Does anyone else find themselves taciturnly encouraged by their organization to chart lies, or to put it another way, to enter fictitious information into flowsheets? Of course the organization would never want you to come out and say you are doing this, nor would they or you want to think of your little data entries in the flowsheets as not being truthful. We always seem to find ways to rationalize what we are doing.
For example, my facility requires patients in restraints to have q2hour visual checks and in the column for that visual check, you are supposed to inspect skin under the restraint, offer fluids or food, check for incontinence, and perform passive range of motion. You're supposed to check off that you did all this, every 2 hours. Now, I know damn well that neither myself nor my peers actually perform passive range of motion exercises on our restrained patients every 2 hours. Most of these patients you want to avoid disturbing at all costs or they'll start screaming their heads off or try to climb OOB. But we all check off that we did passive ROM. Some people might rationalize this by saying "well, when we change his gown we are performing passive ROM on his arms," or some other equivalent stretch of the imagination.
Another example is charting "patient was turned q2h" when they were turned maybe twice in the shift. Another big one is entering in a CIWA assessment for a sleeping patient. I'm sure there are lot of excellent nurses out there who wake their patients to perform CIWA (which is what you are supposed to do) but most I know will not wake up an alcohol withdrawing patient in the rare moments they can be found sleeping unless absolutely necessary. Yet, they all put in the CIWA assessments on time. I could go on and on, with people charting that saline locks are patent without flushing them, non existent pain reassessments, and so forth.
Do you encounter this often? And being as honest as possible, have you or do you do it? Do you feel that you have much of a choice?
I've worked on psych consultation-liaison services in large academic medical centers, managing EtOH detox among other things, for years and we have always told the nursing staff (over, and over, and over, and over ...) that we expect them to wake people up to score them on CIWA during the night. The fact that someone is sleeping soundly does not mean that they are not going into withdrawal, and there is no point in letting someone sleep "because they need the rest," or whatever other plausible reason, only to have them go into DT the next day because you're not treating the withdrawal aggressively. EtOH (or benzo) withdrawal is a life-threatening condition; it is not just poor clinical practice, but dangerous to not actively track and treat potential withdrawal by waking people up to do CIWA scores during the night while they are at high risk of withdrawal.
Yes. I have noticed nurses are falsifying charts because they are being pressured to check a box. Nurse to patient staffing levels are ridiculous. You either kill yourself doing everything you're supposed to do (P.S At the hospitals and Rehab Facilities I've worked at it's impossible) or you chart a bunch of BS. For several days nurses charted a patient had two legs when, in fact, the patient was on the Med/Surg unit because he had had an amputation. Not one day or night shift nurse had been assessing this patient. I wasn't even sure I had the right patient! At a rehab facility a new resident did not get medications for 5 days because the nurses were not looking at the MAR. I always look at the MAR and I have to tell you this resident had no medications. I took his BP and systolic was over 200. Recently I worked at another rehab facility and nurses were repeatedly charting a stroke patient's affected side was one side when it was the other. Nurses are also lying about administering medications that aren't even available or they are taking the medication from someone else. I could go on and on but no one cares. And it doesn't do any good to report problems because then you're labeled a trouble maker. If I could change one thing about my life, it would be my decision to become a nurse. I had hoped to work in a profession where I could do some good. I'm very close to throwing in the towel and going along to get along.. dark days.
elkpark
14,633 Posts
I've worked on psych consultation-liaison services in large academic medical centers, managing EtOH detox among other things, for years and we have always told the nursing staff (over, and over, and over, and over ...) that we expect them to wake people up to score them on CIWA during the night. The fact that someone is sleeping soundly does not mean that they are not going into withdrawal, and there is no point in letting someone sleep "because they need the rest," or whatever other plausible reason, only to have them go into DT the next day because you're not treating the withdrawal aggressively. EtOH (or benzo) withdrawal is a life-threatening condition; it is not just poor clinical practice, but dangerous to not actively track and treat potential withdrawal by waking people up to do CIWA scores during the night while they are at high risk of withdrawal.