Kalipso

Well it's a school and I'm not using my RN license right now, but they are mandated reporters like we are and ultimately the principal decided to report the parent's concern to CPS. I have had contact with a lawyer who specializes in nursing license issues (and while she may be trying to validate her job some) she did say that I have to self report this incident to the BON, because while it wouldn't show up on a regular background check, it will show up on one that is in depth like the may do for an RN position. And while I would only be flagged as an 'accused perpetrator', CPS keeps these records for 10 years. I did recieve, from the CPS office, a paper to submit to have my role as an 'accused perpetrator' removed from the list. I have, of course, submitted it.

Hello, I have been a nurse since 2008. I have worked ER, Home Health, Home infusion, case management, med/surg, tele, IMU, and in a clinic that had me and 2 medical assistants for 9 surgeons in 7 different specialties. I've done nights, I've done days, and I've worked the M-F 9-5. I learned a great deal, liked it all okay, never really LOVED any of it. In 2020, I became a mom at 40. And in 2024 I had another baby. I just want to be a stay at home mom, but, like everyone else, I have to work. In 2025 I quit working at the surgery clinic and got offered a unique opportunity to be a preschool teacher at a private catholic school. I have no familiarity with teaching. I took a course over the Summer last year by Harry Wong and that was all the education I got. It has been a steep learning curve, but I LOVE IT SO MUCH! The pay is atrocious....and I'm not sure I could continue making 30K a year and keep surviving. But I guess I won't have to. A month ago one of my students parent's caught him in the bathroom sticking his finger in his orifice. He is 4. Apparently his mother questioned him about this and he told her that I was taking him to a room every day and sticking my finger in his orifice. His mother told the principal this and I spent 3 weeks out of work so CPS could investigate. The findings were that I was completely Ruled Out as a suspect. I have an aide in my room and I'm never alone with a single student for any reason. And if there is a potty accident the doors remain open to the bathroom as I assist. But because of this I have been told that I will not be offered a position next year as it is "too tumultuous". This also affects my nursing license. I'm in the process getting the CPS report expunged, but I apparently still must report the whole thing to the BON in both states I'm licensed in and see if they want to do their own investigations. So now I'm out of a job, I'm not sure I can apply for a nursing position due to having to report all this to the BON ( my license still says unencumbered on Nursys) and my kids won't have insurance by the end of June. I also REALLY do not want to go back to bedside. Sorry, but after this year of being a human again I had no idea how poorly being a nurse affected me. I'm just plain tired of seeing people die. So anyone in school seen this kind of thing happen before? Can anyone who has basically been falsely reported to CPS recover? Thanks!

Maybe they just need to validate their jobs?

I don't know about practitioners, but as a regular RN in my state when you are over worked like this you can submit a 'Safe Harbor' to your manager. Basically stating that you feel you are working in unsafe conditions that make it increasingly likely that you will make a grave error. That you are officially notifying them that you feel that current expectations and conditions are unsafe and that if something happens you have record that you have stated your concerns and what you feel like you could safely do to your management and they did noting to relieve your situation. Thus you were doing everything you possibly could to provide care for the patients without abandoning your position. Then I would turn in my two month notice with written expectations on how you plan to wrap up your time with them. Like I would say. For the remainder of my 8 weeks you can double book me on Tuesdays, Wednesdays and Thursdays. Mondays and Fridays I will be ensuring that all the services I have already provided are completely documented in case your business is audited. Thank you. And then do that. If they triple book you make the staff go tell the patient that was triple booked that the office made an error and that you do not have time to see them. Yeah, it's going to piss people off, but you are quitting, so they can cry you a river.

Fortunately I had a career as an RN for well over a decade before deciding to give up nursing to try teaching. I have a 5 and 1 year old that took me a decade to get, so I just wanted to be on the same schedule. None of the schools around here had RN openings (LVNs yes, but not RNs, and even though I was willing to take the pay cut, they wouldn't hire me for an LVN spot with my RN.) So when presented with the opportunity to work as a preschool teacher for 4 year olds, I jumped at it. I love kids, and it has been a real joy. Way better than getting cursed at and having pee and poop thrown at you. The 70% pay cut is whack, but I am willing to live in near poverty to see my kids on a regular basis. A week ago one of my student's parents accused me of sexually assaulting her son with my finger. I was suspended with pay. It has been a week and I have yet to have been interviewed by CPS or the police. I have a criminal lawyer that I cannot afford, but will call if the police come. My husband and I are terrified that some how they will end up taking our kids. And the lawyer said even in the best case scenario I will have to pay to have this unfounded CPS report expunged from my record and have an additional investigation through the Texas Board of Nursing to ensure my license stays clear. I have been a bedside nurse for a long time. I worked the ER. I am pretty good at reading people. There was no indication that this parent had an issue with me...and the kid is a good kid. I am left now trying to defend my reputation, which I can, because I have an inch thick folder with every patient letter and manager evaluation I've ever had. I've won awards for my nursing ability and integrity. I have 3 licenses in 3 states, all of which have been unencumbered since 2008. I am so fortunate that I had an aide with me this year. So I am only alone with my class 15 minutes before lunch and 30 minutes for the second half of nap so my aid can eat her lunch. And I've never had to help this kid change his clothes or help him with the bathroom. And sadly, I did help at least 4 of my students with accidents this year....I didn't ask for supervision....I don't have supervision to wipe butts in the hospital. And CNAs are stretched so thin, I usually had to do my own baths....for 17 years and $46/ hr as of last year. But when this is all over, I don't think I will continue this career change. $17/ hr is not enough to hire a lawyer. And what if I decided to move up to Kindergarten where they have no aides? Can other 5 year olds speak up for me and say I didn't touch their classmate? Not to mention what my children would have to go through if such an accusation happened when they were older....how many friends they would lose?…..where they would no longer be welcome. My 5 year old still may have to suffer some of that, but there is absolutely nothing I can do. I hope nothing is happening to my student. But I have no clue how I got wrapped up in it. Don't go into public service, it doesn't pay or secure a future.

