Falsification of Documentation?

[lowetidern]

I have a quick story and then a question to ask my fellow nurses... I am a wound care nurse in a LTAC hospital and have been with the same company for the past five years. Our company has hospitals all over the country. A little more than a year ago my very good friend and charge nurse with this company was promoted to CNO at one of our hospitals about two hours away. Long story short: my husband received a very nice job offer in the same city she was transferred to and, eventually, we moved and I accepted a position in the same hospital. She is now my CNO - my boss.

It is our corporate policy to take photos of any alteration of skin integrity within eight hours of admission. If the wound nurse is not available, the charge nurse is responsible and then the wound nurse reassesses the patient on their next day back. This happens quite often on night shift and weekends. We admitted three new admits the other night and the night charge nurse took photos, however, those photos were lost on the camera. The following day, I retook the photos and did my documentation as the policy states. The loss of the original photos was reported to the CNO. Two days later, while doing a routine chart audit, it was noticed again that the chart was not corporate compliant due to those missing photos. The CNO and Nurse Manager told the quality coordinator to tell me to turn off the time/date stamp on the camera, retake the photos, and then back date the documentation of the photos to the night the photos SHOULD have been taken. I refused.

Am I crazy, or is this blatant falsification of documentation? Nothing about this idea sounds good or right. Forget the fact that my "friend" has suggested this, but the legal ramifications could be BIG!!

I am asking for your thoughts, opinions and/or ideas. Should I be looking at this from a different perspective? Am I making a mountain out of a mole hill?

[caliotter3]

Requests to take part of falsification of documentation happen. It is at that point that the nurse decides whether or not the job is worth the risk. I can tell you that in the situations that I am aware of, each and every time, the nurse involved caved in. In other instances, nurses were the protagonists. They initiated the falsification for self interest, i.e. they falsified their time sheets to get paid for work time that did not happen. When you are made aware of such situations, you get put in a bad place. You report, as required, and you lose your job. Don't report, and you become an accomplice. One of the bad realities of nursing. You have to decide for yourself what you are comfortable with in this situation.

[kakamegamama]

What you did was right.

[proud nurse, BSN, RN]

I think it is false documentation to back time a camera to 2 days earlier. And it's going against what you stated is the corporate policy. I would retake them, but I wouldn't have any part of back dating/timing them. Either the CNO or the nurse manager should do it instead of directing you to.

[Karou]

I see the CNO's request as blatant falsification of documentation. I would refuse.

From what you said, she asked you to take new photos now (how many days from admission would that be?) with the date/time stamp off, and back date them to the admission. Technology mistakes happen and since the original photos were lost, you took them the next day. That's understandable. I would not falsify a date/time on a photo now to satisfy their policy.

She really put you in a bad situation. By refusing, you risk loosing your friendship and standing in the company. It could get awkward and uncomfortable fast. I would explain that while you understand the pressure she is under to make the patients chart appear correct by policy, that you do not feel comfortable doing this. If she pushes it then she is truly not a friend, and is only looking out for herself. At that point you would have to be firm with her and stand up for yourself. I would ask your CNO, "to clarify, you want me to take photos NOW, (insert #) days after admission, and lie on my charting to say they were done on the day of admission, when they actually were done days later? You are asking me to falsify documentation in a patient's chart, which I will not do."

I hope she does not retaliate against you for this. You are right to refuse.

[Pangea Reunited, ASN, RN]

I wouldn't do it, but I'd be OK adding a note to the photos ...something like, "Original photos lost. Wound present on admission."

[Libby1987]

Good grief no. No.

Your charge can *find* the photos that she took with the date and time not turned on. As long as the patient is cared for properly and you know patient was admitted with the wounds, ie the photos don't misrepresent the wounds on admission, you don't have to make an issue out of it.

But don't you do it. You would be foolish in the worst way to be persuaded to do something sketchy like that. Reminds me of the school yard where the bully who talks the underdog kid into something..

[lowetidern]

Thanks, Pangea. That's exactly what I did on the documentation that accompanied my photos the following day.

[lowetidern]

Thank you, Karou. I don't think she will retaliate. I do think that she thought I would be willing to do it because of our friendship...kind of an "I'll cover your back if you cover mine." It really bothers me but sometimes I don't think she gave any thought to the potential detriment to my career and license...or hers, for that matter! I knew in my gut I was making the right decision, but sometimes situations such as this can make you question your own sanity. I appreciate you guys responding!

[lowetidern]

Caliotter3, your words ring true. I have had the same thoughts, however, not nearly as eloquently described as what you have done here. The words I used to my husband were more like, "damned if I do, damned if I don't" in referring to reporting the request for falsification. I made my decision not to comply with her request and I intend to stand firm regardless of any retaliation effort. Perhaps it is time for me to move on and make a change. I won't make an emotional decision in haste, however, it is something that I will likely contemplate over the next few days. This incident would not be the sole reason for my departure, merely the straw that broke the camel's back. Wish me luck!!

[caliotter3]

If you wanted to justify it, you could say that the new photos were taken in sufficient time that there was virtually no change in appearance. I suppose that ninety-nine out of 100 nurses that I have met would do this and go on their merry way. If you stand your ground, you will suffer for it, one way or another, sooner or later. Best to start looking for another job, as you have already determined. Best wishes.

[Whispera, MSN, RN]

The point of the photos is to document skin damage if there is any, so the facility doesn't get blamed for any that was there before the patient got there. It's just not right to do what she asked.

I like the note with the pictures that says the first ones, done on admission, are missing. That makes sense!