HELP! I'm being pressured to lie at work...

Dana1969 · Mar 22, 2014

The training never takes place. We are notified of a change to policy/proceddure, then given a link to an internal website, which discusses the policy/procedure in step by step in detail. Sure, if its just a change like you say "to the official butt-wiping policy which now requires six squares be used instead of four.." then that's just policy. But there are thousands of these documents on this site.

We are so overloaded at work that no one has time to access the site and learn the procedures in question. From the start of shift until end, we run to answer call-lights and bed alarms, while passing meds and doing incontinence care on five patients. I run from one fire drill to the next for my entire shift. Sit-down and read something? Yeah, maybe I'll ride to work on unicorn too.

Smauf · Mar 22, 2014

It's hard to see exactly where you're coming from. Like the others said it depends on if it's an update to policies and procedures, or if it's actually brand new training that you've never had before. Policies and procedures can be updated as often as several times a year, or as little as once a decade (possibly even longer at some places) depending on the specific policy and procedure. Whenever a hospital updates the policies and procedures, in most cases it's the hospital's job to notify staff of the update (usually through educators, or supervisors). The unit educator or nurse supervisor may print out the new policy, or tell you to manually look it up on the intranet, read it, and sign that you have read the new policy and agree to follow it. An example would be: "Our policy of labeling blood draws for laboratory that includes date, time, and initials, will now include date, time, initials, and the site blood was drawn from. Please review updated policy xx.xxxx.xx and sign off that you have read and understand it." If you don't understand it, then it's your responsibility to notify your supervisor or the educator and have them explain it to you or even show you how to do it. By refusing to acknowledge and sign off on updates to policies and procedures you can and will be written up, and eventually terminated for refusing to follow hospital policies and procedures.

Brand new training on the other hand is a different story. If you have never taken ACLS before, and the managers are telling you to sign off stating that you have been trained in ACLS, it is your responsibility to tell them you have not had this type of training and refuse to sign off on it. If they continue to pressure you into signing off on it, alert HR immediately! If HR fails to remedy the problem, alert your nursing law's governing body (in the US it would be your state board of nursing) Many state boards of nursing have adopted whisteblowing protection laws for just this sort of thing. If you do sign off on it you are making yourself liable (instead of the hospital) that during a code you have the knowledge and training to perform ACLS on your patient and failure to do so can be construed as negligence. Usually though in good hospitals (or places that want to retain their nurses) if there is a unit-wide change, such as making the unit responsible for ACLS, the educator or supervisor will sign the employees up for training and notify them about it. Once you've completed your training, again it is your responsibility then to acknowledge and sign off on it, or you can and will be written up/terminated.

So bottom line: Read your policies and procedures, ask questions if you have them, and sign off on them once you have read and understand them. Never sign off on training that you have never completed before, until after you have completed it.

Smauf · Mar 22, 2014

Okay after reading your second comment: It is YOUR responsibility to read the policies and procedures. During orientation you are given many papers to sign. Usually one of those papers is in the form of a sheet or check-off sheet that you sign your name stating I have read and understand such and such policies and procedures (usually specific to your unit). Like I said earlier, failure to follow the hospital's policies and procedures can lead to write-ups, termination, or in worst case scenarios make you liable in a lawsuit. If P&P states that all heparin doses must be verified by another nurse prior to administration and you draw up the wrong dose and administer it without another nurse verifying, and it leads to a patient's death, you are responsible whether you knew about the policy or not. If the patient's family sues, their lawyer is going to try to name anybody and everybody involved in the incident. Usually the hospital will just fire you and settle with the family out of court, but in the case where the family pursues litigation, the hospital's lawyers will argue that there is a policy in place for proper administration of heparin, and that you knowingly went outside hospital policy and overrode it. If you try to argue that you didn't know about it, and no one told you, the hospital is going to produce the paper that you signed in orientation stating you read and understood the heparin administration policy, therefore making you liable.

