Documentation that is true but looks bad

[LandofMaybe, MSN, RN]

Help.

My employer want us to chart why we didn't increase a medication at a scheduled time - everyb30.minutes. most the time that's easy but many times it is because we are busy in another patients room. Someone wrote RN unavailable to increase medication because of care with another patient. Itnisntrue but it also sounds like we are unable to watch our patient that is on a high risk.medication. how can we word it so it is accurate but not a sitting duck for lawyers?

[JKL33]

I would not do this.

I'm curious what your employer's answer to your question would be. Have you asked them?

Not lying, I would DEFINITELY ask them, and when I heard their reply I would be very likely to let them know that if this is what they want done I will be writing "not enough staff on duty to administer protocol" unless they want to use their brains a little/be reasonable. 

[Davey Do]

Whenever a protocol isn't followed per plan, a rationale is not necessary, per se. We need never to incriminate ourselves, our Peers or coworkers. 

For example, "Med scheduled for 1030 administered at 1045".

[FiremedicMike, BSN, RN, EMT-P]

When I miss med timing in the ER, I write "priority of care" in the comments, which is a valid response.

We spent a lot of time during nursing school running scenario of "you have orders for the following 4 patients in front of you, what is the order in which you'll complete these orders - and there is definitely a right answer.  Once I started in practice, I really understood why we spent so much time doing that.

Unless it's untrue, it's perfectly valid to indicate you had more important things going on at the moment.

[Psyched06]

That's kinda hard to get around and make it sound good cause the board don't wanna hear all that. They will just ask why it was not done. . I would definitely set an alarm on my watch or phone q25 min in order to get to that patient on time.

[FiremedicMike, BSN, RN, EMT-P]

Psyched06 said:

That's kinda hard to get around and make it sound good cause the board don't wanna hear all that. They will just ask why it was not done. . I would definitely set an alarm on my watch or phone q25 min in order to get to that patient on time.

This just isn't realistic on a busy unit, unless it's a critical med, but then that goes back to proper prioritization..
 

Quick survey - anyone been before the board of nursing because a med titration was late?  

[toomuchbaloney]

FiremedicMike said:

When I miss med timing in the ER, I write "priority of care" in the comments, which is a valid response.

We spent a lot of time during nursing school running scenario of "you have orders for the following 4 patients in front of you, what is the order in which you'll complete these orders - and there is definitely a right answer.  Once I started in practice, I really understood why we spent so much time doing that.

Unless it's untrue, it's perfectly valid to indicate you had more important things going on at the moment.

This is the most generic descriptor that I have used.  Should something untoward occur and you are deposed they will ask you what that other priority might have been, or why you didn't ask for another nurse to cover that task.  In those instances, it's not always possible to recall what other urgent matter took your attention, months or even years ago. 

Employers will never want you to document that your were unable to complete your duties because they didn't provide safe staffing on the unit.  Never.  

[FiremedicMike, BSN, RN, EMT-P]

toomuchbaloney said:

This is the most generic descriptor that I have used.  Should something untoward occur and you are deposed they will ask you what that other priority might have been, or why you didn't ask for another nurse to cover that task.  In those instances, it's not always possible to recall what other urgent matter took your attention, months or even years ago. 

Employers will never want you to document that your were unable to complete your duties because they didn't provide safe staffing on the unit.  Never.  

"I'm not sure, I would need to have access to my charting at the time to attempt to recall the entirety of circumstances at that moment".

It's extremely rare that we're any worse than 4 to 1, I'm not sure I could argue safe staffing with those numbers.

[JKL33]

toomuchbaloney said:

Employers will never want you to document that your were unable to complete your duties because they didn't provide safe staffing on the unit.  Never.  

Very true. 
 

Thus there is only one reason they would want a staff nurse to document a reason (that isn't already documented elsewhere such as a change in the order), which is to provide individual incrimination of oneself, or anything that can be nitpicked and criticized and written up so they can say it was an individual wrong decision and that person has been dealt with. 
 

...since they know we all believe it to be a hard and fast rule that THEY must not be incriminated. Some of us probably even think it's illegal. 

Being not exactly on-the-dot on time doesn't even have to reflect poor staffing anyway. It's a mere matter of the task coming into conflict with something that is higher priority.