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?

[bsyrn, ASN, RN]

If you did not complete the treatment yourself, or at least check to make sure it was done (and done correctly), then I would advise you not to sign it. I would not risk my license for anyone....

[systoly]

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.

ditto

If it is within the CNAs scope then they can sign or initial. My question is this: Would the administrator who asks you to initial for work performed by someone else allow you to punch someone else's time card?

[seizetheday]

Just a question for those of you who say you check to make sure treatments were done. Does this mean you go in and remove the brief to see that the barrier cream was put on? Do you visually check each treatment? Or by checking do you mean you ask the CNA if it was done? I am curious what checking actually looks like.

[Not_A_Hat_Person, RN]

If the CNA does the treatment, the CNA should sign off on it.

[mazy]

Yes, I agree with the others. Depends on the treatment. Things like Baza are OK for the CNAs to do, removing geri sleeves, tubi-gripas, ted hose, those are in the treatment book and we nurses can sign off that it's done. I usually swing through the residents rooms during med pass at the same time someone is doing some kind of care so I can tell who the CNAs are who actually do it, and how they're doing it, so I'm fine signing off if I trust them.

If I'm really slammed I might pour out a med cup of nystatin cream or powder and ask a CNA I trust to do that treatment, but most of the time I do it myself. We are responsible for doing full head to toe weekly and PRN skin assessments on our residents, and many of us do try to pitch in as often as we can with cares, so we are usually able to stay on top of new issues.

Some nurses do sign off on everything without paying the slightest attention to what anyone is doing but that is the exception.

[onthemark]

Mazy, you sound like a very thorough and good nurse. How many patients are you taking care of and are you in a LTC facility?

[debRN0417]

The problem is- if the treatment is not done or there is a reaction, or something happens- whose initials are on the TAR? Yours. Who is responsible? You. The CNA's need to sign their own sheets- CNA treatments should not be on the nurse's TAR unless the CNA is able to access the TAR and sign the treatments they do themselves.

[onthemark]

Thanks for your input, DebRN0417. It makes sense that the CNAs should sign their own sheets and their treatments should not be in the nurse's TAR unless the CNA can access it and sign. However, others here think it's all right for the nurse to sign if she's sure the CNA did it properly and it wasn't a cruicial treatment...so I'm still a little confused.

[nurse_autumn]

Every treatment has the potential to be a crucial treatment, IMO, otherwise there would be no reason for it to be done. If you are signing it, you are putting your guarantee that it was done, and done correctly. The way I look at it, is this: My initials or signature puts me legally responsible. Anything the CNAs do gets printed in their books. They are responsible to sign for their job duties, just as I am for mine. Just as I would never initial a med someone else said they gave, I would never initial a treatment someone else said they did.

[jjjoy, LPN]

I do have to wonder how many of the repondents here actually work in LTC. And the ones who do, I have to ask how realistic it is for a newbie to actually check on each and every treatment, as the newbie is probably already waaaayyy behind because they are also having to check on everything else that a more established nurse at the facility may not have to... such as checking ID bands, looking up meds, etc. Would the supervisor approve overtime for the newbie to finish everything up properly until they have a realistic chance to get up to speed before they are established enough in the facility and their own experience to develop those elusive "time management" skills?

[sbostonRN]

I work on a skilled floor in a LTC and have 15-20 residents each day. There are certain treatments that I delegate to my competent CNAs like many of the previous posters. Our CNA's are top notch and I have worked side by side with them for several months and seen them in action. They come to me with new bruises, skin beginning to break down, newly incontinent residents, etc.

Therefore I feel comfortable having them do things like protective creams, Nystatin powder, Teds, repositioning and Foley care. I do all wounds, fistula care, dressing changes and skin breakdown treatments. But if we're just putting cream on their bum for protective reasons and there is no breakdown present, I do delegate that. After the CNA's morning care is done, I do a quick visual check to make sure that Teds are on, etc. I don't visually inspect the bottom of each resident each day but I do check it once every few days (min. once/week). Also, our CNAs document on paper and we document the TAR in the computer so it's not possible for them to sign out anything for us.

While it is my license on the line, it comes down to a matter of trust, and I feel like I can trust my CNA's. Until you can, it might be better for you to check their work to make sure it's being done correctly.

[onthemark]

sbostonRN, I'd like to know where you work to only have 15-20 residents! That's the wonderful, and probably the way it should be to give the residents the attention they deserve. You sound like such a good nurse for both the patients and also with regard to the other staff.

Thank you ALL for your very good and thoughtful input to my question. I did ask the DON about this yesterday and was told the CNAs could do basic, protective creams but all else should be done by me. Certainly, all treatments in the TAR should only be done by me. I really don't know how I'm going to manage but will certainly try. Again, thank you all so very much :) Every single one of you has shed some light on this for me.