I didn't know it was possible to do such a thing, but if you got your RN license and you have been renewing it every couple years, then there is nothing for you to do other than take a job and a new RN so that you can learn how to be an RN. Refresher courses aren't going to help you more than hands on training.

I think my other problem is that my dad is chronically ill. he is a type 2 diabetic and I would say he's in the end stages of his disease. Watching him suffer is so different from watching any of my other patients and it makes it much harder for me to take care of patients that are similar in circumstance to my father. I just frequently feel so emotionally raw and its leaking into my daily nursing functions which is not good.

Junebug903 that really sucks when you feel that way. I feel like I use to be a nicer person also. Kepp looking outside of what you are doing for greener pastures...that's what I'm doing.

Thank you hherrn. That was a very informative answer.

Esme12 and Altra, I do not see charting for billing as different from just regular charting. I realize it's importance for billing AND for patient care. However, at other facilites that I have worked at we did chart audits, staff meetings, and individual meetings to improve our understanding of what we were missing, how to improve, and how it affected the hospital. I HAVE NEVER had to go back and change charting on a patient SEVERAL DAYS after they have been discharged from a facility. Mostly because I was told it was unethical. Why? Because how can I accurately document times on events of a patient I haven't seen for says? Do you not think that a lawyer could not pick a part a chart that had 2 and 3 day gaps in the time an infusion end time was charted? Most computer charting systems time stamp everything you chart. Eame12 I appriciate your detailed answer. At least now I know there are other hospitals that complete charts long after a patient has been discharged. To both of you, I do not disagree that accurate charting is an essential part of nursing care, but would not believe you at all if you said you have never had to chose between charting and doing something for your patient. I would have to.question when the last time it was that you were working on the unit as a staff nurse if you are trying to tell me that your employees don't often forget to chart essential/billing items. Since you both sound like managers I would gather that this issue is so seldom because you make sure your ER is frequently filled staffed. Kudos to you. Yes, I have animosity for these employers. I told them 8 weeks in that I felt their ER was very disfunctional due mostly to a lack of leadership. At that time it had nothing to do with the charts. Mostly due to an MD playing putting a suicidal patient in a regular room instead of the safer psych room because the sitter didn' t like that the psych room or staff singing 'staying alive' during a code when the patient's family was right outside the door....I really could go on. I don't trust people here to make good decisions and so when they asked me to go back and 'fix' charting on patients that were discharged DAYS ago it seemed a little sketchy to me, mostly because no one has ever asked me to do it, for at other positions my charting errors were brought to my attention as statistics as to what I forgot to chart and I was asked to improve the percentage, NOT to go back and add the missing information.

A bit more...I didn't beg to stay at this position PRN. They are woefully short staffed and jumped at my offer. I know they don't like me because they refuse to answer basic hiring questions foerother positions I have applied for. Fortunately I have worked enough other jobs that I had enough upper management from other postions to talk with potiential employers. I have another job already. I am just trying help these badtards with their short staffing for a couple of months like I promised.

I understand the business side of charting and how it affects the bottom line and my job. I would like to chart completely the first time around myself....not just because of billing purposes but because it provides better care. But at this time let us not worry about my employment at this job because I don't care if I do or do not continue to have employment at the instuition. My question is about the legal ramifications of charting things 3 or more days after a patient is discharged. I don't care how bad they need the money, if it jepordizes my nursing license then I shouldn't do it. Futhermore, if this institution wants more complete charting they should hire more nurses. I am literally working in a situation where it comes down to either I take care of my patients or I chart. They should be one in the same Altra, but maybe you have been fortunate enough to work at a facility that has enough staff that you don't have to choose. At this facility it is common that end times and other things are missed by ALL the staff so frequently that there is a daily stack of charts with nurses names on it to go back and fix so they can bill the patient. Is this common at other facilities? It wasn't't at my last job. I was always improving at my last job when things were brought to my attention, but I was never asked to go back and chart items that I cannot possibly accurately remember for the sake of billing.

