Lie on notes? Don't follow care plan.

caliotter3 · Jul 22, 2014

Some form of non-compliance, this or other actions/nonactions, is quite common. You will run into this quite often. When you speak up, the agency will blame you for any lack of harmony. They would rather you close your eyes, kiss the posterior of the client, do as they say, even anticipate their unreasonable requests, and keep your mouth shut at all times. When you can't do that, you will find yourself increasingly singled out to the point where you won't be working. The good agency with good administration and supervision, that requires professional behavior of its nursing personnel, while not bowing down to every whim and fancy of the client, to the detriment of the patient, is quite rare to nonexistent.

enuf_already · Jul 22, 2014

In other words, nurses are not expected to provide "nursing" care, they are expected to babysit the client and a sibling? Sounds like insurance fraud to me.

You are correct to question this. Run, run, run to another case. A family willing to defraud the insurance for babysitting is one that would take you down if anything happened to the sibling not under contract by the agency. If they are asking you to "fix" records, what's next?

Maybe they'll get a puppy and let you train and housebreak it in your spare time. (Only half joking. This happened to a colleague who was asked not to come back because the new puppy peed in the floor. It didn't matter that the child needed suctioned.)

Good luck!

anangelsmommy, ADN, BSN, RN · Jul 22, 2014

they told me if mom sees that I am writing everything in my notes I wont be asked back...well she better not read my notes then...

anangelsmommy, ADN, BSN, RN · Jul 22, 2014

The odd thing here is that client has some real medical issues and mom has real control issues. She will stay up all night to care for the client when we could be doing it when we are there:no:?? Mom would have at least 6 hours of sleep if she followed the care plan.

caliotter3 · Jul 22, 2014

I had a client that read the nursing notes and who removed a tasty tidbit that I had written. I came to work and she backed me into a corner, yelling and screaming at me, cursing me out in a language that I don't understand. The agency chastised me without telling me what I had done wrong. Did absolutely nothing to see that the nursing note was returned to the record and did nothing to provide me with new work when the client eventually took her business to another agency. I could not easily leave that night because she was between me and the door. Stayed to the bitter end although I felt physically ill every time I had to get ready to go to work at that house from then on out. I recently had a client laugh like a hyena when I told him about the consequences of something illegal. Laughing at me was his "pleasant mood" reaction. Most of the time, I got the opposite. According to the patient's mother, he did not like that I knew what I was talking about, did my job, and could not be pushed around. You will hear to no end what the unprofessional nurses are doing or not doing, and when you attempt to be professional, the client will attack you when it goes against one of their pet behaviors. At least in other practice settings, there is a possibility of obtaining backup, even from security. In the home, you have two adversaries: the client's family (sometimes the patient too), and your employing agency.

eeffoc_emmig · Jul 22, 2014

I suggest quietly looking for another job/agency. I would also call the compliance department of the agency as well as the fraud line for the insurance company. While working the case, document honestly or you will be guilty of fraud as well.

eeffoc_emmig · Jul 23, 2014

I had a client that read the nursing notes and who removed a tasty tidbit that I had written. I came to work and she backed me into a corner, yelling and screaming at me, cursing me out in a language that I don't understand. The agency chastised me without telling me what I had done wrong. Did absolutely nothing to see that the nursing note was returned to the record and did nothing to provide me with new work when the client eventually took her business to another agency. I could not easily leave that night because she was between me and the door. Stayed to the bitter end although I felt physically ill every time I had to get ready to go to work at that house from then on out. I recently had a client laugh like a hyena when I told him about the consequences of something illegal. Laughing at me was his "pleasant mood" reaction. Most of the time, I got the opposite. According to the patient's mother, he did not like that I knew what I was talking about, did my job, and could not be pushed around. You will hear to no end what the unprofessional nurses are doing or not doing, and when you attempt to be professional, the client will attack you when it goes against one of their pet behaviors. At least in other practice settings, there is a possibility of obtaining backup, even from security. In the home, you have two adversaries: the client's family (sometimes the patient too), and your employing agency.

Wow. You've worked with some real winners! :eek:

anangelsmommy, ADN, BSN, RN · Jul 23, 2014

most of us have all agreed that is the way to go. We had a meeting at the agency and we all had our own meeting prior to about the case. None of want to be guilty of fraud or lose our licenses. The mother doesn't speak english terribly well so I am not sure how well she can read it but I would think if she looked well if enough she would see the times written down - that is her one pet peeve, she thinks if we dont ever write down a time for anything we do that she will be safe from the insurance finding out what she does...So how would that work, I just write down...arrived at 3pm....Gave tube feeding...flushed, gave medication....gave tube feeding left pt in care of mom??? after pages of detailed notes??I think someone that had been reading my notes prior to would figure that out in a heartbeat!!

anangelsmommy, ADN, BSN, RN · Jul 23, 2014

its a legal document that you sign, right? I always put a line at the end and sign my name all the way across in other words no blank area and no easy way for someone to sneak in a comment. and I send in my copy...I leave a copy for the client. But they cant change the one I send it. How did the client change your work copy? its your legal document, isnt it? its like someone saying, "no that isnt how things happened in your mind while you were working..." ?

caliotter3 · Jul 23, 2014

Wow. You've worked with some real winners!

I agree. So, so much negativity over the years. It has been since the year 2001 since I had an excellent case that I would drop everything to return to. I am so fed up with the negativity and drain on my emotional and physical health, that I am ready to hang it up, voluntarily. But I can't pay my rent and this car is not paid for, so I can't move into it, like I've done in the past. Being older, car living does not appeal to me and the local bridge spaces are taken. I seriously can no longer, off the cuff, recommend home health to nurses as a good employment option.

caliotter3 · Jul 23, 2014

You can leave off the times. I have seen it done many, many times and to some extent, write my narratives this way. I will not, however, leave off a time for something significant. If the client has a choking spell that commences at 1510 and is fully recovered by 1522, I will include those times. As for leaving off times of feedings etc., not necessary in the narrative, only mention that a care took place during the shift. But, most agencies have a note that has an intake/output column, where you are prompted to put in times. If that is the case, you can not appease the mother by leaving off times when the feeding was administered. That is how I see it.