Many of us have had our share of horror stories. Well here's another.
Over the past several months we have switched over to a RAI coding system that many nurses have used in various jurisdictions. As part of this switch over, we have a RAI Co-ordinator that many staff view as nothing more than a Tyrant.
As part of this RAI coding there's a sheet that is generated where staff fill out called a Resident Assessment Protocol Summary. At the bottom of this summary there's an area for signatures. One signature area says "Signature of RN Coordinator for RAP Assessment Process". She indicated to me today that I had to sign this area to indicate the RAP's that I had done. I indicated that I will not sign that section because I'm not a RN, nor am I the Coordinator (I'm a Practical Nurse). She was very upset and reminding me that this form needs to be signed off because it's part of the Resident's chart. I reminded her again that I'm not signing that section. She indicated that no one else has a problem signing that section of the form but me and no one in our jurisdiction has a problem with it. I indicated that if government officials want me to sign that form, then the form needs to be changed. She stated that the form will not be changed and left the unit.
Moments later one of the nurse managers arrived on the unit carrying one of the forms and instructing me to sign that area of the form. I indicated to her the same facts that I relayed to the coordinator. The nurse manager indicated that the form is part of a computer program and that they are not going to change the form to suit our facility. She further instructed me to sign the form and put my professional designation beside my name. I indicated that I will not sign that section of the form and reminded her of a similar incident about a year prior where she tried to force me to sign a section of a different form which clearly had "RN Assessment" on it and I refused back then (that form was eventually changed). I indicated to the nurse manager that I will be contacting our regulatory body. The nurse manager left the unit and sent out an e-mail instructing all the staff that when they complete the RAPs on the form, that they are required to sign that section and include their professional designation. In essense, the nurse manager is instructing all the staff to commit an illegal act.
This has clearly devided a few of my co-workers today. My stand is that, if that form was ever called into evidence in a court of law and I was questioned about signing that section of the form, my proverbial butt will be on the line because I'm signing a section of a legal document that is beyond my professional designation. I told my co-workers, that it would be like an RN signing a form where it says Signature of Physician. Unless that form indicates Signature of Physician or designate, an RN (or anyone else for that matter can not complete and sign that section of a form, regardless if they put their own professional designation down or not.
I explained this incident to my wife this evening (who's also a nurse) and she indicated, "You're going to get yourself fired". She said this because she know's the long history of ongoing crap that goes on in the facility that I work at. I told her, that I will not knowingly break the law just to please this tryrant and the nurse manager. I also indicated to my wife that once I contact our regulatory body, I'll know more with regards to where I stand.
Has anyone else had an experience where they were instructed by the powers that be, to do something that was clearly illegal?
Yes I'm a Canadian Nurse and I work in a Canadian facility, but let's stick to the issue here. The issue that I raised in the OP is the fact that I and fellow nurses are being forced to sign a form illegally. Signing ones name and professional designation on and area of a form that is specifically designed to be signed by someone else is an issue that is applicable to all nurses across the globe, not just here in Canada.
Let's be more general here. How many times have people come across insurance forms that have multiple sections and each section is to be completed and signed by a specific individual? For example, I had completed a medical insurance form for the insuarnce company when I went off work for a short while after surgery. There was a section for myself, the employer and the physician to complete and sign. What do you think would have happened if I completed and signed the physicians section?
How many job applications have specific sections where specific people in the organization are required to complete and sign? There are countless other types of forms out there in the world that have multiple sections to be completed and signed by different individuals.
This issue boils down to one of the core principles of documentation that I live by and that is, "Will this stand up in court?" (sorry that's my forensic training coming out of me).
So, if this form was brought in as evidence in a court case, I would likely be asked, "What is your professional designation?"
My response would be, "I'm a Registered Practical Nurse."
I would likely be asked to examine the document that I signed and asked to read the section in which I signed. I would then be asked why I signed that line when it clearly asks for the signature of the RN Coordinator, when in actual fact I'm not an RN, nor am I the Coordinator. Keeping in mind that the Residents chart (like all patients/clients/residents charts, regardless which country you live in) in this case is a legal document.
