. Don't beat yourself up. Just think this thorough, and understand without exception why legally this problematic. If you facility sets you up for failure, you have to look at this objectively too. It may be hard, but you can get another job. When your license is gone, however, what then? Think of it as if you are purjuring yourself in a court of law. That's how serious you have to consider it. No rationalizations. Just accept it for what it is, evaluating where your thought-processes broken down, and what the situation is in your facility that you would do this, and then go from there. Maybe you need to find another position. When a place will not allow you to practice by the standards of practice, you have to decide if it is worth staying.

You have to look at this the way the law would look at this. It would not except rationalizations. It would say, why continue to work in a place that makes it possible to you to practice within the law and with appropriate ethical standards. Unless you are literally a forced slave, you will have no justification. That's why this is such a big deal, and all these other rationalizations made by others do NOT matter one hill of beans, according to the law.

Susie2310 · Mar 27, 2013

Falsifying any patient data, whether assessment, medications or treatments can have very serious consequences for the patient, and is illegal, unethical, and indefensible, as samadams8 stated above. It is a violation of the standard of nursing care as well as an ethical violation. Pre-signing MARS places the patient's safety at risk. If the patient's condition changes and/or for some reason any or all of those medications are not given or are contraindicated, or there are order changes that involve those medications, there can be very serious consequences to the patient if those medications are already signed out as given and the physician and other team members are basing their medical/nursing decisions and care on medications, treatments, and assessments the nurse has documented as having given/done. I read some time ago on another thread where a nurse falsified a blood pressure reading that was discovered to be false by his/her manager. The nurse was called in to meet with the manager and questioned about the blood pressure (the patient had been discharged by the nurse on the following shift), and admitted to making the blood pressure up. The nurse was told he/she was being reported to the State Board of Nursing.

allnurses Guide · Mar 27, 2013

Exactly.
I can always tell which posters here have dealt with a LTC paper MAR and it's thousands of tiny little boxes..... and those who haven't.

We use those in home health/pdn too. Once had to go down to the office with several other nurses and spend hours to re-do several days worth due to a mistake - can't remember exactly what it was now. I just remember how tedious it was and that the case manager was wearing one of those "Heidi" looking scrub tops with the bow in the back and a nature picture on the front panel.

Bottom line, like Joanna said - it doesn't really save time in the long run to do it.

Guest343211 · Mar 27, 2013

Hello there thanks for your post I did not sign the NARC count the night before, you don't know how bad I feel by doing what I did, I do not have a habit of taking short cuts when working I seriously don't understand why I did this I have never done it before and certainly I won't do it again.

Pink, seriously. You need to sit down quietly, once more, and seroiusly consider whatever was your decision-making process in doing this. Don't beat yourself up. Just think this through, and understand without exception why legally this problematic.

If you facility sets you up for failure, you have to look at this objectively too. It may be hard, but you can get another job. When your license is gone, however, what then?

Think of it as if you are purjuring yourself in a court of law. That's how seriously you have to consider it. No rationalizations. Just accept it for what it is, evaluating where your thought-processes broken down, and what the situation is in your facility, such that you would do this, and then go from there. Maybe you need to find another position. When a place will not allow you to practice by the standards of practice, you have to decide if it is worth staying.

You have to look at it in way that the law would look at this. It would not accept rationalizations. It would say, why continue to work in a place that makes it possible to you to practice within the law and with appropriate ethical standards. Unless you are literally a forced slave, you will have no justification. That's why this is such a big deal, and all these other rationalizations made by others do NOT matter one hill of beans, according to the law.

Guest343211 · Mar 27, 2013

I think after 6 pages Pink understands that.

Hopefully, but to me, it would be more important to explore what in the world would have moved me to do this in the first place? What did my thought processes look like, and how did I allow myself to rationalize them? That's where the real learning will take place.

Enough said.

Guest343211 · Mar 27, 2013

Hey everyone. Just noticied I got a warning for language. Opps. I thought I had put in replacement signs and letters, but I guess I typed it, and hadn't. At any rate, I fully apologize to all.

Sorry about that :)

Seriously.

allnurses Guide · Mar 27, 2013

Hopefull, but to me, it would be more important to explore what in the world would have moved me to do this in the first place? What did my thought processes look like, and how did I allow myself to rationalize them. That's where the real learning will take place.
Enough said.

Sorry for the snippy reply samadams! I was in the process of editing when you replied to me. I understand where you are coming from completely, and said in an earlier post this particular episode of pre-charting was outside the norm, and as someone else pointed out, most people are still in the ultra-paranoid stage 10 months out of school.

Guest343211 · Mar 27, 2013

Sorry for the snippy reply samadams! I was in the process of editing when you replied to me. I understand where you are coming from completely, and said in an earlier post this particular episode of pre-charting was outside the norm, and as someone else pointed out, most people are still in the ultra-paranoid stage 10 months out of school.

Hey no worries. These are good things to post about, b/c if someone didn't, these kinds of things would go on without the learning process. And also, it's good that people posted about the environment that might pressure people to do these things. That has to be discussed for growth too.

Thanks again. :)