Charged with abuse for causing skin tears

Nurses General Nursing

Published

I worked at a SNF. I removed a bandage and it was fairly routine didn't think anything of it. I replaced the dressing with what I saw. when I removed the dressing there was a small amount of blood never having seen the wound before I didn't think much of it. As sometimes wounds can bleed. I cleaned the wound replaced the dressing and went on with my night.Later that night the administrator told me that the CNA thought I was rough in handling the dressing change. Was told that CNA reported to another nurse and then management. I was placed on leave pending investigation. Today after a five day investigation they decided it is reportable to state. Being accused of elder abuse for causing skin tears. I don't believe I did cause the skin tears. Is this something that can ruin my license? Is my job being unreasonable? I feel that the facility is out to get me. They accused me of pushing a resident when I wasn't even in the room. I have witnesses to back me up. And I was cleared of all charges.

Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I'm sorry that this happened to you. I would find myself in exactly the same boat if I was unlucky. At my facility, wounds are measured once a week. Dressing changes come up as a treatment order, and there is little to no documentation available to you about the wound itself. I think our wound care nurse may have a file in her office with information on her weekly rounds, but other than that there's nothing to look at. I would have done exactly the same as you and probably not given it another thought. Especially for skin tears, we just write the treatment order that we get and pass is along to the next shift verbally. Unless it's something really awful or unusual we'll just get "skin tear", and go about our work. Good luck!

Specializes in Hospice / Psych / RNAC.

As an RN you measure every time, every time. That is the crux of wound care. If your facility doesn't take pictures, draw a sketch of what is looks like when documenting on it as mesured. What materials did the facility have for the nurses to measure the wounds? What were the orders for the wound drgsing change on the TAR?

One little knick can escalate to stage II in no time. Measure the wound/wounds, what do the edges look like, macerated or dry, appearance, moist, previous dressing and date/initials, raised; look up how to measure and document on a wound. A general description is not enough, you must document that wound completely and of course initial and date.WNL should never be used; it actually means we never looked.

Someone is definately out to get you out. Get an attorney for the sake of preserving your reputation. As you know if you have an elder abuse charge on your record you cannot be hired in healthcare. I understand some states BON will put you on probation and after 7 or whatever years you're eligible to get another nursing license (I just read this and don't know how true it is). That in itself is ridiculous in my opinion. A public charge vs a private one...hmmm. Very interesting legal question. Did they call the police and have you charged with elder abuse or did they just report it to the BON?

Nip this in the bud right now. If you can't afford an attorney call legal aid. Research lawyers. Do something now...this is a very serious issue. I haven't read the previous posts so excuse if some things have been repeated...this is a very serious charge and has the potential to ruin your career in healthcare. Your facility knows this.

IMO this should have never been reported as abuse. But that's a whole different topic all together. I would get a set of the facilites p/p manual. It would be interesting to see what it says about the chain of command. I have seen my fair share of people fired for abuse of patients. It ususally involved verbal abuse and physical intent to retstrain without orders (in very unorthodox manners). I don't know if not measuring a wound/skin tear is considered abuse. It doesn't sound like it; it sounds like a knowledge deficit.

Get an attorney and get the records to see how every RNs measured the wound. If every measurment is exactly the same you will know that no one mesured but copied off of each other. How did the wound happen...they are considered "never events" by CMS. Did the facilitly report the wound to the proper channels when it happened? Oh, so much to brainstorm here with.

Why did the CNA try to ruin you...because you can look at it anyway you want, but that's what they did. Why didn't the charge, the CNA report this to, not come to you? My God; how deceptive and maliscious IMO .Were you allowed to gather your things, did they escort you to your car? Could there be discrimination involved? It sounds like they went to a whole lot of trouble to get rid of you, instead of just firing you (right to work state?).

Did you change the order by not adhereing to the current wound order? You weren't allowed to chart...that's a big one right there. You were not allowed to record the true events as you did them. Did you request to chart and they refused? That doesn't sound like elder abuse to me. It sounds like a set up. Oh my no! certianly not in nursing (sarcasm).

I'm sorry but this ticks me off to no end. I have been a target in a similar situation and have seen many good RNs targets as well. It's usually the natural leaders. Facilaties like yours like sheeple...do as I say and it might be alright. Good places like leaders who know their place and work as a team.

Start a journal if you haven't already. Put down every little thing you remember. Look up dates, remember times, every day write down what's happening. And never go into a meeting with these folks without a witness. The less said the better. Do everything electronically or by written reports. Don't turn this into a he said she said...email, texts, written letters are proof in court.

If they call set up a meeting and don't talk to them over the phone unless you're recording them and let them know you're recording them because they are recording you (if you have a smart phone there are many apps that work very well with phone conversations). The trick is that they must know you're recording them. Now with meetings in areas and board rooms that have no expectation of privacy you can record them without their knowledge (that's only in certain states so look it up and if you can't just let them know you're recording them). We have technology; use it.

I was just writing about how I had hoped that this type of culture in nursing was not occuring as much as it had in the past. When we have to go to work and do our duty like there is a potential target on our backs; the system has failed.

Best of luck to you. Thinking positive will turn positive but I know that can be difficult to do. Meditate, think, write in the journal and I think you will be suprised at what you start to remember. :) It's all relevant.

Hi,

I'm pretty sure the managers are supposed to measure weekly. There is little to no documentation, just clicking off if it's done or not. And as I have said before they sent me home before I could document anything. I'm still trying to figure where they get the abuse from. Sometimes skin tears just happen despite our best efforts to avoid them.

Yes managers are supposed to measure weekly and I can almost assure you it did t happen. And I didn't follow the order at the time because surprise surprise we didn't have the correct supplies. That happened all the time. As far as the CNA I'm told they get a cut of the fine if one is levied against the facility in Michigan. This could be the motive, I'm told this particular CNA has done this before and loves to cause drama. They did not call the police or file a report as far as I know. I haven't heard anything and it has been 5 months. I check my license from time to time and I check my mailbox daily. I have to say I have developed a nervous tick every time I get the mail. Is today the day that the charge will rear it's ugly head? I do have professional libiality insurance and it comes with license protection. I also have texts clearly stating that I would not punished. I hope the day never comes that I have to defend my license against what I feel is a bogus claim but I am ready.

I see that this is an old post, but updated. You would have known by now if it was reported to the state and if there was any actions against you.

As far as suspected abuse. If the CNA saw a nurse handling a resident in a rough manner, they must report it. It is up to the facility to investigate it and determine if in meets the definition and also to report the allegation of abuse to the state.

Every facility should have their own p and p for wound care.

We measure wounds weekly. We are still paper charting so all of our treatments are in a book. We have all wounds (pressure and non-pressure wounds including bruises, incisions etc) on thier own sheets. If we had a question on the size or appearnce of the wound, we are able to see what what documented at the last measurement. If they are on skilled charting for the wound, then there should be a daily nurses note about it.

Specializes in Case manager, float pool, and more.
In every facility where I have worked I was required to thoroughly document the condition of a wound during a dressing change. That includes description of the wound and measurements, especially if this is your first encounter with the wound. Part if the problem appears to be inadequate documentation. Brush up on those skills. Having worked in the SNF environment I know only to well how easy it is to get a bit sloppy with documentation.

Be aware that just because something is reported to the BON doesn't mean that you will lose your license, but you have learned a valuable lesson and proper through documentation will save your butt every time.

Hppy

100% agree. I have worked LTC ( just per diem ) here and there but I know how easily skin tears can happen even with being careful. I wonder why they did not let you document before sending you home though? I would think they would say to finish any documenting and then go home.

The CNA has to report any suspected abuse. This does not mean it happened though. Your facility is the party that investigates and goes from there as the person above me said very well.

Hope all works out. Best of luck.

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