Bottom line: READ your policies and procedures. If they refuse to let your read them, or allow time for it, then find another job immediately. I once worked at a place and during orientation I kept asking to see the policies and procedures, but my preceptor and the nursing supervisor said they didn't know where they were at. I refused to sign off on them, and refused to start working off of orientation until I had read them. Magically they found them the next day, and I spent my last two days of orientation reading them...and yes sometimes there are a thousand of them. But again it's YOUR responsibility when you sign YOUR name. The hospital is not going to take the fall for you if you fail to comply with P&P. Protect yourself, protect your name, and protect your license!

redhead_NURSE98!, ADN, BSN · Mar 22, 2014

Typically I would stay after my shift to read P&P (I call them "read-and-sign's.") I stayed clocked in. No one blinked. So the time factor should not be an issue.

SE_BSN_RN, BSN · Mar 22, 2014

Hmmm....in my old facility, if we had something like that, it came on a written training form that was to be read by staff, and an attendace sheet to be signed saying you read and understood that procedure/change....of which I would make a copy of. Are you saying there is no documentation for the new policies/procedures?

jadelpn, LPN, EMT-B · Mar 22, 2014

If a shift is 7a-7:30 p, and the next shift comes on at 7p-7:30a, then there's a half hour (or say 20 minutes) extra after reporting off especially with the SBAR reporting that is being put into play with reporting now. That would be when I would review the newest policies.

However, if it is impossible to do this, I would ask the nurse educator when it is that you are to do this reviewing. There needs to be some sort of plan in place. If all of your communication is via email, then when would anyone know anything if there's no time to access it? Do you have staff meetings to review these?

Another thought is that your charge gives each nurse 15 minutes a day to review emails and new pollicies. If you know that from the start of your shift until 7:15 you are to be reviewing, then get report, it may just work out. If everyone is feeling this way, it needs to be brought to the attention (again) of the DON and the nurse educator to rectify. And your union should be able to help with that as well.

As a complete aside, you should most certainly obtain malpractice insurance on your own if you have not already done so. It is important for any nurse to have.

Ldy76 · Mar 22, 2014

I work at a government run Magnet hospital in the East SF Bay area, with a group of wonderful RNs. The problem is, Management is pressuring RNs to sign off on training which they haven't received.
This is how it works. Our Nursing Education department, sends out an email to the floor RNs, saying that there is a new policy (or protocol, or procedure, etc.) and that it is the "Nurses Responsibility" to conform to policy.
Then Management sends senior RNs (aka Staff Nurse 3s and 4s), to each unit to with blank training forms which they ask you to sign to "update your training records." Regardless of which senior RN is assigned to you, they all use the same key words saying " expects you to sign this form." That's the implied threat. If you don't sign, you will be reported to your unit manager as a malcontent.
Last year, a Staff Nurse 3 harassed me for nine months, to sign-off on training and I finally caved in and signed. A while later, one of my coworkers had a patient go bad, and she was suspended without pay, and then had to go through a probationary period where she was closely monitored. When she filed a union grievance, Management produced her training record, with all this training signed off as completed by her. I'm a single parent, and I need my job. I'm just so afraid that a patient will go bad, and I'll be the next one to be thrown under a
bus.

I'm not a nurse but I've worked direct-care in a hosp for 12 yrs. If I were you I would've looked for another job once adm asked me to lie. At the end of the day, it'll b on ur conscious if anything happens to a pt n u could've prevented it. Signing off on a training that never happened risks ur job, the other person's job n of course the pt's welfare.

Ldy76

toomuchbaloney · Mar 23, 2014

You are a professional and have some responsibilities relative to that status.

One of them is maintaining the knowledge base required to safely complete the duties of your job.

If your employer has mandated that new Policy review is to be completed by a certain date, YOU are responsible to complete that. The FLSA regulations require that if this must occur after your normal work shift the employer must pay you.

They are not asking you to lie, they are asking you to confirm that you have completed that which is mandatory.

Tell them you haven't completed it and why and see what happens.

As a manager I would be asking you why you didn't come to me prior to violating the deadline rather than waiting and then responding with an excuse.

