Getting everyone else to sign their books

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how the heck do you do it? As you know I am on day 5 of my new job as a new unit manager at a LTC facility/Sub Acute Rehab and the biggest issue I see are the gaps. How do you get the nurses who give meds and do treatments and the CNA's to make sure the accountability sheets are signed? This is very frustrating. Of course this is a new month and I am sure that the nurse manager who was there before me did not do EVERYTHING because she couldn't of. How do you not get behind in ALL of the rudundant paper work? How do you deal with CNA attitudes? :uhoh21: I have tons of questions but this is all I feel like typing now. LOL:nurse:

MrsStraty

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Specializes in Gerontology, Med surg, Home Health.

It's a constant battle no matter where you work. I've had to send yet another memo asking nurses to double check the MAR before they go home each day. It was part of our plan of correction as well. I've told them that if I find blanks, it will be considered a med error and will be written up as such. I hate to resort to that, but the surveyors don't cut you any slack.

At one place I worked, the nurses switched MARs at the end of the shift and checked each other's books. Sometimes they did it, sometimes they didn't.

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Specializes in Geriatrics, LTC.

we are having the same problem, and it's soooo frustrating, because it makes all of us look bad and realistically puts all of our jobs in jeapardy! State is definately not cutting slack there! We too are going to start writing people up for their holes before we are ALL out of jobs. But state now says if it is in your facility policy then you can sign the meds as you pop them out, you just have to make sure if the person refuses to go back and circle them.

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Specializes in LTC, Home Health, L&D, Nsy, PP.

Our manager has the same problem. I work in labor and delivery and she is constantly on us about signing our books and logs. Believe me I do understand the importance of these, and I also understand your position because I covered for my manager while she was off having surgery.

One thing that I can tell you though, not saying that it is the same where you are - I can only speak for my facility - we as nurses are soooo bombarded with things that "have to be done" such as the various log books, etc., then we are covered up knee deep with the patients, families, and managers (sorry :blushkiss ) watching over us and pulling us every direction. It is a constant juggle just to keep the absolute minimum done sometimes, and I do admit that I forget from time to time to do these things. Also one of the big problems we have is the fact that when we get a little time to breathe and go back over things, we usually have a supervisor standing over us rushing us to finish so she can float us out to another department. All this with our manager (sorry again : ) ) telling us that we are to clock out on time EVERY DAY and that if we don't we had better have a darn good excuse!

Don't get me wrong because I certainly NOT flaming you. I admire you and I absolutely adore my manager. Just a little look at things from my side of the fence. :nurse:

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Specializes in Rehab.

At our LTC facility we are expected to do everything by state regs and are constantly being audited by the mangers and administration. Med passes are by the book or it's a med error.Our Pharmacy also is in at leasr once a week to watch you pass your meds, like state does, you sign the med after it's been given, which to me now is now second nature. This allows you to make sure all meds were given and not over looked, as sometimes can happen as we start getting comfortable passing the same meds to the same resident. We still have a couple of holes or prns not correctly charted but it is becoming infrequent instead of constant. We have more problems keeping the MDS grid filled out on a daily basis then anything. I really like the way the LTC facility handles this problem, where I work, because when State does arrive, we are not scambling to correct our slacked, or easier ways of doing the nursing care. It just comes naturally.

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I really want to implement a way to make sure that everyone signs their mars and tars but I'm afraid it will be like stepping on toes of people who have been there for years. :nono: I might have to resort to writing people up for med errors, which people will hate, but you know it is a med error because if it was not documented then you did not do it. And the PRN is horrible. The last place I worked if you gave a PRN there needed to be a nurses note to go along with that PRN, and here they don't do that. I am still in the sitting back and observing phase before I jump in and make changes. There is so much paper work. The last nurse manager would just fill in the gaps, forging the signatures, and they think that is FINE. I am NOT OK with that kind of practice. I hope I don't get fired for doing the right thing......because this seems to be the norm. :blushkiss

MrsStraty

PRN= patient receives none.

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Seems to me a bit more micromanagement and afew more responsibilities should help the situation.

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Don't laugh....what is micromanagement?

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In our facility, we realized that med ommissions where at an alarming rate (mostly due to missed signatures). First, we put every nurse through a mini inservice to review the med admin policies and procedures. Then, we made it our habit (as supervisors) to frequently/randomly remind people to check each others' MARs at the end of each shift. I usually wait until just before the next shift comes in and say "What are the three things you are going to ask your relief to check on your MARs?" It not only prompts them to ask for a second pair of eyes but they go back and make sure the signatures, new orders, and pre/post pain assessments are completed appropriately before they hand them over. Last, but not least, we make a copy of any MAR with missing documentation and we have the person responsible fill out the incident report. This is not a disciplinary document, it is a tracking tool and when the nurses fill it out themselves it makes them realize how often it happens and how one missed signature can generate alot more paperwork. Our med ommissions dropped to nearly non-existent after these steps. I have worked the floor in a busy rehab unit for ten years and I know how easy it is to miss something like a signature now and then due to the other overwhelming pressures of the job. Sometimes, its all about raising awareness and building better habits.

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Thank you. That sounds great, maybe I'll try that.

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Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

Look at why they are not doing their charting or book work. Are they not allowed for time to do it uninterrupted? Are they just to overworked to do it at all? Is there not a good team work attitude to allow for one at a time to have 10 or 15 mins to do the charting without interruption? 5 days on the job has revealed the obvious, the next 2 months will reveal the why. Maybe (and this is just a suggestion) your multiple documentations are so redundant that no one takes them seriously?

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It is not the multiple documentations.......It is signing for meds that you give that I am having the biggest issue with. There are far too many gaps on the MARs and that should not be. If you give the med sign for it. I have worked several different places where the documentation is getting redundant....even in the hospital setting.....but that is no excuse NOT to do your documentation. And the other nurse manager was signing the nurses initials because she said that is easier than chasing around the nurses to sign on the MARS. It is my job as the nurse manager to see that all the MARS are signed correctly. I am not feeling ok about just initialing someone elses name and this seems to be common practice. :nono:

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