How do unethical nurses sleep at night?

Sabby_NC · Jun 3, 2007

I had the very same experience and actually confronted the nurse in a non threatening very tactful way.

I just happen to mention what was said to me by some patients but no names were mentioned.

I said that she may need to be careful of what she is doing in the home.

I let it go but she changed her habits and actually started to assess the patients as she should. I felt this nurse just got complacent and lazy on the job but a tactful comment to her made her 'see the light' :);

MrChicagoRN, RN · Jun 4, 2007

As a professional and as a patient advocate it is your duty to report this to your supervisor.

Who is paying for these visits? Submitting charting and billing for a 60 minute visit, though the visit doesn't meet the standards for a billable visit, is fraud. Not to mention falsyfying documentation

Keep this to your self and you are an accessory to the fraud.

Report it and let your supervisors take it from there.

Jo Dirt · Jun 4, 2007

I imagine she goes to bed at night the same way a lot of businessmen and politicians and government officials go to bed at night.

Did the patients suffer ill effects from her charting that she assessed lung sounds?

Is it that maybe she is overworked and barely has time to do what she is there for in the first place? Maybe she is burned out and in a rut and anymore her job to her is like the cashier at Wal-Mart, just run the items over the scanner and gets them out of the way?

She may be a lazy bum, but she may also be a nice person who means no harm and is just having a hard time. It is kind of unsettling when I see posts from other nurses who are so perfect they could never be capable of any kind of omission or couldn't possibly be guilty of ever taking any short cuts. That doesn't excuse a person consistently fudging their paperwork but you are either perfect or you aren't.

DutchgirlRN, ASN, RN · Jun 4, 2007

Did the patients suffer ill effects from her charting that she assessed lung sounds?
Is it that maybe she is overworked and barely has time to do what she is there for in the first place? Maybe she is burned out and in a rut.
She may be a lazy bum, but she may also be a nice person who means no harm and is just having a hard time. It is kind of unsettling when I see posts from other nurses who are so perfect they could never be capable of any kind of omission or couldn't possibly be guilty of ever taking any short cuts.

That's the thing exactly. She is very over-worked. The patients are getting the care they need such as wound care, etc...I feel as though she should at least be getting the vs and lung sounds as that only takes less than 5 minutes and certainly not be charting something not done. I have learned the hard way when to pick my battles. This one issue I will not address. If I get a chance to meet this nurse I will address it with her. There's no harm in charting that a visit only took 30 minutes because most of mine do only last 30 minutes. It is what it is. Just like with the vs, if I didn't take them, I won't chart that I did. I have taken shortcuts just never lied to cover them up.

Jo Dirt · Jun 4, 2007

I have taken shortcuts just never lied to cover them up.

Me neither, that is something a person has to be very careful of. I'd probably find an opportunity to mention how they are coming down hard on people lately for charting deficiencies and such. Better to leave it blank on the form than make up something because it will likely come back to bite you in the butt.

Home Health Columnist / Guide · Jun 4, 2007

I've a run across HHA supervisory visit lasting 5 min, SN visit where family tells me RN in home 10 min while it takes me 30 min to do VS and wd care "gee nurse told us no gloves needed as long as handle outside of bandage-she hasn't used gloves in 3 wks cared for wife." RN who submitted 2 months of home care notes without ANY temp being recorded as patients all refused ---yet other RN visited pt able to get temp.

Also ran across HHA documenting in home for 2 hours , same time I was visiting but pt tells me no one feed her and foley cath bag full to point of bursting and emptied 3 liter into bedpan..... was submitting time to my agency and also billing another agency for same time in home under another program: daughter splitting monies with HHA.

When people fall into complacency and are pressed for time to do more, corners tend to get cut. Thankfully the check and balance system does work. And i never have to worry about my license over fraud.

tattooednursie, LVN · Jun 4, 2007

I did a home health hospice rotation for clinicals. I learned that when you walk into a patients home you should consider it that you are walking on sacred ground because they are welcoming you in their home. There is no way 4 patients could exaggerate the same thing! I couldnt sleep at night if I did my patients like that. They probably look forward to the visit if anything else, and they should get that.

CapeCodMermaid, RN · Jun 4, 2007

I'm certainly not condoning the falsification of medical records but...patients sometimes pit one nurse against another and patients do not always tell the truth either.

Some people are very quick with their assessments and other tasks. I had a daily wound on a woman. Every day I did a full set of vitals,lung sounds, bowel sounds...you name it I did it. And yet I was never there more than 30 minutes. Why? Because my background is long term care and when you have 30 patients to assess and do treatments on, you develop a method to make things move more smoothly. Did I chart things I didn't do? Never...was I in and out in less than 30 minutes? You bet.

Talk to this nurse and get her story before you put her in the stocks in front of town hall.

rn/writer, RN · Jun 4, 2007

I'm certainly not condoning the falsification of medical records but...patients sometimes pit one nurse against another and patients do not always tell the truth either.
Some people are very quick with their assessments and other tasks. I had a daily wound on a woman. Every day I did a full set of vitals,lung sounds, bowel sounds...you name it I did it. And yet I was never there more than 30 minutes. Why? Because my background is long term care and when you have 30 patients to assess and do treatments on, you develop a method to make things move more smoothly. Did I chart things I didn't do? Never...was I in and out in less than 30 minutes? You bet.
Talk to this nurse and get her story before you put her in the stocks in front of town hall.

No one is talking about putting anyone in stocks. In fact, Dutchgirl said she was not going to turn this into a battle.

You're correct that patients don't always pick up on everthing that is being done for them, but it does seem unlikely that four patients in a row would deny that their v/s and lung sounds had been assessed. Temp and blood pressure are pretty obvious procedures. And you'd know whether or not you'd been approached with a stethoscope.

People sometimes do cut corners. They need to know that this can turn around and bite them later. Especially if they falsify their charting. They also occasionally need a wake-up call that their patients deserve better.

I hope Dutchgirl has the opportunity to give this nurse a nudge for the benefit of all concerned.

DutchgirlRN, ASN, RN · Jun 5, 2007

No one is talking about putting anyone in stocks. In fact, Dutchgirl said she was not going to turn this into a battle.
You're correct that patients don't always pick up on everthing that is being done for them, but it does seem unlikely that four patients in a row would deny that their v/s and lung sounds had been assessed. Temp and blood pressure are pretty obvious procedures. And you'd know whether or not you'd been approached with a stethoscope.

:yeahthat: :yeahthat: :yeahthat: :yeahthat: Yes, well put and 3 of the 4 patients are younger than I am. Totally orientated.