So I think we all know about how our charting affects billing. The best example I know of this is hospitals nagging us to remember to chart the end times on IV infusions like normal saline or antibiotics. If there is no end time the insurance will not pay for the infusion and the hospital loses money. The same for like DME products such as ankle air splints or wrist braces. My previous hospital use to audit our charts for these errors and give us a print out of what we missed. It was nice because I could tell where I needed to improve my charting. But they NEVER asked me to go back into a patient's chart and 'fix' it. My new job audits the charts for these errors also, but instead of just pointing them out to you they require that you go back into a chart and 'complete' it. So days after discharge of a patient I'm suppose to go back into their chart and put the end time for the normal saline bolus they received, just so billing can bill the insurance. Now I can understand that money is necessary and all but I have a problem with this for a couple of reasons. 1) Any charting done days after a patient has left is not accurate. How does it look in court if they can see that I charted a note 3 days after the patient was discharged when their IV fluids were discontinued? Not to mention couldn't a lawyer tell that only all the chargeable parts of my charting were complete but that other parts were woefully neglected? How does that look? 2)I am all for complete charting. Mostly because if I have time to good complete charting that should cover both my butt and the hospital's. However, like most places I would guess, if I'm doing nursing care the correct way I usually am taking care of my patients and my charting is minimal CYA at best. I would LOVE to have the time review my charting before departing my patient's chart, but if there is only enough staff to barely care for the patients, much less take time to do clerical tasks like charting, how is it my fault that you (the hospital) is loosing money? Yesterday I got off a 7 day stretch that I feel darn near killed me. It was no lunch, hold your pee, get out late every single day. I picked up because the department was short. Everyday management mentioned to me that I had charts that I needed to 'complete' while watching me power walk up and down the hallway. Needless to say I did not 'complete' my charts. Now I'm suppose to be off for 14 days on vacation but I get a phone call today, which so went to voicemail, telling me that I need to come in to complete my charts so that billing can be completed. I'm not going to go in. (Side note here: I've only worked at this place for 3 months, I've already turned in a two week notice but then worked it out with management to try to stay on PRN.) Anyway how ethical is it for nurses to go back and 'correct' their charting days after a patient has been discharged? What do you think? Anyone have any idea what the legal implications of this would be in court? Does anyone else do this at their hospital?

Having worked at both magnet and non-magnet facilities, I have to tell you that I LOVE magnet hospitals. To me it does make a huge difference. I find their policies make much more 'sense' as far as nursing goes. The polices are more detailed and complete leaving less guess work. Which to me is wonderful because if you and a more senior nurse or administration disagree on a practice then usually it can be found in a policy. If the policy is not detailed enough the disagreement does not get settled and this can sometimes lead to 'this is how we've always done it' practices continuing even though a newer nurse may be more educated about evidence based practice for that procedure. Magnet nursing hospitals also tend to enforce participation and extra education on their nursing staff. It can feel like a pain in the butt to have to spend more than your 36 hours a week at work because you have to go to a committee meeting or do education but overall it makes for a better staff of coworkers. Also the status generally leads to more reasonable nurse/patient ratios which is better for the patients. I also find that magnet hospital nurses are better at understanding and practicing teamwork which allows nurses to feel safe to do things like go pee, eat, and take a 15 minute break. I think magnet hospitals do give better patient care.

Thanks for the comradery. I'll check some of the suggestions out. I have applied to a substitute school nurse position but I think it would be so much fun to teach a class! At my previous job I use to give tours of the emergency department to elementary and middle school kids, then teach first aid. I thought that was fun. Firstinfamily I totally agree that night shifts and middle shifts get gypped when it comes to ability to contribute ideas and management. My last manager was so awesome though, she made an effort to work from 3pm to midnight one day a week to try and be there for the night shift. Not perfect, but at least she was trying. Most managers do stupid stuff like ask you to be in a committee that meets at 10am on Tuesdays. Regardless if it is your day off or not, that is equal to asking a day shifter to come to a meeting at 10pm... I just meant that most of the jobs I'm looking at are on night shift. I am not a good night shifter....latest I can seem to handle is 1pm to 1am. I'm also just sick of what nurses are willing to say 'well that's just part of the job.' I cannot tell you how many times in the last month that I've gone 12 hours without getting a lunch break and having to wait hours to pee. We really should not be alright with that. And those in charge who do not make sure that people get a break, or those who refuse to take a break 'because I never do' should be ashamed of themselves and punished for depriving others from basic human functions. I could just go on and on and on. Thanks again for the support.