Made to Falsify Documentation :(

Chad_KY_SRNA · Jun 12, 2004

You are never to falsify a medical document, it is malpractice. That said, it is impossible to provide the appropriate level of care with the minimalist staffing policies. I work 2p-10p and this is how it goes.

2:00pm-Clock in, begin bedcheck

3:00pm- start doing the 10 showers and pass ice

4:00pm- get residents up for dinner

5:00pm-pass trays and feed residents

6:00pm-collect trays and begin putting residents to bed

7:00pm-one CNA goes on lunch while other passes snacks and does the one person transfer showers

8:00pm-next bedcheck

9:00pm-empty carts, document everything, clean out shower, and rotate out for a ten minute break.

10:00pm-clock out and go home.

Even when you work non-stop, you can almost watch the residents go down hill. I have talked to the restorative aides, nurses, the head of nursing, and everyone in OT and PT. Basically they may be ambulated 20 feet three times a week. To do any good it should be to the bathroom and to meals. If you don't ambulate them four things will happen, 1.) Resident Falls 2.) Incontinence 3.) Pain while ambulating and 4.) Loss of ability to ambulate. As far as bedchecks go we clean, dry, and turn them every two hours but that is still almost nothing compared to what the elderly deserve.

So we know what the problem and the consequences are, all we need is a solution. Unfortunately, The only workable solution is to hire more staff and thus decrease the ratio of residents/CNAs to a workable level where the CNAs are not running around like lunatics pulling out their hair. This is unfortunate because this is impossible. Most facilities are barely able to stay out of debt with the current staffing it would bankrupt some facilities to hire the appropriate amount of help.

You feel like you are robbing the residents of their dignity and independance and that is probably a big reason for the 200% turnover rate in Long Term Care. This makes me sad and angry. I hope that I have been helpful to you.

Blackcat99 · Jun 12, 2004

Yes false documentation is a fact of life in LTC's. Nurses are expected to be liars too. For example, an LPN/RN has no treatment nurse. They are suppose to have a treatment nurse to do the 40 medical treatments such as changing dressings, etc. However, some nights the nurse is expected to give out medications for 40 patients and in addition to do the 40 medical treatments too. I have told numerous RN supervisors that I only had time to do 7-8 of the actual 40 treatments ordered. I am always told to lie and initial that I did all 40 medical treatments.

jyoung1950 · Jun 12, 2004

You are never to falsify a medical document, it is malpractice. That said, it is impossible to provide the appropriate level of care with the minimalist staffing policies. I work 2p-10p and this is how it goes.
2:00pm-Clock in, begin bedcheck
3:00pm- start doing the 10 showers and pass ice
4:00pm- get residents up for dinner
5:00pm-pass trays and feed residents
6:00pm-collect trays and begin putting residents to bed
7:00pm-one CNA goes on lunch while other passes snacks and does the one person transfer showers
8:00pm-next bedcheck
9:00pm-empty carts, document everything, clean out shower, and rotate out for a ten minute break.
10:00pm-clock out and go home.
Even when you work non-stop, you can almost watch the residents go down hill. I have talked to the restorative aides, nurses, the head of nursing, and everyone in OT and PT. Basically they may be ambulated 20 feet three times a week. To do any good it should be to the bathroom and to meals. If you don't ambulate them four things will happen, 1.) Resident Falls 2.) Incontinence 3.) Pain while ambulating and 4.) Loss of ability to ambulate. As far as bedchecks go we clean, dry, and turn them every two hours but that is still almost nothing compared to what the elderly deserve.
So we know what the problem and the consequences are, all we need is a solution. Unfortunately, The only workable solution is to hire more staff and thus decrease the ratio of residents/CNAs to a workable level where the CNAs are not running around like lunatics pulling out their hair. This is unfortunate because this is impossible. Most facilities are barely able to stay out of debt with the current staffing it would bankrupt some facilities to hire the appropriate amount of help.
You feel like you are robbing the residents of their dignity and independance and that is probably a big reason for the 200% turnover rate in Long Term Care. This makes me sad and angry. I hope that I have been helpful to you.

Heck, on my assignment (and every other aids') not only was there paperwork for walking, but restorative exercises too - on 3-11 shift! If we dedicated ourselves to completing this, half our residents would still be up for the 11-7 shift to put to bed. And believe me, our grave yard shifters wouldn't stand for that past one night.

If we were honest and charted that it was not done, we had to go to a meeting with the Restorative Charge Nurse who informed us (actually yelled) that restorative will be done completely and we couldn't count lifting and bending their arms and legs when we dressed or undressed them as restorative.

LTC is a lose-lose business proposition. Sooner or later it's going to collapse under the weight of costs, state regulations and staff that give up on it.

We all better start remodeling our homes so we can care for our parents ourselves.

elkpark · Jun 12, 2004

Falsifying documentation is a v. serious business, and nurses lose their licenses over it. You can be sure that if something goes wrong and the doo-doo hits the fan, the administrative people who told you to lie are not going to step up and say, "Oh, well, it's really my fault, because I told them to write it down even though it wasn't done." They are going to make sure that you take the fall ...

