Frustrated LTC 11-7 Lpn

[Sassy5d]

I'm really confused about my position as an lpn on third shift.

When I was hired at my facility almost a year ago, it was common practice for me and my fellow 11-7 nurses to take a fax sheet and send a note to the doctors about whatever.. be it "Oh just letting you know that so and so has refused their 9pm meds for 3 days" or "Just letting you know so and so has a small skin tear blah blah blah" This is what the policy was....

Now all of a sudden, we are no longer permitted, per the doctor's, to fax anything after the office's close at 4pm. So when I come on, I'm not permitted to fax the doctor about ANYTHING.. I guess, from what I'm told by my don, is that the doctor's have a problem with faxes because even if they are not in their office, they are still liable for whatever is said on those faxes.

I'm at a loss.. that means I have to burden 1st shift with every teeny tiny lil thing that I come across... That means I have to put a lot of faith in my coworkers.. Let me just say, it's driving me insaine..

I'm getting extremely frustrated! What I liked about faxing is that I KNOW it was sent to the doctor.. I don't have to depend on someone else to call the doctor and have it addressed. We'd fax the doctor, they'd fax back with an order or no new orders.. voila, done. Now I have to keep giving the same report every day basically about all of my residents because nothing is getting addressed at all. I've thought about writing up a bunch of fax sheets and handing them to my dayshift nurse to fax during office hours..

This also brings me to another problem.. I was spoken to last week about my charting. Sometimes I chart too much and other times I don't chart enough. Apparently it was my not charting enough that got me into trouble. I understand it's about helping pt care, protecting the doctors, my coworkers, the facility and my nursing license.. but now I feel so "off" about working 3rd shift.

I was doing some reading up about charting.. the do's and don'ts. And how much rides on our charting... then I'm trying to put it into prospective about my role as a third shift nurse working with the geriatric population. Everything I'm reading about charting talks about describing the problem.. addressing it and then the outcome..

Well, many of the things I come across working 3rd shift, would be things such as edema, a new bruise, a skin tear, cold symptoms.. Minor changes in condition.. I'm not quite sure how the heck you are to chart that.. I'd probably be out of job REALLY quick if I called and woke up the on call doctor every time one of my paper thin skinned residents got a skin tear or a new cough. How am I protecting anyone charting "Blah blah has a new skin tear etc.. will pass on to next shift"?

Are there any other Ohio 3rd shift ltc nurses here that can give me some pointers? Do you think I should just call my don and ask her what she'd like me to do? lol I wasn't aware of this "legality" issue with fax machines until last week.

Thanks in advance!

[barefootlady, ADN, RN]

Hello Sassy,

Welcome to the real world of nursing. I do understand exactly what you are concerned about. I would

urge you to remember that charting is the only form of communication recognized in a court of law. It is the only way to prove a patient was taken care of properly. Does your facility use flow sheets? Do you have a communication book regarding patient concerns? You must chart when a patient has changes in condition, skin problems, falls, and so forth. You must include the doctor was notified. I know at one facility when the physicians demanded no faxed be done 11-7, the nurses would continue to keep the list of problems, give it to the supervisor/DON on days, making it clear it was their responsibility to notify the physician of problems on day shift since they would not allow 11-7 faxes. Actually the physicians did not want any faxes after 7 pm, so that nurse started a list, it was added to if need by the 11-7 nurse and given to the day nurse/DON to look over, check the patient, then fax the doctor. It took a meeting with the DON, Administrator, and all of the floor nurses to get this approved, but the nurses felt their license was in danger. Hope this is an idea to help.

If you truly feel left out on a limb without any help it may be time to look for a day job. Good luck.

[Sassy5d]

Thank you Barefoot!

As much as I'd love to work 1st shift, it's just not possible with my current situtuation.. Actually, my situation stays current for a few more years, you know.. kids and all.

How do you chart things? If you make a list, which sounds wonderful to me, and I try to do it now.. How do you document that?

Again, this is covering minor things.. Skin tears, edema that was probably there but nobody else documented on etc... I want to chart that it was noticed and we did something about it.. such as elevating or what have you... but I'm not sure how to end it.. Do you really say.. Report given to next shift nurse? I just can't imagine paging the doctor..but the doctor needs notified...

I've never been so frustrated in my life! I used to work dayshift.. and there was always someone, a PA or a doc that was in the building to page and get orders from... When I worked 3rds, before here, we'd pass the minor things off and it was always addressed and that was the end of it. Now I'm just so paranoid and I second guess every move I make... I just upped my stress level ten folds

[barefootlady, ADN, RN]

Chart exactly what you see and what you do. ie: 2+ edema noted to both feet, feet elevated on pillows, no breakdown noted to heels. Then yes, I state reported given to day shift charge for further attention/orders from doctor/ or whatever. Unless it is a quiet time and I can go back and chart how the situation/problem was relieved on my shift. No very likely, but I still want it known I did not allow problem to just drop. This is not always popular with other shift nurses, but you have your orders, no faxes, and unless there is really another problem with the patient, edema can be addressed on day shift, so I fullfill my duty and let it pass to the day nurses to do their duty.

Honey, nursing is not for the faint of heart, sometimes it is not easy being a good nurse and a good employee at the same time, but in the end, you have to remember you are there for the care and needs of the patient. I hope this helps. Keep doing what you do to protect your license and care for the patient, in the end, I am sure you will be fine.

[Sassy5d]

Thanks again Barefoot.

I love my residents.. I really do like the place I work.. there are just some issues that I need to work on to figure out how to resolve.

I feel a tad let down because I feel like any time I try to speak with my don, I'm just being an annoyance. Trust me, I'm not like other people I work with, I do not go out of my way to hunt her down and bother her with things. She usually calls me in her office to question me about whatever she wants to know.

My knack for noticing things are really right on (at least I'd like to think so) I can walk into a room and immediatly know somethings not right. Sadly, this is the feeling she gives me.. I know she's stressed, and has a lot of burden placed on her.. She's newer and feels like she walked into the middle of someone elses mess she has to clean up.. but it's very hard to approach her.

Maybe if I can find a way to get my concerns across.. Such as, most things I pass on, or "discover" were already known by at least a previous shift. Maybe I wouldn't feel so bad about things, and being so stressed about having the documentation that a doctor was notified.

Again, thank you for answering me.. I guess I'll just have to figure something out.