What happened to honor?

[JBudd, MSN]

I got called by risk management last week, and asked to call one of the hospital lawyers about a chart. Seems someone has filed a complaint (or sueing, not sure which); so they are calling me. Ah, wasn't my patient, but my signature and handwriting are the only legible ones on the chart. Fortunately, I wrote a really good CYA note (person brought in by police, restrained by them, sedated by us for behavioral reasons) about our actions. I work in the ED, we are a team, if someone is busy, another nurse will step in and start a chart for them.

But, since they can't figure out who else charted anything, I'm the only one getting questioned. What happened to being proud enough of your actions to chart them, write proper notes, and being honorable enough to sign clearly? I had another nurse tell me years ago this happened to her, only her signature identifiable from a long inpatient chart, so only she got named in that suit (as a nurse, they were suing the hospital, doc, etc.). She's refused to sign legibly ever since.

Now, our hospital requires us to put our employee numbers with our signature, just so they can identify signatures! Why is my number the only one on there?!?

Am I really worried about the complaint? No, followed policies etc. Carry my own malpractice aside from the hospital's. Been called before and deposed about charts. What gets me is the lack of honor and pride in others regarding their own practice.

[dscrn]

and why are supervisors NOT auditing charts, and addressing the problem,,,???

[Batman25]

I would think RM could have managment look at the schedule or the chart to decipher who was involved. You should make them aware of this situation. It's cowardly and unprofessional. The documents not being filled out properly alone puts the hospital in a bad spot. The opposing side will attack this and it leaves your employer vulnerable. Present it as a liability that could cost them in court and they will be more apt to take action. I'd also make them aware in writing so they can't sweep it under the rug. I'd be as furious as you are.

[Chico David, BSN, RN]

Frankly, something about what they are telling you sounds bogus to me. The schedule will disclose who was working at that time, the list would be relatively short, and a quick examination of a few charts should make clear whose sig was whose. The idea that it would be impossible to determine who made the other notes is absurd. Obviously legibility is a legitimate issue for management to address with the nurses concerned.

[invernessfl]

I'd be really ****** off if that happened to me. I sympathize with you. I don't work in the ER but what is happening to you is so unfair. It's beyond unfair what's happening to you. My advice to remember is that the law is there to put people in jail, its not really interested in finding out the truth or 'doing the right thing.'

[onetiredmomma]

I also had a coworker once that said she figured if the drs could write illegibly so could she. That way if she got called into court only she would know what her charting said;(. As others have pointed out, the schedule should provide the info RM needs and if they aren't able to figure that out, feel free to point that out to them. One reason I like computer charting is that over the years my handwriting has gotten bad, I have an occasional tremor when I write that doesn't help but I still try very hard to make it legible cause it is a legal document.

[wooh, BSN, RN]

I think most people write illegibly just because after lots of writing, it starts to get illegible. I know there are times I don't really recognize my own signature. But really, it shouldn't be too hard to figure out who's names are on the chart. Like was said above, get the schedule of who was working, and it shouldn't be too hard to decipher.

[JBudd, MSN]

Thanks guys,

I haven't laid eyes on the chart yet, its all been phone calls so far. I'm fairly sure I can say who else is on the chart. Also, they looked up who was in charge, then told the lawyer he wasn't there anymore..... ah, yes he is. Good friend of mine. It just sounds like Risk Mgmt isn't very thorough.....

The lawter was asking ME about what was legal???? Asked under what conditions we could hold people; aren't YOU supposed to be able to me that? sigh.

[morte, LPN, LVN]

Thanks guys,

I haven't laid eyes on the chart yet, its all been phone calls so far. I'm fairly/ sure I can say who else is on the chart. Also, they looked up who was in charge, then told the lawyer he wasn't there anymore..... ah, yes he is. Good friend of mine. It just sounds like Risk Mgmt isn't very thorough.....

The lawter was asking ME about what was legal???? Asked under what conditions we could hold people; aren't YOU supposed to be able to me that? sigh.

A good lawyer never asks a question he/she doesnt know the answer to, i would bet he was leading you into admiting/describing an erroneous knowledge of the subject

[Tweety, BSN, RN]

We have a "signature sheet" in which we are required to print our name legidbly and then with our signature. But now that you mention it, we start it in the floor, not the ER. That should be looked into. I see an opportunity there for your unit. Of course getting someone to change how they do things is like stopping a freight change with your bare hands. We have a lot of electronic charting in our ER now so they should be able to figure it out where I work.

[XingtheBBB, BSN, RN]

We have a "signature sheet" in which we are required to print our name legidbly and then with our signature. But now that you mention it, we start it in the floor, not the ER. That should be looked into. I see an opportunity there for your unit. Of course getting someone to change how they do things is like stopping a freight change with your bare hands. We have a lot of electronic charting in our ER now so they should be able to figure it out where I work.

I was thinking the same. My unit, the ER, and the OR all have separate pre-printed sig sheets with teh names and sig of all regular FT, PT staff. There are blanks at the bottom so if your name isn't on the photocopy because you are new, agency, or a float, you add it. They are updated every so often as employees change.

Usually, the lack of clear writing, signature, and in your case, emp #, comes from being crunched for time. We don't have time to care for our patients, help our co-workers, and properly chart about it. I'd like to tell a lawyer that if my writing is tidy, I was sitting on my rump a lot. If my writing is messy and my signature fades off into asystole... I was probably running my rump off trying to save the pt's life.

[JoeMacERRN]

Over my 23 yrs of ER nursing have been to court once, but I've been deposed in discovery hearing by shifty lawyers many times. Alot of stuff never makes it to court. If you are asked to go to a discovery hearing, that doesn't mean you'll end up in court. It's just each side showing their cards by questions asked. A hospital attorney told me once he thinks nurse's talk too much. We want to explain things that really don't need to be explained, or rationalized. Keep to the facts. Short answers. And wait at least 10 seconds to think about your respose before saying anything. This is a freaking game, need to learn the rules.

In the mean time, I'd become an expert on chemical restrant, JACO standards regarding chemical restraints, your hospitals policy on use of chemical restraint. And hope to hell the proper procedure's were done. Usually includes a specific doctors order for the restrants used. I assume you had some limb restrants also. Need to check the policy and be able to recite it without notes if you want to be act like you know what's up. Which I'm sure you do.

You should have a briefing with the hospital's lawyer before you talk to the dude you sedated lawyer's. My response, once you've talked with the lawyer, " I was following doctor's orders, and there was no indication that there was any contraindication of the orders. Dude was at risk to harm himself."Don't saw anything without consulting counsel. If you have malpractive insurance...call them. Don't let the hospital hang you out there. They'll be going for the hospital's insurance carrier, and you may end up being a witness for the guy you sedated.