Forgot to carry out an order? Reportable to the BON?

[Cola89]

Hello, so my unit goes over charting with a fine-tooth comb. I have only been at this job for three months and have gotten called in to the office 2x already because say in admission documentation "patient education" was not documented on (I didn't document it because there was only 2 hrs. left in my shift when I got this admission from surgery and it was actually NOT a good time to do patient education).

There was a new order to do orthostatic BPs on a patient 1x/shift and I didn't do them. Did the routine BPs, but not an orthostatic. I just completely forgot because I had such a hectic

day... many huge changes in status and just, it was terrible. So I forgot that one thing. As far as I know, that's all I forgot to do.

Is this something that is reportable to the BON?

[Horseshoe, BSN, RN]

Can you imagine how overwhelmed the BONs would be if missing an orthostatic BP once in a shift or failure to document patient teaching were being reported to them?

This a specific job issue, not a license revocation or board reprimand issue.

[CBlover, BSN, RN]

OP...you said they don't report nurses who divert for messing up there reputation basically!? Did I understand that right!? They're all in neck high trouble with the state in their future!

[DowntheRiver]

Please enlighten. Are you a manager?

There is life outside the floor for nurses, my friend

[dirtyhippiegirl, BSN, RN]

If one (well, heard of two nurses at this place) diverts narcotics, they don't report for that because of the "stain" on the reputation of the company. They let them work on they psych unit. I don't know if they have them go to treatment or not.

These people have turned me in to a shaky leaf.

To be fair, many states have confidential monitoring programs for first time offenders. My hospital did not fire me for my alcoholism. They reported me to the state monitoring program which is confidential. I then had to apply to positions within the hospital system that did not require narcotic or benzo administration. These monitoring programs are not a walk in the park and treatment is required.

[CrazierThanYou]

I can relate. There are some aspects of my new job that makes it feel like a hostile work environment. And they must check our charting in a similar manner. Last week a huge deal was made because I accidentally pulled a mag ox tablet under the wrong patient name.

[Cola89]

OP...you said they don't report nurses who divert for messing up there reputation basically!? Did I understand that right!? They're all in neck high trouble with the state in their future!

I don't know for sure, but that's what one of my coworkers said about one of their former coworkers. She was found to be diverting fentanyl and they "didn't do anything" but send her to work on psych. It's rumored that another current floor nurse calls MDs for heavy high orders of morphine and diverts, but I haven't seen it or observed this nurse to look impaired. So, I don't know how true any of this is. It was coming from two very different sources (different shift, different clique).

[Cola89]

I can relate. There are some aspects of my new job that makes it feel like a hostile work environment. And they must check our charting in a similar manner. Last week a huge deal was made because I accidentally pulled a mag ox tablet under the wrong patient name.

Ugh. That is ridiculous.

[Karou]

Wow. Who has the time to comb through someone's charting like that? Must be nice for whoever has that job!!

That's such an incredibly minor omission that it's laughable that you received any punitive action for it. I have caught missed blood transfusions, missed time sensitive medications, missed discharge orders, ect... Those things I would make a fuss over. Missed orthostatic vitals? I may mention it to the nurse when I see them again, if it's something the physician really wanted done or was actually information they was needed. I see orders for orthostatics all the time that the physician probably forgot to D/C. I wouldn't act like the sky was falling for it.

[hawaiicarl, BSN, RN]

We have a neighboring hospital who has a micromanager like that in their ICU. I love it, scooped up some of her best staff they were so paranoid about getting called into the office.

Here's a tip for the education part, on admission, chart that the patient was oriented to the room/unit, and the call system under education.

Cheers

[gonzo1, ASN, RN]

If I'm not able to chart anything meaningful under patient education due to time constraints or patient condition then I put something to the effect of "Pt unable to comprehend education at this time due to altered mental status, however all care explained as it is being provided to patient." Something like that. Quick and easy.

[jadelpn, LPN, EMT-B]

Orthostatics done by a nurse for diagnostic/relation to admitting diagnosis is something the facility gets paid for.

Patient education is part of meaningful use, and the facility gets paid for.

So the crux of the matter is that you did not do something (or a couple of somethings) and the facility loses profit.

Which is seemingly a huger deal than patient safety.

You could argue that you had no orders (if you did not) as to what to do if the patient was found to be orthostatic. (did you? I am always amazed at ortostatic orders with nothing else....so, what are you to do with that information?) And that patient education was not done due to the patient being a fresh post-op and nursing is a 24 hour gig. (and did they get any education pre-op? Sometimes they do)

You will more than likely be counseled in hitting all the price points you can on each admission. Dressed up and tied in a bow to give the illusion of patient safety.

Get some malpractice insurance. It is a good thing to have.

[jadelpn, LPN, EMT-B]

Haha, point taken. This place has my nerves frazzled with their scare-tactics. We get called into the office about minor charting issues all the time. They take "screen shots" of our echarting, and then pick it apart I guess. Wish the manager would've mentioned this in my interview!!! I have never felt so unappreciated, scrutinized, etc. I would like to leave. It feels like a hostile environment to me. No one wants to float to our floor.

"Screen shots" is a privacy violation. Especially if on one's personal cell. I would report that to the parent company pronto.