Oh, Geez! I was the same as you. Always on the go. Never took a break. This almost sounds like deja vu with an RN I used to work with only she was not as outgoing and always trying to hide. I and another LPN caught and nailed her but good for documenting false glucometer readings and not giving medications. We were pretty sure she was sleeping for a couple hours a night on the job, but no one could ever find where she was hiding out to do this. Here's what we did.
The glucometer has a memory and retains old readings. If you find the directions (or they may be on the manufacturer's website) you can find out how to access the memory. We started checking the blood sugars our nurse was documenting on the MARs against the blood sugars in the memory on the glucometer. We couldn't find the blood sugars that she was documenting on the MARs in the memory of the glucometer. We found every other nurses, but not hers. We documented this, dates, patient names and blood sugars, and sent a memo that we signed to the DON. I also documented a statement made to me by one of the patients. The patient asked me why I was the only nurse who stuck her finger. This lady was on sliding scale insulin and while she was a bit confused, she wasn't totally in left field! I think it was her statement that started me checking the glucometer.
Because I was real anal about the medication cart being neat and orderly and the meds ordered, I became aware that a lot of the meds that were only given during the night shift, which is the shift this nurse worked, in our Alzheimer's wing did not need to be re-ordered at their regular 30 day intervals. Then, I noticed a new bottle of liquid vitamins for a tube feeding patient that should have been opened by this nurse and given by her had remained untouched for a week! I started counting the pills in some of the Alzheimer patient's containers and sure enough, I was coming up with the same count every day indicating that this nurse was not giving these patients their medications. I hounded the DON about this. Finally, the pharmacy service arrived a hour before one of her scheduled shifts and completely inventoried the medicine cart she would be using as well as checked the memory of the glucometer without her knowledge. They came back and did another inventory as she was leaving the next morning and boy! did they find all kinds of discrepancies! The pharmacy was able to give an official documented report to the facility of their findings. The nurse was asked to come in and meet with the DON. She resigned and we never saw her again.
I still get angry over the whole thing. She should have been reported to the state board and for all I know maybe she was. Technically, she was falsifying medical records when she made up blood sugars and wrote them on MARs. Not giving medications is failing to follow medical orders.
Maybe that will give you some ideas. A word of caution though. Keep quiet about what you are doing if you decide to "monitor" this lady. These people can be smart. If she's falsifying blood sugars she's probably smart enough to know which patients she thinks she can safely ignore and which patients she absolutely has to do a real fingerstick on. She'll also be smart enough and experienced enough to know how to make you look like you've done something wrong if she suspects you are watching her and she wants to retaliate. I had 25 years of experience behind me and could go toe to toe with my nurse, but you're a newbie and still wet behind the ears. So, if you do this, collect good evidence and make it one big bang that will hang her sorry butt. One thing I did do before talking to my DON was make copies of patient MARs with the false blood sugars. I also kept xeroxed copies of all the memos before I sent them to the DON. I was prepared to send all this evidence to the state board of nursing if the DON wasn't going to do anything.
Something else that I started doing very early in my career, I can't tell you why, I think I heard it mentioned at a legal seminar, was to develop a unique way of signing off doctor's orders and of making my initials which makes it very difficult for them to be falsified by anyone else. In LTC I also initialed the tape I applied to any dressing changes I did. My two initials of my name only take me a second to scribble
, I know exactly what I'm writing, but to most people it looks like scribble and they can only kind of make out the initial of my first name. I draw specific lines on top an under doctor's orders so no one can add more orders to make it look like I forgot to transcribe any additional ones when I sign off doctor's orders.
If your nurse is doing anything like what I've described above she needs to be run out of the business. A patient "damaged some of my property". What a load of crap. I don't know what kind of "property" she brings with her to work, but all I ever brought with me was what was in my pockets and a digital blood pressure cuff which I let the CNAs use and fully expected to get knocked around. What did he do? Grab a pencil out of her hand and break it in half? Stick his hand in her pocket and bend her bandage scissors in half?
What a horse's arse.