I am a RN in LTC. It has been well over a year now that nurses are not following important protocols. The new nurses in the last year are not taught to follow protocol or to document correctly, then they orientate new nurses without teaching them protocols, then no one knows what they are doing. Recently I have reviewed approx 30 charts for the MDS, and found many problems with documentation. Here is just a couple of protocols they do not follow:
1. Skin Protocol & Protocol for Pressure Ulcers - many nurses document like this: open area on buttocks, duoderm applied, check daily for placement or
open area 1cm x 1cm, duoderm applied, check daily. Thats all thats done. My main gripe is Protocol for pressure ulcers, no prog note, skin sheet not started, order for labs, orders for zinc and vit.C not obtained by MD, referral to dietician not made, care plans not updated, no skin assessments to follow, pressure relieving devices not initiated. This is a constant problem, no inservices to correct this problem.
2. Fall Incident Reports - the nurses do not fill out the incident reports correctly, and the prog notes are extremely vague. Reading the prog notes, I have no idea when the fall occured, how they fell, no vitals, no intervention to prevent fall and care plan not initiated or updated.
I am not in the position to make corrections with the nurses. The DNS is and is not doing so. Any thoughts on this?
Oct 22, '06
I feel your pain. My DNS is sometimes quite unwilling to take what I think is necessary action, also. Mostly, I just move on, keep quiet, let her be the boss.
I don't know if you have tried going over her head to the Administrator but that is one possibility, albeit a possibly inadvisable one. You might get into lots of trouble, you might find the same lack of receptivity there. Going to Corporate or your facility's attorneys - same thing. It could go very well or it could backfire.
There is the choice of going outside the facility and reporting this to the authorities who oversee and accredit your facility, those who license it. I guess that would be CMS (Medicare), maybe some state agency, maybe your state legislators.
Or you could try informing the newspaper, TV, radio stations, and senior citizen advocacy groups.
They're all pretty darned scary and there's no guarantee you'd still have a job or be able to effect the change you seek to effect.
I guess I'd need to really think this through, figure out if I would be willing to risk my job and maybe wind up having to sue the place - or try to (wrongful termination, retaliation for whistleblowing, etc.).
You might want to get some legal advice from a private attorney before doing anything in order to avoid being fired, charged with slander or libel, having false accusations made about you to the state Board of Nursing, etc.
I think you need to ask yourself how vital it is for protocols to be followed, how the patients are faring in light of the protocols not being followed, and whether you might be able to quietly, informally teach the protocols to the staff. Or can you get them instituted on your own, by doing the work yourself that the staff should be doing. And if you do that, hopefully the staff would pick up on it.
You could post the protocols prominently around the nurses' station, coat room, locker room, toilet, wherever they'd be most likely to be seen - maybe the smoking area, LOL.
One other thought - do you know why your DNS is unwilling to take action? Maybe understanding her reluctance would help you figure out a solution. With my own boss, it is due, I think, to the fact that she can't stand having anyone else come up with good ideas. Yep, megalomaniacal, power hungry madness. In all its splendor. At least, she doesn't take kindly to suggestions from me or from at least 1 other person I know. She "hears" only some of the managers - the inner clique. It's really frustrating. Sometimes I do things on my own, quietly, unobtrusively, thinking of the patients' welfare, keeping my own counsel, with God my everpresent Friend and Strength. And I think about the fact that I will soon retire and not have to deal with her for much longer, LOL.
I don't envy you, I truly wish you good luck, and I hope you find a workable solution.
Last edit by TrudyRN on Oct 22, '06