Keep in mind I don't do well with confrontation, I usually get so angry I start crying...
Two weekends ago I had run out of blood test strips for our monitor on my last patient that morning. I removed the chip from the monitor, and grabbed a new box, intending to replace the new chip and put the new strips in the basket. I got sidetracked by a patient request and didn't follow through with my intentions.
When I got back to work that night, the box of strips was still unopened in the basket and the last readings were the ones I did that morning. The nurse who was on should have done 8 different readings. I also checked the other monitor (our back up) and there were no readings on it that coincided with the numbers the nurse had written in the MAR. Needless to say I was very angry, especially as she recorded that she had given sliding scale insulin to one patient.
I tried calling my DON on the phone to get her input on how she would like to handle this. No answer. I recorded everything on the monitor and the MAR. Worked my shift and reported off to the same nurse. She did the same thing that day. For two days the only readings on the monitor were the readings I had done myself at HS and in the morning on our patients who do not get sliding scale.
Luckily I did not have to report off to the same nurse on Monday morning or I would probably been fired for verbal abuse of a co-worker...
I did, however, write up a two page letter to the DON, highlighting the readings, the falsified numbers in the MAR and the circumstances that led up to it. As of last Tuesday, nothing has been done about this. The DON did tell me on Tuesday that she had gotten my note. I asked her what had been done, she said, "Nothing yet."
I am very upset by this. What should the next step be? Talk to my Administrator or the BON?
I remember driving through central and northern Idaho and western Montana a few years back. The thought of it burning saddens me.
The fires are down to 4 from 20. The firefighters will be able to go back out today and finish them off, we hope. They had to stop for the night as the fires are up in the mountains and too dangerous to try fighting them in the dark.
I know a nurse who admits in her years of nursing she has fudged vital sign records (not just once or twice, but she makes a practice of it) as well as chem sticks and MARS.
I can't say I haven't been sloppy, there have been times when I haven't gotten to someone's eyedrops or wrapped their heels with a granulex soak that was ordered Q shift.
But you don't mess around with things like heart meds and blood sugar. You get a blood sugar that bottoms out and you're in a real mess.
I understand that it doesn't make much of a difference to fudge on a vitamin pill but what about heart and BP meds? Not that I'm some superhero who never does wrong, but I worked PRN at this facility and came in on the end of the month. This man got metoprolol every morning, provided his pulse was above 60. In the spaces where you wrote the pulse, it said between 76-80 across the whole board. I took his pulse and it was 48. I worked throughout that week and it was never higher than 52 while I was there. I do know the med was eventually D/C'ed.
I hope I never have to go to a nursing home. The more I see in the medical community the more concerned I am, and that's sad.
Thank you. I did write a statement and I kept a copy of it. I did not have the DON sign it, good advice.
Other Posters,
As stated, I did check our back up monitor. I did not check the others monitors in the facility...understand, this is not the first time I have noted this nurse not doing her job...it's just the most recent and dangerous. I have also reported all other instances, but this one I feel the DON has really let the patients down by not addressing it...by tomorrow it will be two weeks.
None of these patients has their own monitor and the nurse in question is demonstrably too lazy to go looking for another monitor on another unit.
Again, I thank everyone for their good advice.
Elizabeth
I do beleive ultimately patient safety is important. If it is clear this nurse has been falsifying records and you can provide evidence of that and it is clear that the DON is not pursuing, you are obligated (I think) to report it to the Board of Nursing. Falsifying records is a serious issue. When you approach the DON to ascertain what they plan to do about the situation and they have no reasonable answer for you. I would state that you plan to report this incident to the Board and that in the report you will have to state that you notified the DON. I recognize that there is a certain amount of confidentiality at stake and the DON cannot reveal to you any discplinary action that was taken against the nurse but at least with Board you will have a record of this nurse's actions.
I know a nurse who admits in her years of nursing she has fudged vital sign records (not just once or twice, but she makes a practice of it) as well as chem sticks and MARS.
I can't say I haven't been sloppy, there have been times when I haven't gotten to someone's eyedrops or wrapped their heels with a granulex soak that was ordered Q shift.
But you don't mess around with things like heart meds and blood sugar. You get a blood sugar that bottoms out and you're in a real mess.
I understand that it doesn't make much of a difference to fudge on a vitamin pill but what about heart and BP meds? Not that I'm some superhero who never does wrong, but I worked PRN at this facility and came in on the end of the month. This man got metoprolol every morning, provided his pulse was above 60. In the spaces where you wrote the pulse, it said between 76-80 across the whole board. I took his pulse and it was 48. I worked throughout that week and it was never higher than 52 while I was there. I do know the med was eventually D/C'ed.
I hope I never have to go to a nursing home. The more I see in the medical community the more concerned I am, and that's sad.
How do you "fudge" any records if you didn't take the vitals or give the pills, you simply don't document it. To do anything else is falsifying records.
Just do your own job, and unless you see something done in front of you, keep your mouth shut. Are results downloaded ? If so, it will catch up with her. My advice is always "dont be a rat"..but, obviously, you allready are one or you wouldnt have this dilemma. Why are you comparing readings anyway? You can remember what reading you got a day ago? Seems to me you were looking for trouble. Just because you found it doesnt make YOU right.
Giving sliding scale insulin without having a recent blood glucose level is a MEDICATION ERROR!! Same as not giving sliding scale insulin because you did not check the blood glucose level.
In the state I work in, a nurse is legally responsible to report such things, and is in violation of the nursing practice act if she doesn't. Nurses have a duty to report.
I'm wondering how anyone has the time to be so closely monitoring another nurse's work and get her own job done. And what is up with immediately jumping the gun and reporting someone to the BON?
You had better be darned sure, and I mean absolutely have all the facts and all your ducks in a row before you even remotely consider going to the BON. You could be in for a world of trouble if you wrongly accuse this nurse, and "Oops...my bad!" isn't going to make up for it if you're wrong.
Follow your chain of command in the hospital, and let admin. do their job. Leave the fact-finding missions for them. Your first responsibility is to your patients.
Yes, bad nurses need to be dealt with. But that should be the responsibility of the NM; she/he may be privy to information you don't have.
I'm wondering how anyone has the time to be so closely monitoring another nurse's work and get her own job done. And what is up with immediately jumping the gun and reporting someone to the BON?
You had better be darned sure, and I mean absolutely have all the facts and all your ducks in a row before you even remotely consider going to the BON. You could be in for a world of trouble if you wrongly accuse this nurse, and "Oops...my bad!" isn't going to make up for it if you're wrong.
Follow your chain of command in the hospital, and let admin. do their job. Leave the fact-finding missions for them. Your first responsibility is to your patients.
Yes, bad nurses need to be dealt with. But that should be the responsibility of the NM; she/he may be privy to information you don't have.
:yeahthat: Great response. BTW, I always enjoy the way you state your opinion. There is no guessing upon how you really feel!
TreetopAngel_RN
83 Posts
The part of the state that is apparently burning down right now!
Thanks for the offer of help!
Elizabeth