Dana1969 · Oct 8, 2014

Let me give an actual example, PCEA (Patient Controlled Epidural Analgesia). A patient comes from PACU with a PCEA after a hip/knee replacement. Specialty RNs assigned to the hip/knee unit are given 10-14 days training on the care of there patients. Failure of something is simple as improper positioning in bed can cause the analgesia (fentanyl/bupivacaine?) to migrate up the spine and adversely affect the respiratory center. Our med-surg unit started taking these patients, and instead of two weeks training, we received ONE DAY WITH FIVE PATIENTS!. In the span of two weeks, I saw TWO patients go into respiratory arrest, have to be dosed with narcan and transferred to ICU for mechanical ventilation. The primary RN was suspended for 90 days without pay, the patients survived, and it was quietly covered up. But it all comes down to budget. Every dollar saved on training, is one more dollar available for administrator compensation (like our CEOs new Lexus every three years, $1.1M in 2013 compensation, six weeks paid vacation a year, and free lifetime auto/life/health insurance for administrators and their families). I can't get the medical supplies and training I need to be a safe, competent professional RN. But my CEO can donate $200,000 of hospital funds to a charity that her husband has a paid board position with. That's my MAGNET EXPERIENCE. The senior executives distract the public with this "GREAT MAGNET ACCOMPLISHMENT" while stealing everything which isn't nailed down.

icuRNmaggie, BSN, RN · Oct 12, 2014

Let me give an actual example, PCEA (Patient Controlled Epidural Analgesia). A patient comes from PACU with a PCEA after a hip/knee replacement. Specialty RNs assigned to the hip/knee unit are given 10-14 days training on the care of there patients. Failure of something is simple as improper positioning in bed can cause the analgesia (fentanyl/bupivacaine?) to migrate up the spine and adversely affect the respiratory center. Our med-surg unit started taking these patients, and instead of two weeks training, we received ONE DAY WITH FIVE PATIENTS!. In the span of two weeks, I saw TWO patients go into respiratory arrest, have to be dosed with narcan and transferred to ICU for mechanical ventilation. The primary RN was suspended for 90 days without pay, the patients survived, and it was quietly covered up. But it all comes down to budget. Every dollar saved on training, is one more dollar available for administrator compensation (like our CEOs new Lexus every three years, $1.1M in 2013 compensation, six weeks paid vacation a year, and free lifetime auto/life/health insurance for administrators and their families). I can't get the medical supplies and training I need to be a safe, competent professional RN. But my CEO can donate $200,000 of hospital funds to a charity that her husband has a paid board position with. That's my MAGNET EXPERIENCE. The senior executives distract the public with this "GREAT MAGNET ACCOMPLISHMENT" while stealing everything which isn't nailed down.

In the event of a sentinel event or near miss event as described above, the very first thing the risk management or legal dept. will do is pull the educational file for the nurse. If she was not signed off or given a competency on the epidural, they are liable for failing to ensure that she was competent in the care of that patient. Her suspension is a ruse to deflect responsibility on their part.

Without knowing your facilitys policy for monitoring a pt with an epidural, it is hard for me say if the nurse monitored the pt according to standards of care or if she was negligent. If you feel the patients are unsafe due to a lack of education, contact your immediate supervisors via email and ask for training on epidural analgesia and nerve blocks be provided. Forward a copy to your personal email. It might come in handy when you get called to a root cause analysis and an administrator says "This is the first weve heard about this!"

At the same time, I would mention to the anesthesiologist and or orthopedic surgeon that you don't feel comfortable having pts with epidurals and that you and your coworkers need education to safely monitor these patients. Say quietly this is unsafe. I guarantee you they will be going to a different unit from now on.

As to the original question, if you are being asked to sign off on a yearly competency that we all should know such as standard precautions, contact precautions, airborne precautions, Fire safety even, I would be okay with that. Anything clinical or concerning anesthesia, blocks, epidurals or concious sedation, even policy for the CPM machine, no way.

What happened to your colleague is appalling and you are wise to be careful about what you sign and please keep copies of education records or healthstream transcripts. Were they trying to get you to sign off on education related to epidural analgesia?

If someone tries to intimidate you into signing for education that you have not received you can politely ask when is the next class or is there a competency for me to read. Are there any post tests? I will take care of that right away, thanks, ..... Do not cave in to the pressure.

I do believe you. This sounds like a bootleg outfit and you might want to start looking for another job or a well managed unit within the facilty.

Also if you are using your real name or identifiers on this site, change that immediately and have this thread removed by the admin desk.