Destinystar · Jun 12, 2004

the fact that you cannot get your work done is no excuse for falsifying documentation. you can initial the boxes, put a circle around it and in the summary write, these times are only an apporximation, i have no way of knowing exactly how much time i spent on each one of these tasks. never put yourself in a situation of not being able to perform your job safely. if something happens the fact that you accepted the assignment will make you liable if any of the residents get hurt. try doing private duty or working in a setting where the residents need less care like in psychiatric or with developmentally disabled folks. if enough of us make a mass exodus out of ltc, turn written reports into the department of health and to our congressmen about these problems, then they will be forced to improve the situation. as long as we stay we are telling them its ok. you can always find a new job, but if you loose your cna you will not get another one. your preception of ltc is very accurate.:angryfire

Blackcat99 · Jun 12, 2004

Falsifying documentation is a v. serious business, and nurses lose their licenses over it. You can be sure that if something goes wrong and the doo-doo hits the fan, the administrative people who told you to lie are not going to step up and say, "Oh, well, it's really my fault, because I told them to write it down even though it wasn't done." They are going to make sure that you take the fall ...

Yes you are so right about that. I really shouldn't work in LTC but I sure do love working with the elderly. I heard on this board that when a nurse leaves a blank space or initials it and then circles it that the medical records dept. then forges the nurses initials and then crosses out any nurse that writes for example med not given-not available. I was told that medical records do this all the time in LTC's or else they get in trouble with the state and have to pay heavy fines. I really do need to start thinking about my LPN license before I lose it by working in LTC's.

dotter · Jun 12, 2004

Some things are just plain hard to handle. I've been working in a facility for about 4 yrs. It's very close to where I live and I'm just trying to ride it out for 3 more yrs until I can retire. We have certain vital signs that are to be taken every shift, such as medicare pts, falls, pts on ABTs, new admits, etc. There are hardly ever more than 10 pts on the list. When I started at this facility the LPN who was orientating me said "well sometimes we have to lie a little" and she'd make up vital signs. Mostly it was because the cnas were just too sorry to get them. ( please don't anyone take that personally). I make sure they get them on my shift and I make sure I chart them. If for some reason I don't have the vital signs I just chart on the patient without them. I've noticed on weekends that most of the nurses don't even chart them half the time. Why have the cna's get them if they are not going to chart them? I don't know how this facility gets away with some of the stuff I've seen. gripe, gripe gripe. :chuckle

night owl · Jun 12, 2004

Ok...so I'm just learning the ropes as a new CNA on board and charting is one of the tasks. We are supposed to check and change (if needed) everyone on our team (20 people) every 2 hours for incontinence as the single CNA. Our floor is heavy and there's no possible way. Yet, at the end of the shift we are expected to write the times in perfect 2 hour increments that we checked each person, and our initials. I have a problem with this. Problem #1 The resident isn't getting the care (s)he deserves obviously! Problem #2 There's no way I can do this all by myself and the nurses say there's nothing they can do and pass the buck. Problem #3 Those are my initials on there and that means that my integrity is on the line. I take that seriously.
The same of the above goes for ambulation which rarely gets done for those residents who cannot walk to meals or the toilet. Lots of other stuff gets fudged too. I doubt it's the facility that I am working at because it's really one of the nicest ones around. All of the CNAs do this and they care but they say there is no possible way that things can be done properly as they would like to.
Does everyone do this? Is it commonplace to lie on charts for the files just in case the state comes in to check?
Thanks,
Shel

LTC needs to become more realistic between what has to be done and what they have to work with. Realistically one person cannot do everything for twenty needy people, especially say out of that 20, 15 are total cares. IT'S IMPOSSIBLE! TPTB are doing what they are "told to do" and that is to make sure each unit is staffed with at least the minimal of help. BUT they have to realize that not everything is going to get done. They say, "Do the best you can." and realistically, that's about all you can do. As far as being made to falsify any documentation, I wouldn't plain and simple. No one is making you lie, you do that on your own.

LydiaNN · Jun 13, 2004

I believe what you're saying, because it happened to my Mom. A series of financial mishaps put her in a situation where she desperately needed a job, and one of the County supervisors from where I grew up attended our church. He was able to get her hired on as an aide at the County run LTC. He wasn't able to protect her from the savage backstabbing and barely veiled threats of what would happen if she reported all the gross violations of standard of care she observed. She refused to cut the corners that would have been needed to truthfully document all the care the LTC "claimed" was given to these patients. She used to work through her breaks and lunch, to no avail. There was just no way to get it all done. She quit before her probation was up, but she would have almost certainly been fired otherwise. This is the way it has always been at that facility, and at the facility for persons with developmental disabilities as well (they used to call that the "state school". Given that the County Home is now called some flowery name, I assume the "state school" is as well, but I've been gone from that county for years). I hope falsifying these documents doesn't come back to haunt you. Are you looking for a different job?

shel_wny · Jun 13, 2004

I hope falsifying these documents doesn't come back to haunt you. Are you looking for a different job?

This is my new job! I quit life as a pharmacy tech to get my feet wet in the nursing field as a CNA. I'm currently a new nursing student and I've pretty much made my mind up already that I am not cut out for LTC if it means I have to lie through my teeth. I'm not quite sure what to do now. I don't want to be a whistle blowing rat and cause all kinds of uproar. The facility already has a tough time with staffing and I feel like me quitting will not only put me out of a job, but it will make the problem there worse. I thought I could always milk the place for my certification and then leave for a hospital job. Are hospital jobs any different though? Do you have to lie and say you do things that you don't? Maybe I'll talk to the DON or the Administrator. They seem like approachable people. The Administrator also talked about Integrity in general orientation so I could probably build a bit off that. I'm just at a loss...

Shel

suzanne4, RN · Jun 13, 2004

Lying is not accepted and you could prevent yourself from ever becoming an RN. It seems like such a waste to me. If you were smart, I think you would not jeopardize your future.

But the choice is ultimately yours.................think about it....what happens if a fmaily decides to sue the facility? Where are the fingers going to point?

You did the charting.................... :uhoh21: