RN1212

He wanted me to write a note but not call it an admit note. Why could I not error admit note out and put assessment? The admitting nurse did not have a problem with me writing it (she was off at the time). At the time when I asked him about it, he was vague about it and did not act like it was a big deal. A few days later he grabbed the chart and said we had a five minuete conversation about it and he lied and said he told me not to write it. RN1212

Thank you for your reply. Can you not error out a note? What if it had been a note on a wrong patient? Do you see what I mean? Thanks again RN1212

Need opinions please. A situation arose at my work where a nurse had left her admit note omitted. I thought I was helping her and I came in 8 hours later and put ....Late entry admit note and signed my name with todays date and a generic admit note with admit information on it. My boss said write admit summary and I forgot what he said. He agreed that a note would be better than no note and the matter was over...or so I thought. I came back to work in 2 days and was called into the office with my manager and the director of nursing. The director said it was ...or could be considered fraudulant charting. I was suspended pending an investigation. To me this matter could have been fixed with an error or something. Does anyone know the legalities of this matter and what the employee can do? Thanks in advance RN1212