Help, need legal advice, may get fired...

[Lulupalooza]

Hello, I'm an LPN working in an assisted living facility. About 2 months ago, I was informed when I arrived at work at 7:30 am, that a resident had been found on the floor in her apt. at 6:10 am. I went to her room immediately and found her in her bed, where she had been placed by the aide who found her on the floor. She was barely responsive, with noticeable left-sided weakness and drooping to the left side of her mouth. 911 was immediately called and she was transferred to the hospital to r/o CVA.

Last week the resident passed away and forms were faxed to DOH. DOH is investigating why there is no documentation of what happened between 6:10 and 7:30 am when I arrived at work. Can I be held responsible for what happened before I got to work that day? Can they fire me?

Supposedly, the aide never documented what happened when she found her on the floor. I remember her telling me that she was able to assist the resident to her feet and she put her back in bed. The aide said that she asked for coffee, and that she seemed OK but just tired.

I wrote up an incident report and documented what I found at 7:30 in her chart. My new supervisor called to tell me that could not find the incident report and that my documentation was incomplete. Whenever I wrote an incident report, I was told to leave it for my supervisor, which I did, along with the chart of the resident so my documentation could be reviewed by her. This supervisor resigned form the facility shortly after this occurence and a new supervisor took her place. Can I lose my license over this?

Please, I need advice quickly. Thank you for any and all responses.

[fiestynurse]

It sounds like you did everything right. You arrived at work and went immediately to the resident's apartment when you were told about the incident. You called 911 and she was taken to the hospital. You are not responsible for what the aide did or didn't do prior to your arrival. Nor are you responsible for the lack of documentation between 6:10 and 7:30.

There should have been a system set-up for incident reports to be sent directly to the risk management department. There is always a risk that an incident report will mysteriously disappear if left on a Supervisor's desk.

I don't see this as cause to report you to the board of nursing for possible license revocation. From what you posted, it doesn't sound like you did anything wrong. In what way was your documentation incomplete? Is the Supervisor asking you to do a late entry in the medical chart? It sounds like the DOH needs to speak to the aide that found her after the "fall."

[Lulupalooza]

Thank you for your reply, fiestynurse. My documentation was said to be incomplete because I didn't document what the aide did between 6:10 and when I got in at 7:30. I was unaware that I needed to do this. In my note I wrote that the aide had found the resident on the floor at 6:10 and that the resident was assisted to the bed and made comfortable (this was per the aide in question) and I was informed when I reached work at 7:30 to check on the resident which I did.

I found her in bed, hard to arouse. I assisted her to a sitting position and noticed she was listing to the left and then saw that the left side of her mouth was drooping. I called the front desk and told them to call 911 and had the aide stay with the resident while I got her paperwork ready for the hospital transfer. I then went back to the resident and stayed until EMS arrived and answered their questions.

I spoke to my former supervisor, and she remembers that I wrote the incident report. Unfortunately, she left the job a week later, so who knows what happened to it. We have a nurse where I work who is notorious for missfiling in the charts. I am going to look in other resident charts to see if it was missfiled. I don't know what will happen if I can't find it. The new supervisor seems to think this is all my fault. I feel that I did what was right from the point that I came into work.

[Bird2]

Thank you for your reply, fiestynurse. My documentation was said to be incomplete because I didn't document what the aide did between 6:10 and when I got in at 7:30. I was unaware that I needed to do this. In my note I wrote that the aide had found the resident on the floor at 6:10 and that the resident was assisted to the bed and made comfortable (this was per the aide in question) and I was informed when I reached work at 7:30 to check on the resident which I did.

I found her in bed, hard to arouse. I assisted her to a sitting position and noticed she was listing to the left and then saw that the left side of her mouth was drooping. I called the front desk and told them to call 911 and had the aide stay with the resident while I got her paperwork ready for the hospital transfer. I then went back to the resident and stayed until EMS arrived and answered their questions.

I spoke to my former supervisor, and she remembers that I wrote the incident report. Unfortunately, she left the job a week later, so who knows what happened to it. We have a nurse where I work who is notorious for missfiling in the charts. I am going to look in other resident charts to see if it was missfiled. I don't know what will happen if I can't find it. The new supervisor seems to think this is all my fault. I feel that I did what was right from the point that I came into work.

