nurse doesn't do her charting

[NayNeyRN]

I work night shift in a specialty surgical hospital. We get lots of admits, even well into my shift, and patients tend to discharge the next day (not all, but most).

There is one day nurse in particular, who never seems to get her work done. She frequently times out the autologous blood re-infusion drains and has to waste the blood, and she barely does her hourly rounding charting. Most concerning though, is she often doesn't enter her admission assessments, saying that she'll come in and do them tomorrow. I had one patient that she did this on, and I went back in and looked at their chart after discharge, and she hadn't entered one at all, and it was now 48 hours post admission. She even told an orientee to not worry about charting, they could do it later and to make sure meds were passed and such, then went home and left the orientee at work hours after her shift trying to catch up on charting.

I have brought these issues up with both the day shift supervisor/charge nurse and my unit manager, and am frequently told that "day shift is so busy" or that "they have 24 hours to get the admission assessment in". I feel as though my concerns are being pushed aside and swept under the rug, and I worry for both patient safety (what if we have an emergency or have to transfer a patient out and I can't present all the necessary data because she wasn't charting properly), as well as for my own license when I follow her. I am at my wits end, and I have no idea what I should do.

[broughden]

Seriously! The mind boggles at how so many incompetent nurses manage to hold onto their jobs. The best hypothesis I've come up with is that some managers just don't have it in them to confront people, and so it's more trouble than it's worth for them to fire someone, in their minds. This obviously makes no sense, as others have aptly pointed out, because when the ish hits the fan the lack of charting becomes glaringly obvious and lawsuits can occur. I will never truly understand it.

1. Depending on the facility the Manager is promoted to management or hired to management not because they are an effective leader or advocate for their staff, but because they will do WHATEVER corporate tells them too.

2. Quite frequently what corporate tells them to do is keep labor costs low to increase profitability. So ignoring safe pt to nurse ratios, and keeping lazy incompetent nurses on staff because firing them and training a new nurse increases unit costs.

#FollowTheMoney

[TriciaJ, RN]

1. Depending on the facility the Manager is promoted to management or hired to management not because they are an effective leader or advocate for their staff, but because they will do WHATEVER corporate tells them too.

2. Quite frequently what corporate tells them to do is keep labor costs low to increase profitability. So ignoring safe pt to nurse ratios, and keeping lazy incompetent nurses on staff because firing them and training a new nurse increases unit costs.

#FollowTheMoney

And for whatever reason they are slow to sniff out lawsuits waiting to happen. Do they really think they can keep pushing the envelope? Do they think they're not going to get hit with vicarious liability even after they've thrown the nurse under the bus? That's the part that boggles my mind.

[broughden]

And for whatever reason they are slow to sniff out lawsuits waiting to happen. Do they really think they can keep pushing the envelope? Do they think they're not going to get hit with vicarious liability even after they've thrown the nurse under the bus? That's the part that boggles my mind.

They have insurance to cover litigation costs. Those aren't direct costs like labor is.

Why do you think US corporations screwed over the middle class and off shored all the manufacturing jobs to overseas lower cost labor markets?

Their stocks went up when they cut labor. That's why.

[mtmkjr, BSN]

And for whatever reason they are slow to sniff out lawsuits waiting to happen. Do they really think they can keep pushing the envelope? Do they think they're not going to get hit with vicarious liability even after they've thrown the nurse under the bus? That's the part that boggles my mind.

Apparently it's cheaper to absorb those costs...what's mind boggling is that with those ethics, they can sleep at night.

[peachtreednurse, RN]

It is to no ones benefit to ignore such behavior or to believe it's someone else's job. eventually someone will burn and if I was the nurse following this skip it and hope it doesn't backfire...I would set the explosive and prepare for the boom. I have had physician's both medical and surgical who did not respond as effectively or as timely as deemed acceptable and found documentation my best friend. I don't know what SPECIALTY SURGICAL can claim that title with an allowance for a 24 hour window to enter pertinent info; but I would do whatever was required by my typical shift duty and make notes as to any missing info as "not available for review" report it to shift supervisor, make out an omission incident report and continue until things changed.