If I felt that this issue was exclusive to Canadian Nurses, I would've definitely posted this thread there.
I do not feel the issue you posted about is only a Canadian issue either. I live in Wisconsin, and in our LTC facility our LPN's are off-the-record "expected to do initial assessments." Now, by our state's nurse practice act, it clearly states that an LPN my not do the initial assessment. Many LPN's do this initial assessment and sign it, most of the time, it is only signed off by them!! Now as an LPN, i have also done an initial assessment, but am always sure to have a RN also sign off in agreement of my assessment. It sounds to me as if your nurse management is attempting to bully you into doing things the way they want you to...without regards to the legal aspects or to the ethical aspects. Before being fired (and yes, i think they will find a reason to let you go sooner than later) Find a more ethical employer!! Good luck to u!
His previous posts have all dealt with his conflicts at work in a Canadian facility. He usually posts in the Canadian forum.
Tone? How do you interpret tone from the printed word?
Canadian issues are different, yet similar to American issues. But misinformation is still misinformation. Like the American posters who reply in the Cdn. forum and tell us to get our ADNs. This educational route doesn't exist up here.
You can always click on a poster's history to get more background before replying to a post. A lot of us do that.
I interpret tone from the printed word by reading the combination of specific words and phrases used and then absorbing the overall attitude expressed thereby. Admittedly, it is more difficult to do online than it is in person, and if I misinterpreted your intended tone, then I apologize.
However, I do find it a little...dismaying...that we should all somehow be expected to dig into a poster's background and puzzle out his/her intentions before posting in response to a request for help; I find being derided if we fail to do so more dismaying yet. For some people, like you, it is convenient to go through a poster's available background before posting responses, but I'm not certain it's a step most posters would take before responding to each thread, nor do I think it should be expected of us in general. If an individual posts a query on this site, requesting assistance or information or support, the burden is on him or her to make that question or explanation as straightforward and clear as possible.
I'm also uncomfortable with the idea that those posting responses should double as detectives, constantly trying to puzzle out the OP's true meaning. In this instance, the OP has since indicated that he didn't consider his question a purely Canadian employment issue, nor did he desire only a Canadian perspective. The others who responded gave their best advice based on the information provided by the OP, who chose not to emphasize his nationality in his question. So for me to sit here and second-guess the OP as to what type of advice he needs and from whom - that seems rather presumptuous to me.
I apologize for offending you by my comment on the tone I perceived in your posts, but I do stand by that characterization. However, it's easy to overlook how words on a screen can sound to a stranger a country away. I will try to be more careful with both my own words and my appraisal of those of others; it's a lesson we can all stand to review from time to time! :)
So they don't have an RN anywhere in the OP's facility?
And if they do have at least one RN in their employ, why not just have THAT person sign off as the "RN Coordinator"?
Yes, we do have RN's in the building on all three shifts. Unfortunately, over the past few years the Nurse Managers have passed on alot of the responsibilities that used to be handled by the RN's, to the RPN's (LPN's). The RN's have become more and more, as nothing more than supervisors. I'm not saying this to be offensive to RNs, it's just the reality of this employer.
When we started doing this RAI MDS coding, the employer decided to give the coordinator possition (one per facility) to RPN's (LPN's), yet they have a sufficient number of RN's in each of their three facilities (three RN's on Days, two RN's on Evenings and one on nights per 150 bed facility) to have at least one of them (per facility) as the Coordinator. Even the National guide book on the RAI MDS that we're using, indicates that the coordinator possition is supposed to be an RN. The degree of politics and gross mis-management of this employer continues to baffle each of the staff.
I know some of my co-workers had thought that I was trying to advocate getting rid some of the RN's that we have because they litterally don't do as much as they used to. I had to keep reminding them that I'm not one to advocate getting rid of any RN because I believe they are a valuable resource. What I have and continue to try and do is advocate better utilization of the RN resources that we do have. Unfortunately these Nurse Managers continuously remind the RN's that they are not supposed to be doing things like dressings, medications, quarterly assessments, etc. and that the RPN's (LPN's) are to be doing it all.
