Do you remember this lesson in nursing school?

[StealthRN]

A nurse is a patient advocate. A nurse's duty is to the patient first.

We've all heard that right? We were all taught that weren't we? Yet what happens when you get that first nursing job... who do you become loyal too?

Like every job in America, an employee is always afraid of losing their job if they tell anyone outside the organization what goes on INSIDE the organization. Even when people follow proper channels and report unethical or fraudulent conduct to the corporate counsel your job is still at risk.

You don't have to search far to find stories on the news, on the internet, or from someone you know where a person who reported what they saw and felt was wrong doing that person then was demoted or even later fired or laid off from their job.

That's how the ball bounces... and it's certainly how the ball bounces if you are a registered nurse.

Has it ever happened to you? We all know what sentinel events are. We all know the difference between occurance reports and incident reports.. one is part of the chart and discoverable and the other one isn't. One is completely "secret" and there's a good reason for that but it's also abused and used... to keep secrets from patients and family when an incident occurs that is not so obvious that it can be withheld from the patient and the family members. Some things you can't hide... some things you can hide.

Obviously you can't cover up operating on the wrong leg.... you can't cover up doing a biopsy on the wrong breast... but you can coverup medication errors that cause harm... you can coverup incidents where the mistakes were made in judgement... you can coverup incidents where machines malfunctioned and caused harm.

Speaking of machines malfunctioning... how many of you have seen machines mess up and YOU got the blame. Do you need an example?

Take the monitors in the rooms for instance... Most monitors are set to record vital signs on a regular time frame. So answer this question... How does a monitor that has been checking the blood pressure every hour suddenly stop checking the blood pressure?

How many of you have gotten swamped and had to later go back and pull up the history on the monitor to get the last 3 or 4 hours of vital signs so you can write them down?

Have you ever went back and seen that for some unknown reason the BP cuff did not blow up and check the pressure? What would you do if you went back to review vitals and record them into the record only to discover that the DANG MACHINE did not check the blood pressure?

Obviously depending on where you work... where the patient is at, and what protocols are in play, you, the nurse, are faced with a decision to make.....

Do you create some vitals out of "thin air" or do you just leave a great big, HUGE, gaping hole on the vitals sheet for someone to see and you know what is coming next right?

You're going to get into trouble. Yes... you messed up. You could easily avoid getting into trouble by writing anything down to fill in the blanks. No one would know... but you would know. What you would do?

The truth is.... we've all done it. I have... you have, and anyone saying they haven't is probably not telling the truth right?

When a patient is sitting there walking and talking... from 12 o'clock to 5 o'clock and he or she is getting stronger, walking farther, and eager to get turned loose, what harm would it do to fabricate a few hours of vital signs?

We've all heard that you won't get into trouble. That self reporting, or even telling on your coworkers won't have repercussions... that reporting is so important to the learning and training process that the system wants you and encourages everyone to fess up... you'll be OK. Your job is not at risk.... go ahead.... do it.

I dare you to believe that lie.

[OCNRN63, RN]

Maybe you fabricate patient information, but I don't, and I don't appreciate being called a liar. Speak for yourself.

These last four threads you started make me think you're looking for an argument.

[psu_213, BSN, RN]

I don't know if I should dignify this with a response (I tend to agree with OCNRN's impression of things), but I just had to say one thing…machines are only as smart as the humans that use them. Sure there is the occasional (rare) malfunction, but I would wager money of the fact that the BP wasn't taken because of human action: the machine was off, the frequency for measurements (for example, q 15 minutes, q hour, etc.) was not set correctly, the BP cuff was removed so the patient could go to the bathroom and was not put back on, the "stop measurement" button was hit when the pt. was being bathed, a family member accidentally brushed the "off" switch on the monitor…you get the idea. If you are that swamped that you cannot even make sure the machine is getting the vitals, then have someone else take a quick look at it and maybe even record them for you.

[toomuchbaloney]

I have been practicing nursing for more than 35 years. I have never fabricated patient data. If I don't know what the BP was at a particular hour I don't make something up. This is from an RN who spent more than 15 years practicing in a state of the art urban hospital in critical care and transport venues followed by plenty of community and home based nursing.

Nope, many (if not most) of us do not make up stuff about patients in order to fill in a blank on a form. Speak for yourself in that regard.

[Esme12, ASN, BSN, RN]

I am not sure what you are asking? or are you trying to prove a point.

Never in 35 years have I made up vitals.

What is your point?

[jadelpn, LPN, EMT-B]

OP, if a patient is on a monitor, they need to be, well, monitored. Which means that you need to poke your head in at least once every so often, LOOK at the patient, and assess any changes, interventions if needed.

Ever so often, you need to at least glance at the central monitor.

All fun and games until the patient has coded, and no one notices until they have to do paperwork for the last 12 hours of monitored vital signs....and the patient has been dead or at least 6 of those hours.

"I thought the patient was napping" is not a valid option.....

OP, I get it. You are red hot over something. Many of us are over this or that. But the longer you allow this stuff to rent space in your brain, the only one who is going to do a slow burn is you. Which is not helpful/healthy for anyone.

Yup, big business comes in and takes over, staffing is ridiculous, mangers are not even practicing nurses, and patients make hobbies of yelling "jump" just to see how high we can. With all of the bowing and evening at the improv stuff, nope, not a whole lotta time for that pesky paperwork. And the nurse coming on get po'ed because they know that with the continuing bowing/submitting/general kiss butt-ness, THEY will not have the time either. But you have to tell the patient "I have the time"....because, well, no one gets paid if you don't create time outta nothing at all.

Point/vent taken. And yes, it is a suck-fest. But no more taking up space in your head when you are on your time. Sometimes. one's own time is the only thing that is sane.

[BuckyBadgerRN, ASN, RN]

Sigh.... THIS poster again?..

[Altra, BSN, RN]

The lesson I remember, from waaaay before nursing school, is that you don't lie to cover your ass.