Home Care Orders.....I need help!

[np7797]

Hi all! I'm new to this so please bear with me!

I just started working as a QA nurse at a small home care agency. They are asking me to do things I'm not sure I am legally able to do. I am an RN, BSN.

They are asking me to make changes in charts for patients I have never seen. I told them I would not, they have not asked me to do this again since I refused.

They are asking me to sign off and write orders for admitting patients to home care. I am to write these orders by basically copying old orders (for patients that we've had before). I am not taking the verbal order from the physician myself, the physician tells the clerk who they want home care to see, then the clerk tells me and I am to rewrite new orders based off of the old orders (most patients are repeat patients). I never actually hear any of this from the doctor. Is this ok for me to do? I feel like if it's going to be a verbal order, I need to be speaking with the doctor, not getting the order from the clerk who got it from the doctor. At the other home care agency I worked at, the doctors would write their own orders and fax it to the office, so this new method seems weird to me

Another part of the reason I am suspicious of this company is that I heard the clerk was photocopying nurse signatures and copying them onto missed visit notes to maintain compliance for visit frequency. And I know the director of nursing is writing in charts of patients she has not seen herself. I worked too hard for my license to lose it. Can anyone out there help me?!

[LobotRN, BSN, RN]

Your gut is spot on.....RUN, RNBSN, RUN!

[caliotter3]

The part about writing off old orders for the 485 for the doctor to sign is ok as long as he signs them. All you are doing is suggesting the order based upon the doctor's usual protocol for that type patient, and the order technically isn't official until the signature is affixed to the document. If the doctor doesn't like what he or she sees that you have written, they will line through it and write it the way they want it. No problem there. Another way to handle this is to get the admitting RN to transcribe everything from the prescription labels at the house when she talks to the client/family during the intake. You will then know that the doctor (or a doctor, if not the PCP) has already provided these orders.

But, based upon the other information you provided in your post, if this is in fact true, I would start looking, and leave at the first opportunity. Enough is going on that is not according to Hoyle, that you do not want to get caught up in, in any way, shape, or form. Start looking now. Good luck.

[caliotter3]

I answered in your duplicate post. You need to leave this place.

[np7797]

I have only worked there a total of 8 business days.........what do I even tell them? "umm, you guys are shady and I don't want to get caught up in this risky business?" I'm just feeling so sick about this whole situation! I'm glad that you both agree with me and that it's not just me overreacting though :/

[Redhead28]

I would think the doctors need to be giving you phone orders or faxing in orders. I would not write orders and hope the physician will sign them, that puts you at risk when JCAHO visits, assuming the company is medicaid/medicare approved. The secretary copying signatures, can you say illegal? Sounds like they are doing many sketchy things just to be in compliance. I would stand my ground and start looking else where.

[caliotter3]

This is a good time to use the standard "Not a good fit" answer and it will really be true.

[vhern246]

This is a good time to use the standard "Not a good fit" answer and it will really be true.

I agree. Tell them you appreciate the opportunity, but that this is personally not a good fit and that you feel grateful for the experience.

Say all this as you slowly back out the door with your coat on and your stuff in your arms.

If you lose your newly acquired license, then its game over before it even really began!

[elprup, BSN, RN]

Just wanted to say, good for you for standing up for yourself! Especially as a new grad! It's not easy to do.

I stood up for myself when I was asked to do things that I did not feel comfortable with (recently as a new/old grad BSN in nursing home). Boy did they make me feel like I was wrong and stupid. But, my gut told me to do it my way and I stood up for myself and did it the way I was taught. I don't work there anymore........Good luck.

[medsurgcutie]

If you didn't hear that MD give the order don't write it, you are setting yourself up for failure. That sounds like trouble, period. Get out fast!

[np7797]

So if I quit without giving them 2 weeks notice, can they refuse to give me my paycheck? Also, am I, as a nurse, under any obligation to report the things I've seen......if so, who do I go to?

[caliotter3]

If you suspect insurance fraud, then report the fraudulent behavior to the insurance entity involved, or to the police. Do an internet search to find out the proper authority or find out from your nursing board. In my state, when you quit, the final paycheck must be handed to you as you leave the building if you request it. If they withhold your paycheck, then report them to the Labor Board to get your wages.