Is it illegal to initial when.....

[onthemark]

I'm a new lpn at a nursing home. When I finished passing the meds, the nurse orienting me told me the cna had done the treatments and all I had to do was initial the TAR. I asked if I should check the residents to make sure the treatments had been done correctly, but she said checking was not necessary, that this is how it is often done, and just to initial. I felt funny signing my own initials when I hadn't done the treatment and did not even inspect it. What do you think? Isn't this illegal? How should I handle this next time?

[glutton4punishment]

CNA's do your treatments?

Hmm. I personally don't work in LTC, but I would never initial for something that I didn't do.

[LPN_mn]

There are some treatments that the CNA's do. I always check and make sure that they are done before I initial the tx sheet. I would not initial if I could not check to make sure it was done. CNA's where I work mostly just do the nystatin powder, and some creams. I make it a habit of popping into the room when they are doing cares and see that it is done. That also gives me chance to see if the tx is working or if the tx needs to be changed.

[FLArn]

It depends on the treatments. Often times in LTC the Balmex etc that is put on as part of incontinence care is listed in the TAR but are delegated to the CNAs. Those I would sign. Until you get to know your CNAs and know who is reliable and who are the slackers, it might ease your mind to spot check the patients before signing. The treatments for actual wounds requiring dressings etc.; I would not sign those unless I did them myself.

[onthemark]

thanks, glutton4punishment! That's how I see it, too. It's just an awkward situation since the nurse who told me this is training me. I'm not sure how I should handle this.

[onthemark]

Thanks, LPN mn and FLArn! You both have clarified this for me. I'll have to try to remember what the CNAs can/can't do and also what I need to check. Thanks!

[DennRN]

There are whole courses on legal issues relating to documentation. You were spot on for wanting to check that they were done before signing. LTC facilities have a high patient to caregiver ratio resulting in shortcuts, in the end though if you are signing for something you are qualified to do or deligate to others, it is your license you are betting with. Would I trust my license to an underpaid and overworked CNA without building a solid foundation of trust and an understanding that if they didn't get to something they should tell me? No way, you worked to get licensed, protect yourself.

I'm not saying that you shouldn't trust your CNAs only that you have to realize that they are at least as overworked as you (probably more). If your mentor is telling you to take shortcuts in order to get by, it's very plausable that the CNAs are too busy to remember everything/are taking shortcuts as well.

[Emergency RN]

i remember years ago, when confronted by documentation problems like this, that i used to write in little tiny text "done by cna (lpn or rn)" if it was not personally performed by me. i did this to let anyone reviewing the mar know that it was performed (albeit not by me), so as not to duplicate something that was already done. in those situations where i was asked to sign for stuff that wasn't performed by me; i flat out refused. i told a unit manager once that if forced to sign, i would sign her name instead. needless to say that thereafter, she didn't take kindly to me, but i was never asked to do something like that ever again.

[nurse_autumn]

In my facility the CNAs have their own book for the things they do, nurses likewise. I would not initial for anything I personally did not do.

[merlee]

Until you are comfortable with what the aides are allowed to do you should at least ask them if it was actually done. Also, SOMEONE needs to be eyeballing what is actually occuring! If the pt is getting some type of skin care, who is checking to see if the area is improving or not?

I know it would be almost impossible to do all of those topical treatments on a timely manner, but if you could see a few of them every day - the newest or worst, then some others - at least you would know whether or not the treatments are effective.

Best wishes!

[CoffeeRTC, BSN, RN]

Sad but true there are alot of treatments that nurses sign for but might not actually do.

Cath care q shift...are you doing this or your cnas?

Moisture barrier q shift or prn inct?

Turn q 2 hrs

postition with xyx

I am not putting moisure barrier on each inct resident with each inct episode and I'm not doing cath care and I'm not the one position them in the wc etc.

I do check that these are done and will do them if I am with the resident or in the room.

My facility has these on the TARs that nurses sign out on. It would be nice if the CNAs can sign for them tho.

Since you are new (and I would explain it to the CNAs etc) I would check on those things you intial for at least until you know your CNAs etc.

[onthemark]

Thank you ALL for your thoughtful responses! You are all giving me helpful approaches to this

I really want to be a good LPN and appreciate your input.