dishonesty in clinical rotation

[donnapalmer]

Hello, all...seeking advice or information...I am a first year LPN student, going part time, mornings. My dilemma involves a couple of fellow students.

We have just started our clinical rotation in a LTC facility, one I happen to have just left after 14 years of employment as a CNA.

One of the residents assigned to our care has often been found to be dressed by the overnight shift, which has been their routine for many months. He often refuses to be undressed, rebathed and redressed, and we report this and document it, and perform whatever else we can that falls within our skills to date. I was assigned to bed bathe him today, as a matter of fact, and the scenario played out exactly as I write it above.

Monday, though, two other SPN's were assigned his care. As team leader, I offered assistance to the various pairs of caregiver/students, and was in and out of nearly all of the rooms, fetching linens and taking notes for them. I entered Mr. B's room 30 minutes after we received report and got out on to the unit, and found him fully dressed in bed, with the students assigned to his care standing at bedside. With no other motive than to find out what his status was, I asked if he was found to be dressed, or did the students provide him with care (a complete bed bath!) and dress him. The response was that they had indeed done his complete bed bath, and dressed him, and begun to assist him with his breakfast, within the past 30 minutes. My gut said that they weren't being honest, but let it go after confirming that I understood that THEY had done the bed bath, not the night shift workers at the LTC facility. Later, during the exit conference with the instructor, they repeated this information. Another fellow student tapped me on the shoulder, and informed me that she had been in the room shortly after we received report, at about 8:20 a.m., and Mr. B. was dressed at that time. She had not been aware of my misgivings, so that had nothing to do with her telling me that; I see it more as because of my assignment as team leader that day.

Today, when our regular instructor returned, we had an opening conference, and the two students told her that they had bathed Mr. B. yesterday.

It sounds pretty petty in the re-telling, but the four of us who are aware of the dishonesty are pretty disturbed by it, and are inclined to report the behavior to the regular instructor. Our first week in class, we were told every day that honesty and reliability is a requirement of the nursing program, and that cheating, dishonesty and untrustworthy behaviour would not be tolerated, and would be grounds for dismissal from the program. I naturally don't wish to be the catalyst for someone being removed, but I also don't want to be in a professional or accountable position with these two women, who are lazy enough to not do their assigned work and dishonest enough not only to lie, but to repeat the lie at least 3 times.

Any thoughts?

[BunnyBunnyBSNRN, ASN, BSN]

What would you do if you already had your LPN and you found another LPN or RN documenting that they had done something when they hadn't? It could be anything...giving a bed bath, changing a dressing, or giving pain medication.

Start thinking like a nurse, you're on the road to being one!:)

[donnapalmer]

Funny, it's the hardest part of transitioning from CNA to LPN, is no longer thinking like a CNA! One day in the lab, while demonstrating a bed bath to my instructor, I found a "wound" on a sim.--I verbalized that I would be reporting my findings to the nurse! :chuckle Realized next moment...that's me!:roll

Thanks for the food for thought...I would probably deal one-on-one professionally; wondering now if I should tell the two students in question that some of us are aware of the dishonesty, and they should refrain from it in the future, or we will be bringing it to the instructor's attention.

Thanks again!

[PJMommy]

Ditto what Sara said. Think of the logical progression... now in a acute care setting... "Did you check Mr. Smith's wound? How did it look?" -- "Uh, yeah -- it's fine" (while Mr. Smith has the beginning s/s of a raging infection). Now...what if Mr. Smith is your father or brother or husband or friend?

You think like a nurse now!! I'm with you...what is more disturbing is the fact that they had at least three times to tell the truth and made the choice not to. Are they charting their cares? The chart is a legal document and, if they charted a bath, etc. then they've just lied on a legal doc.

PJ

[RNIAM, BSN, RN]

What I would want to know before doing anything is. Are you certain that they did not bath the patient? Were you there and did you see it? If you didn't how do you know, absolutely know what has occured or has not occured? Please never take anyones word for anything. If you see it sometimes it is not what you are really seeing. They could ahve bathed him. I am not saying they did or they didn't. I guess what I wonder is why this other student felt the need to tell you she had seen this patient at 8:20 and the patient was already dressed? I am sorry but as a studnet I might be able to say I saw the patient and whether he was dressed or not. To tell you what time it was seems just a little fishy to me. Why would she care what time she was in the room? I guess something just doesn't seem right to me...

