jlynn2303 4,813 Views
Joined: May 15, '09;
Posts: 106 (18% Liked)
; Likes: 54
I doubt any "quality indicator" on a LTC is accurate. They are very keen on making everything look good on paper. The best way to find out about a facility is probably from the CNA's. IMO it is time to find a new care model as these "for profit" facilities in general have a horrible track record.
I used to joke that the next thing we would be doing would be brushing their teeth for them.
A lot of what we're seeing are the results of State regulations. You want CMS $$? Prove that you're doing x,y and z, with x,y, and z to be determined by the State.
Not all of it is "bad", and does provide better patient outcomes for a patient population that isn't exactly known for self-care (like taking their rx's to the pharmacy, or making and keeping appropriate MD appt.s) in the first place.
The multidisciplinary care plans are a bugger. They are now essentially MDS care-plans you find in nursing homes, and yes, it is designed to manage the entire patient.
Problem is, is that in NH's there are designated MDS/Care Plan Coordinators that do nothing all day but track and ensure they are completed.
Conversely in dialysis, the dialysis RN's are doing these. Unfortunately along with the trend of decreased RN staffing levels this adds even more burden to manage treatments. Da Vita and FMS have done away with post-tx patient assessments by the RN as there is simply no time. I find this appalling.
I have spent the last two days interviewing candidates for an open RN position on my floor. Last week I went through the 14 resumes HR sent over to pick out the ones I wanted to interview. Eliminated eight of these for various reasons ( poor grammar and spelling, history of job hopping, inappropriate email address), and scheduled six interviews. I did the last interview this afternoon, and still have not found a suitable candidate. I know there are plenty of resources online that give job search tips, so please, put a little effort into writing an appropriate resume, and learning how to interview. I don't care if you are old, young, fat, thin, new GN or crusty old bat, gorgeous or if you wear a paper bag over your head. Please present yourself in a professional manner when interviewing. You don't need to wear a business suit, but don't come in jeans or shorts. Don't come with overdone hair and make up and tons of bling. Learn to communicate in a professional manner as well. You are a college graduate, you should at least have an understanding of basic grammar and know how to express yourself. Express a sincere desire to work on my unit. Don't tell me that you really don't want to work on a telemetry unit, that you just want to get into the hospital so that you can transfer into ICU as soon as there is an opening. Don't be cocky or dismissive of CNAs and other ancillary personnel when I introduce you to the staff for the peer interview.
I have read numerous posts from nurses who cannot find jobs in the present economy, and I feel for them. But it can be just as frustrating for a manager looking for staff who are professional, caring, and committed to their profession. I feel like the last two days have been a complete waste of my time. Please, if you are lucky enough to get an interview, make sure you are presenting yourself as a professional. If you cannot make the effort to do so, don't waste your time or mine by even scheduling the interview.
At what point does a life become worthless? Are you going to be the one that decides who holds value in society and who does not? At what point do we shut off healthcare? Is a life worth a fiscal cap of 2 million, 3 million, or some other arbitrary number? Should services be cut for those over 65 since they no longer contribute to the GDP and are simply a drain upon society?
Just because some nurses assert that they do not falsely document does NOT in any way imply that they are saying they are "perfect" and it is unfair and misleading to suggest that they do.
With more institutions moving to an electtronic Medical Record, it is becoming increasingly difficult to document "creatively." Although in most EMRs you can go back to an earlier time, the charting will still reflect the actual time the entry was made in the chart. So if you do all of your charting at the end of the shift, you can document those hourly checks on time, but anyone reviewing the chart will see that you did all of your documentation at one time. Our hospital has gotten around this by allowing an explanation for this in the progress notes. We write something like, "Hourly checks done as ordered, documented at..." Of course, we are expected to do what we charted, or we will be looking for a new employer.
Agree to disagree? How about agree to agree? You nailed it! I work in an Alzheimer's facility and there are days (evenings in my case) where we're lucky to be able to keep our "strippers" from doing a strip tease in the dining room, get everyone fed on time, and deal with the five families we have who seem to think that thier family member is the only person we have to take care of, on top of two med passes, treatments, wound care, four foleys to deal with, seven residents on hospice, etc, etc, etc, etc. Usually I have little post its everywhere reminding me of who did what and when and then, when everything has settled down and all our charges are finally in bed, I sit down and chart, chart, chart. False documentation? Technically. Real life versus the ideal? Most definitely.
