Confronting Unsafe Practices

[kkrn1116]

Hi there! I'm a private duty nurse (RN) with an ethical and safety question I've been dealing with. I'll give some background first (with all info de-identified, of course).

I have a client I'll call "Mary," whose care I'm concerned about. Her caregivers chart in a way that makes assessments difficult, often only listing arrival, departure, and meal times. There may be as few as two entries in a twelve hour period. This became a safety issue when "Mary" had a medical emergency during my weekly appointment with her. I was told by the caregiver on staff that the PCAs had noticed marked changes for a week, but there was no mention of it in the documentation. I believe this resulted in a delay of care. Fortunately, the client had no lasting issues and the problem was resolved.

At my next scheduled appointment, I spoke with the caregiver on staff and discussed documentation. I recommended charting regularly and noting any changes in conditions. She had questions that I didn't know the answer to, and I directed her to call her agency management.

A few days later, I received a call on my personal phone from the case manager, who was upset with me. I was told that there aren't specific charting requirements and it was implied that I was out of line for mentioning this to the caregiving staff. I also received a call from the caregiving agency and their manager seemed upset with the misunderstanding as well.

I don't want to step on any toes, or cause issues between different agencies, but I'm very worried about the quality of care given. I feel that there is no excuse for incomplete charting and that concerns shouldn't be put off. There's a lot of additional issues regarding advance directives, but treatment for the emergency situation was well within the client's expressed wishes. Was I correct in addressing the issue? I asked my manger, but was told it wasn't my place to speak to the caregiving agency. I would really appreciate your input!

[brownbook]

Your manager sounds like a idiot. I am inclined to tell you to quit.

Perhaps you could apologize to the case manager for getting off on the wrong foot. Explain you didn't know the charting requirements for the PCA's.

Say you both want the same thing. Good care for the patient. Maybe you could meet, treat her to coffee, and clarify the PCA'S duties and what you are expected to be responsible for.....or something like that?

[MunoRN, RN]

Just based on the limited information you've provided it's not really possible to say whether or not the other nurses were charting inadequately or if the problem is that you over-chart and are concerned that other's don't do the same. There's an important distinction between something that is clinically significant and something that is not, and the main reason why we have nurses is to differentiate between the two. The only specifics you've provided is that you're upset something wasn't charted even though it didn't prove to be clinically significant, so I'm not sure what your complaint is.

[psu_213, BSN, RN]

Are these caregivers unlicensed? If so, there charting requirements are likely pretty low.

In addition, have the caregivers know the patient well? Have they seen her wax and wane before? I have seen this issue before. Pt is sent to the ED with their newish caregiver saying "she [the pt] is off today." A long time caregiver comes in and says "oh, she has days like this. She'll be fine tomorrow."

I know that you have the best interests of the pt at heart, but I'm thinking you can't really expect the caregivers to chart more.