Let's just say that a few RN's, RPN's (LPN's), Health Care Aides, etc. that have started at our workplace recently over the past few years, just scratch their heads at how these facilities are managed compared to others that they have worked at.
Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
Yes, we do have RN's in the building on all three shifts. Unfortunately, over the past few years the Nurse Managers have passed on alot of the responsibilities that used to be handled by the RN's, to the RPN's (LPN's). The RN's have become more and more, as nothing more than supervisors.
Well, if the RNs are supervisors, shouldn't they be the ones to "sign off" on the assessments done by the RPNs? Just tell the facility to have an RN on duty that shift to sign off where it says to have an RN sign off.
I absolutely *detest* bureaucratic red-tape BullStuff like this. If it's "no big deal" who signs the darn thing, then why are they making such a big deal about it when they have RNs on staff?
First this is a Thank You to all those who were very supportive with regards to what I had posted in this thread.
Secondly I have gotten a response from our regulatory body as well as the government Ministry that I would like to share here.
From the Regulatory Body: They indicated that they couldn't answer the questions of whether or not individuals other than a Registered Nurse could sign the Ministry form. For that information I would have to go directly to the Ministry them selves.
From the Ministry: Thet sent me an email this morning and suggested that I read an attached letter that was allegedly sent to LTC facilities 4 years ago. In the letter it states, "The Ministry of Health and Long Term Care is confirming that any Registered or Licenced Health Professional with RAI-MDS 2.0 Coding and trainig may undertake the role of 'Assessment Co-Ordinator' for the purpose of signing Section R2b and VB1 of the Resident Assessment Instrument - Minimum Data Set 2.0." They go on to say, "An amendment to the Long-term Care Homes Program manual will be issued shortly." Unfortunately that was 4 years ago and we haven't seen any revised manual.
The Ministry's email didn't answer the question of whether or not LTC facilities should change these forms to allow for any Regulated or Licensed Health Care Professional to sign in order to ensure the legal accuracy of the the form, while we wait for the new manual to be released.
All I know is that I'll be keeping all of the correspondence that I got from the Ministry and our Regulator body, if in the event that I have to defend my self in a legal proceeding, as to why I signed a form that requires the signature of someone else.
Truth66
122 Posts
My response to Fiona59 and perhaps a few others.
Yes I'm a Canadian Nurse and I work in a Canadian facility, but let's stick to the issue here. The issue that I raised in the OP is the fact that I and fellow nurses are being forced to sign a form illegally. Signing ones name and professional designation on and area of a form that is specifically designed to be signed by someone else is an issue that is applicable to all nurses across the globe, not just here in Canada.
Let's be more general here. How many times have people come across insurance forms that have multiple sections and each section is to be completed and signed by a specific individual? For example, I had completed a medical insurance form for the insuarnce company when I went off work for a short while after surgery. There was a section for myself, the employer and the physician to complete and sign. What do you think would have happened if I completed and signed the physicians section?
How many job applications have specific sections where specific people in the organization are required to complete and sign? There are countless other types of forms out there in the world that have multiple sections to be completed and signed by different individuals.
This issue boils down to one of the core principles of documentation that I live by and that is, "Will this stand up in court?" (sorry that's my forensic training coming out of me).
So, if this form was brought in as evidence in a court case, I would likely be asked, "What is your professional designation?"
My response would be, "I'm a Registered Practical Nurse."
I would likely be asked to examine the document that I signed and asked to read the section in which I signed. I would then be asked why I signed that line when it clearly asks for the signature of the RN Coordinator, when in actual fact I'm not an RN, nor am I the Coordinator. Keeping in mind that the Residents chart (like all patients/clients/residents charts, regardless which country you live in) in this case is a legal document.
If I felt that this issue was exclusive to Canadian Nurses, I would've definitely posted this thread there.