Disclaimer: This is my personal opinion and I hope we can agree to disagree if need be. If you are a perfect nurse, please do not read.
I have seen many threads on AN about false documentation and while most replies to these threads have been helpful many members feel the need to judge the OP for false documentation.
In my opinion, many floor nurses are guilty of false documentation, so what gives some of you the audacity to judge and berate another nurse.
How many times have you given a medication outside of that "one hour" window but charted it was given on time?
How many times have you documented your assessment at the time it was supposed to be done, when in reality it was done much later or even much earlier.
For my LTC, nurses are you 100 percent positive that your 20-60 residents were turned and repositioned every 2 hours, or that each one of them was toileted every two hours? Yet you will still initial those two initials in that square box.
When I was a nursing student I would often floor nurses "magically" come up with a patients weight, vital sign, or blood sugar and document, knowing that it was NEVER done. I was so quick to judge as a student and thought their license should be taken right away. After working as a nurse, I realized that while I don't condone that behavior I understand it.
If you answered NEVER to all my questions you are either a super nurse or either you work in a place that have perfect staffing, perfect patients, and perfect coworkers.
The purpose of this thread was for us to sit here and evaluate ourselves before we judge someone for false documentation.
I'm not talking about the nurse that is clearly negligent, lazy, and etc. I'm talking about the nurse like myself who provides competent and quality care to patients but faced with staffing issues that makes it nearly impossible to document every single thing as it is being done.
Unfortunately, some of us work in places where we no longer take care of patients but instead we are taking care of the higher ups in their effort to please the state.
Maybe if we can get rid of some of this customer service BS we can actually have more time for proper and precise documentation.
We are saving lives everyday. I rather give a calcium chew tablet 2 hours late than to ignore my patient that has CHF and having SOB.
So the moral of this story is that people in glass houses shouldn't throw stones.
For all of you nurses that never had to participate in "false documentation" I admire you, envy you and hope to be like you when I grow up.
At the onset, when administrative bureaucracy came up with the requirement to document :
Q 15' checks for ANYTHING
Q 2 hour checks for restrained patients... checking the restraint site, checking the toileting needs, checking the need for continued restraints, checking the vital signs...
We unanimously agreed...
They are MAKING us lie! The very act of initialing all of their precious little boxes .. makes it too time consuming to perform the tasks!
This is not just LTC... it is everywhere.
Any one that doesn't see that .. has their head buried in the sand.
Kudos to you for having the guts to bring this issue into the real world.
Ooh the lengths, we will go to ask for better staffing for better patient care!
Congrats to anonrnc for winning our second caption contest! you won $100!
This was a very close contest, several very good captions were submitted. Here were a few runner up captions:
Sweetheart, what type of clinic?
Most of the people in my class are taking the first job they have been offered. No such luxury as choosing.
I have been a nurse since 2003. I started in a very busy and large ER. I went home crying after every shift for the first 9 months!!! And then one day, it just got a little easier. And the next day was even better. Dont get me wrong, we all have bad days and there are still days I want to cry but I promise you will get there!! Keep your chin up and remember, if you can survive nursing school, you can and will make it!!
At 7 months in and just as I was starting to feel some sort of flow to my overwhelming 12 hr shifts, I was just audited by the most anal retentive RN on our unit (awesome nurse but with no social life and who is suspected by some to be a bit on the spectrum and touched with OCD so everyone is dreading her audits....and as the new RN on the block I am under the microscope).
I want to be open to the learning she can provide me but after being audited by her I have zero confidence and am feeling like I will always suck. Am so tired of hearing about everything I am doing wrong -- I work too fast, I need to take it slow and be more careful yet I'm not supposed to work any OT and am not supposed to clock out and still keep charting and on and on.....
The humiliation is ongoing and the rewards so few and far between; Feel your pain and am really considering quiting.
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