[donnapalmer]

The only reason I believe they did not bathe the resident stems from the fact that a similar bath the week before took the students nearly an hour to complete, and that was leaving the resident in a nightgown, not dressing him in t-shirt and slacks...it wouldn't be an issue at all but for the dishonesty involved (if it is indeed). My gut told me something, and I was kind of mulling it over when my fellow student volunteered the other time information. I can't speculate what her motivation was, perhaps she is also uncomfortable at the sudden possibility of lying in our clinical class. Will continue thinking on it...thanks for the insight, guys.

[colleen10]

I would vote to go to the instructor but keep a few things in mind............

Bathing is an integral part of patient care that should not be under estimated. For one, it is of the most basic care, providing the patient not only a physical benefit but also an emotional and psychological benefit as well. Also, as others have stated what better way can a nurse or care giver complete a physical assessment. If you knew that these students had say, not given AM Meds. to their patients or had made a med error, perhaps mixing up two patients meds., would you turn them in?

As RN2B mentioned, look at the incident from a number of different angles, can you be sure that they did not give the bath? If so, what makes you so sure? You may want to write down times and what you saw, etc. before you go to your instructor because your instructor is most definately going to ask you if you are sure about this.

I would also think about how to approach the instructor. You do not want to appear as a "tattle-tale". Perhaps you should go to them and just lay out the facts as you know them to be and allow them to make up their mind and handle the matter from there.

Good Luck, I do not envy your situation but I do know that the profession of nursing is one that upholds the virtues of integrity, honesty and altruism which, if these students have done as you have stated, have broken each of these values.

[proud2basn]

Clinicals are a time to learn how to do things, not a time to learn how to get out of things. There is a lady like this in my clinical group. One week we had clients in the same room. When we got there they were already bathed, dressed, and their beds made. Our instructor came by and asked us if we had done it. I told her no, it was done when we got there. Our instructor assigned two other people to bathe and dress & make their beds. This other lady got mad and chewed me out for telling our instructor that! This lady also gripes to our instructor constantly "because the other groups don't have to do that". If these people are more worried about what everyone else is doing, and how they can get out of doing things, what kind of nurse are they possibly going to make? I look upon everything that I can possibly do in clinicals as a learning experience, be it a bedbath or whatever else. Bathing is actually a good time to do your assessment. Are these people going to let the aides pass their meds when they become nurses? Lazy people just do not belong in this field.

Getting down off of my soapbox now. :wink2:

[donnapalmer]

I truly believe that the lazy ones will be weeded out by the time the program closes, but I fear being associated with their attitudes and work ethics. I do believe that tolerating poor behavior is tantamount to supporting it, but this is a new situation for me. A little more brainstorming, and I should arrive at a workable solution...maybe I'll email my instructors the hyperlink to this thread! :)

[PJMommy]

Just one more comment... Jennifer made an excellent point about bath time being a great opportunity for assessment. I'm doing a preceptorship right now. When I came on shift the other night, the nurses reported the pt had a bath during the day (we are on night shift). Well...when I went to reposition the pt, I had my preceptor inspect the pt's backside while we had him on his side. Guess what... he had 7 cm, stage 1 pressure sores on his bottom with blanching redness all around them. They weren't reported and weren't charted. If this guy got a bath, it wasn't a very thorough one.

[chris_at_lucas_RN, RN]

What's the difference between documenting that a bath and basic care had been done but not, and that meds had been given but not? Aren't they both neglect and dishonesty?

Maintaining skin integrity is such a big issue for elderly, chronically ill and bedridden patients, and bathing is a very important factor.

I'd give my two classmates two options: 1) go to the instructor and confess their error or 2) you will.

On the other hand, you also have to watch your back--your life can be very miserable when you advocate for your patients by being honest and forthright with the instructor (analogous to a supervisor). You might consider giving the instructor the info in a "hypothetical" format.

Also, beware instructors and others in authority who will "protect" your identity if you are honest with them. I had one tell me that, then, when I was honest with her, she immediately called in the personnel I'd had problems with!

Good luck and hang onto your idealism. It is anything but petty. You are right, and your patients are lucky to have you!

[donnapalmer]

Good luck and hang onto your idealism. It is anything but petty. You are right, and your patients are lucky to have you!

Thanks for the warm fuzzies...I'm sending select of my fellow classmates over here ASAP to get an eyeball on what the real world of nursing is like, outside of our limited experience in our LTC facilities and classroom.

You folks have been very helpful!:kiss