It was the supervisors responsibility to investigate what happened. Why did the aid not call 911? Sounds as though they (management) should have done some educational inservices on how to handle emergencies when a nurse is not on duty. Who ever handles the incidents reports should have maintained a copy in a separate binder. I personally never think that it is a good idea to put the incident report in the chart. It appears that many things went wrong but you did as you should have. The new supervisor may just be upset trying to fix a problem that occured before she even started.

[BeenThereDoneThat74, MSN, RN]

My documentation was said to be incomplete because I didn't document what the aide did between 6:10 and when I got in at 7:30. I was unaware that I needed to do this.

Sure the doc. is incomplete, but not by you!! If your shift began at 7:30, where was the nurses documentation from the previous shift (I'm assuming your CNAs don't write note). How can you possibly document an event that did not happen on your time?

In my note I wrote that the aide had found the resident on the floor at 6:10 and that the resident was assisted to the bed and made comfortable (this was per the aide in question) and I was informed when I reached work at 7:30 to check on the resident which I did.

.

IMO, you should not have even documented what the CNA reported to you. That did not happen on your time.

I spoke to my former supervisor, and she remembers that I wrote the incident report. Unfortunately, she left the job a week later, so who knows what happened to it. We have a nurse where I work who is notorious for missfiling in the charts. I am going to look in other resident charts to see if it was missfiled. I don't know what will happen if I can't find it. The new supervisor seems to think this is all my fault. I feel that I did what was right from the point that I came into work.

Did the new supervisor speak to the former supervisor? The old supervisor should have signed the occurence. Unfortunately, I could see how the occurences can get 'lost', since they do not get filed in the chart, and they pass through so many hands. Why can't you/they just generate a new occurence report?

[barefootlady, ADN, RN]

You cannot be responsible for things that happen when you are not on duty, much less even present in the facility. This is a shoddy piece of work on the part of the previous supervisor and this present supervisor is trying to push it over onto you. I would not generate a new ocurance report, it would look too much like you were covering up something, unless you declare at the beginning of the report it was being written to replace a report that was written and lost on the date of the incident, you are writing the events as you remember them, and it is being done at the request of the present supervisor. Tell the events as you remember them, and only what you can clearly remember, and sign it and date it for the day you are writing it. I would be on the look out for a new job, this supervisor is not going to appreciate your truth or covering your own license.

[Lulupalooza]

It was the supervisors responsibility to investigate what happened. Why did the aid not call 911? Sounds as though they (management) should have done some educational inservices on how to handle emergencies when a nurse is not on duty. Who ever handles the incidents reports should have maintained a copy in a separate binder. I personally never think that it is a good idea to put the incident report in the chart. It appears that many things went wrong but you did as you should have. The new supervisor may just be upset trying to fix a problem that occured before she even started.

The aide said that she found her on the floor, sitting... she said she assisted her to get up and walked with her to the bed. The resident told her she was tired because she was out with family the night before to celebrate her birthday. She said she just wanted to go back to bed and would like a cup of coffee, no pain or injuries were noted by the aide.

When I came in, I was told that the resident was found on the floor and could I please check on her, which I did. She showed the s/s of CVA so I called the front desk and told them to call 911. I documented this in my note.

Unfortunately, the aide did not document what transpired bet. the time she found the res. on the floor and when I came in... The aides have a log book that they are supposed to use to communicate any incidents so the nurses can evaluate any potential problems or needs that the residents may have.

I think they may try to pin responsibility on me because the aide did not document and I did not include all of her info in my note. There are nurses in my facility for only 12-14 hours per day. Two aides are on each shift per day. We have approximately 60-65 residents in the bldg, about 60% need assistance with ADL's and meds to one degree or another. From 9-10pm to 9am most days, there are only aides in the bldg.

[underwatergirl]

No you shouldn't be held responsible for what happened before your duty time, however I think it is/was your responsibilty to know that the CNA properly document the happenings, simply because ultimate responsibilty does fall on a licensed staff member. Now am I saying every nurse should check everything done prior to shift? Not always but when sending someone to the hospital it should be documented...Now questions for you...