[marable]

By admission assessments do you mean the admission sheet? This is what I did when I had a patient without this sheet filled out , I filled it out myself , if something were to happen to this patient without this admission sheet filled out I think you would leave yourself wide open for some trouble.....I would definitely tell this nurse that she needs to complete her work and that I was going to report missed charting , incomplete admission sheet and the blood that she was wasting to the nurse manager.....This is wrong on so many levels....I don't know if any of you have ever been subpoenaed for a malpractice suit or not, I have had the misfortune as a nurse to be subpoenaed four times.....EVERY name on that chart will receive a subpoena , you will be taken into a huge board room with hospital lawyers, patient lawyers , doctors lawyers , hospital administrators .....They will pick apart every word or punctuation that you have written.....It is mind boggling to experience something like this ....What I am getting at is to ALWAYS protect yourself .....If a nurse is not doing her job , correct what you can by filling out that admission form , etc and tell the nurse manager .... If you are the misfortunate soul who follows a nurse like this to save yourself by doing what she did not do , not only is she going to be subpoenaed everyone else will be to including nurse managers , charge nurses etc....

[NayNeyRN]

By admission assessments do you mean the admission sheet? This is what I did when I had a patient without this sheet filled out , I filled it out myself , if something were to happen to this patient without this admission sheet filled out I think you would leave yourself wide open for some trouble.....I would definitely tell this nurse that she needs to complete her work and that I was going to report missed charting , incomplete admission sheet and the blood that she was wasting to the nurse manager.....This is wrong on so many levels....I don't know if any of you have ever been subpoenaed for a malpractice suit or not, I have had the misfortune as a nurse to be subpoenaed four times.....EVERY name on that chart will receive a subpoena , you will be taken into a huge board room with hospital lawyers, patient lawyers , doctors lawyers , hospital administrators .....They will pick apart every word or punctuation that you have written.....It is mind boggling to experience something like this ....What I am getting at is to ALWAYS protect yourself .....If a nurse is not doing her job , correct what you can by filling out that admission form , etc and tell the nurse manager .... If you are the misfortunate soul who follows a nurse like this to save yourself by doing what she did not do , not only is she going to be subpoenaed everyone else will be to including nurse managers , charge nurses etc....

No, what you are thinking of is the nursing report sheet, or kardex. What I am referring to is the initial assessment done on every patient when they first report to the floor post surgery. Your head to toe assessment, that sets the baseline for patient health. For example, if a patient who had a knee replacement was admitted early in the morning, and I do my assessment, and find that the patient has drop foot when I wasn't told that in report, I'll go look at the admission assessment to see if they presented to the unit that way, or if it was a new. The kardex gets handed from nurse to nurse, the assessment is a part of the official medical chart that is subject to legal examination.

[NurseBlaq]

No, what you are thinking of is the nursing report sheet, or kardex. What I am referring to is the initial assessment done on every patient when they first report to the floor post surgery. Your head to toe assessment, that sets the baseline for patient health. For example, if a patient who had a knee replacement was admitted early in the morning, and I do my assessment, and find that the patient has drop foot when I wasn't told that in report, I'll go look at the admission assessment to see if they presented to the unit that way, or if it was a new. The kardex gets handed from nurse to nurse, the assessment is a part of the official medical chart that is subject to legal examination.

Is the nurse of discussion even doing assessments? I can't believe patients are post surgery and no assessments are being documented and management is blahzay. There has to be physicians raising a fuss because they need to know if the patients are stable.

[/username, BSN, RN]

Are you this nurse's direct supervisor?

[BlinkyPinky]

You have done what you can do. Now you need to decide if this concern is enough to make you seek employment elsewhere. The nurse acts this way because management allows her to do so. They give you the excuses for her and expect you to stop complaining. Perhaps the nurse they hire in your place will have the same work ethic as the other nurse, so the unit will be one big, happy, dysfunctional place to work.

Sounds just like the place from which I recently resigned. One big cliquey cesspool of ennui and dysfunction. And those that are disturbed by it , tend to be happier elsewhere