This notebook that the CNA's document in, is it part of a patient chart??? Where do the CNA's document things when they are there that are part of the patient chart??? What is the policy on such happenings???? Now if it is part of policy that only a nurse formerly document in a patient chart(not acceptable for times when the nurse isn't there, IMO) then you should have documented exactly what the CNA said...something of this sort...start with your time of documentation. Then state CNA (initials) reported at such and such time the patient was found like this and he/she did this...at 0730 writer arrived and did blah blah blah...Because such things must be a part of a patients chart...this is a significant event, again who can document in the chart??? Incident reports should NEVER be filled in a patient chart..they are for QA(quality assurance) nothing more..it is a facility form not a chart form that is what your nursing note is for...just FYI whenever I need to fill out an Incident report, I make a copy for my records...it is kept at the facility I work at...my desk or locker...depending on a availibity...of course I always would shred those documents upon my leaving a job...protecting HIPPA.

As for if you can be fired or not...well we can be fired for just about anything in this day and age unfort. However the only way I see that happening is this, a specific policy states to do such and such and you didn't follow policy(side note here, that is why it is EXTREMELY IMPORTANT for nurses to know their facility policy's, now of course we can't memorize them all but the most important we should and if we come across a new situation then we should read that policy prior to the end of your shift...I know we get busy but you need to protect your patients and your staff. Now if you were fired for not following policy and it was reported to the nursing board, I really don't see them as prosecuting you or punishing you for this...because the only thing you may have done wrong was not document everything...you can't change what happened when you were there. Now if you were fired because the new boss was kind of a jerk...well unemployment and plenty of nursing jobs will help you through that...I don't see neither of the above happening.

However I do agree with barefootlady in developing a new incident report, but make sure you state it exactly how she said...make sure you state on such and such date I turned in original copy to so and so, and state exact names(old supervisor) because if this ever comes to a nursing review or court of law it is her that has to answer to them for the location of that report. You did the right thing, the next step turning it into your supervisor.

Hun I wish you the best of luck, but don't fall for anything that may hurt you or your license in the future. Don't take the fall for a facility with poor policys/policy enforcement. I think in such a facility if a patient is found in that condition...an on call nurse or 911 should be called by a CNA. I would also recommend for you to research your policy's and copy the appropriate ones, should this ever go beyond anything...that is your documentation/proof you did what you were suppose to...

Good Luck Hun and stand by your Guns!!!

[ZASHAGALKA, RN]

I doubt you'd lose your license - you can't be held responsible for anything after your appointed time to work. If you weren't supposed to be there till 730, then anything before 730 just simply isn't your professional responsibility.

But do you want to work for a place that sounds like it wants to scapegoat you?? Can't find the incident report my a** - don't want to find it is more likely.

Sounds like you need to lose your job (by your choice) - in a hurry.

~faith,

Timothy.

[BeenThereDoneThat74, MSN, RN]

There are nurses in my facility for only 12-14 hours per day. Two aides are on each shift per day. We have approximately 60-65 residents in the bldg, about 60% need assistance with ADL's and meds to one degree or another. From 9-10pm to 9am most days, there are only aides in the bldg.

So there was no nurse in house when this happened? What kind of establishment is this!!! And how is it your fault if you were not there when it happened? You responded immediately and appropriately as soon as you founf out about it.

[Lulupalooza]

So there was no nurse in house when this happened? What kind of establishment is this!!! And how is it your fault if you were not there when it happened? You responded immediately and appropriately as soon as you founf out about it.

In NY, nurses are not required to be in ACF's, med aides can give the meds to the residents who need med management. We have a Personal Care Director- an LPN, who works 5 days a week, the med aide works same days 7-3 with the PCD. 2 LPN's, myself and another split the rest of the time. So 5 days a week a nurse is on duty from 9am -10pm Sun. I work 4-10pm Fri. and Sat,Sun. 7-3 and Mon. 7:30am-9pm. Sun. evening, the PCD covers 3-10 because the other nurse was unable to work that shift.

When I am on shift I am responsible for all med passes. At least when the PCD is on she has the med aide to deal with that. On the day of the incident, I was doing 7:30am -9pm. It was an unbelievably crazy day, starting as soon as I walked in the door. I know I handled the situation correctly, but looking back at my note, I see I should have added more detail. At the time it seemed adequate. The incident report turning up missing could be just that the other PCD misplaced it. She was leaving 5 days after the incident and was bogged down with trying to clean up as many details as she could. My incident report seems to have gotten lost in the shuffle. I spoke with her and she remembers the report and the aide witnessed me writing it, but I don't know if that will help me at all.

Will the DOH want to talk to me and the aide? Would it help if we did? If I write a new incident report, stating that the other was lost, would they even accept it, or would they think we were covering something up?

[BeenThereDoneThat74, MSN, RN]

What do you mean by ACF???