StealthRN

No, I did not get into trouble for making something up. I left a huge gaping hole where 5 hours of vital signs should have been knowing that I was going to get into trouble for it. I knew when I realized that I could not pull up any data that I was in trouble. It did not matter that there was a ton of other charting on the patient... like notes for each time I took the 10 minutes to get the patient to the toilet and back due to the patient being given kayexalate on the previous shift. The nurse that gave the kayexelate took the easy way out and restrained the patient in the bed... letting the patient defacate in the bed multiple times... As soon as I came on shift I started getting the patient up and helping to the bathroom. It was a labor intensive event... he had two IVs, one in each arm. He had a foley, and he had some partial paralysis in his right leg. This started at the beginning of the shift and went completely through the 12 hour shift.... for some reason the pump took vitals up to 12pm and then stopped even though it was hooked back up to him after each trip. And yes... I accepted full responsibility when called into the office. I accepted that reponsibility when I did NOT fabricate data out of thin air... like I know so many others will and have done in the past. As an added bonus... having 1 critical patient, 2 stepdown patients, and 1 immediate postop back surgery arrival tends to make it hard to do everything.... unless you have a clone that comes to work with you everyday. Hey... where's mine?

How many of you have come to work the next day to find out that some nurse that followed your shift had done went and told on you about an alleged mistake... or failure on your part to do some random task and they ended up having to do it on their shift? Is there any insult bigger? Is there any betrayal that hurts worse than that? DO you find yourself going to work and looking around at the other nurses and instead of seeing teammates that are there to help you, to support you, to work towards one single goal... that of providing great care to the patients on your floor? Who are you? You are one of two kinds of nurses.. that's who. You are either the nurse that complains or you are the nurse that does your job. Nursing is a 24 hour a day, around the clock job. Obviously YOU are not reponsible for all 24 hours of care and it's not your job to complete every task before you go home at night or in the morning after a long and arduous shift. There's two kinds of nurses that work those shifts. There's the nurse that comes to work ON TIME... is standing there ready to get report from the off going nurse at 6:45 or you are the nurse that walks in at 6:45 to 6:55 and still needs to drop your stuff off in the breakroom. Still needs to get your paperwork ready, still needs to make your cup of coffee or some other time delaying deed.. and then you finally show up next to the nurse that has stopped doing everything that still needs to be done and been waiting for you to report to your place of duty so they can give you report on the patients and then finish the things they haven't done yet before they can go home. Which nurse are you? Are you the nurse that complains to the charge when there's a new admission that arrived on the previous shift but all of the "admission stuff" that we all hate has not been done and now YOU are reponsible to see that it get's done? Are you that nurse? Admission paperwork.... yes, the pain in the butt crap that has to be done when a patient initially arrives on your floor or your unit, has to be completed within 24 hours atleast at every hospital I have ever worked at.... but that's not what is expected of YOU if that patient arrived on your shift now is it? Some hospitals try to make it fairer... some have policies that say if a patient arrives at 5:30 or later.... some have it at 6:00 or later... that the receiving nurse does not have to work on all of that Crap... that needs to be done, but if the patient arrives before that appointed time it then falls on YOU to do all of the paperwork... tons of silly questions about sexual habits, past drug use, smoking, drinking, past surgical histories, past medical histories even those dating back 50 years. And then comes the Medication Reconsiliation mess... the paperwork that probably leaves us all frustrated... after all, how many patients come to the hospital with that information? You'd think that for those that say I don't have a list, that this would be easier but NOPE.... now there's even the button that you can select that describes the color of the pill. For some unknown reason, it's left up to you to sit there past your time to clock out and go home, to sit there in front of that patient and ask them.... WHat color is that pill? How often do you take that purple pill? What is that yellow pill used for? and on and on and on. If you don't... expect to get called into your boss's office the next day to answer the question "Why didn't you do your job before you left last night?" Perhaps those thinking about going into nursing, or getting out of nursing will read this and it will help you make up your mind. Here's my advice, If you can't come to work and do your job without complaining to management about your coworkers... Don't become a nurse. If you are already a nurse... QUIT. Seek out a career that has complaining and tattling in the job description. If though.. you recognize that there's 1000 things that the nurse before you had to do that is not documented on paper... so you have no way of knowing what that nurse had to do to get through his or her shift..... keep your mouth shut and do your 12 hours. Do what you too can do in that time frame. Then pass on to the oncoming nurse the tasks that still need to be completed and clock out and go home. Your job is to take care of that patient for 12 hours... it's not to complete every single task that needs to be done. It's your job to prioritize and do the best you can do... then provide a proper report to your relief so that those things that still are pending can be addressed by the next person who picks up the care of that patient.

A nurse is a patient advocate. A nurse's duty is to the patient first. We've all heard that right? We were all taught that weren't we? Yet what happens when you get that first nursing job... who do you become loyal too? Like every job in America, an employee is always afraid of losing their job if they tell anyone outside the organization what goes on INSIDE the organization. Even when people follow proper channels and report unethical or fraudulent conduct to the corporate counsel your job is still at risk. You don't have to search far to find stories on the news, on the internet, or from someone you know where a person who reported what they saw and felt was wrong doing that person then was demoted or even later fired or laid off from their job. That's how the ball bounces... and it's certainly how the ball bounces if you are a registered nurse. Has it ever happened to you? We all know what sentinel events are. We all know the difference between occurance reports and incident reports.. one is part of the chart and discoverable and the other one isn't. One is completely "secret" and there's a good reason for that but it's also abused and used... to keep secrets from patients and family when an incident occurs that is not so obvious that it can be withheld from the patient and the family members. Some things you can't hide... some things you can hide. Obviously you can't cover up operating on the wrong leg.... you can't cover up doing a biopsy on the wrong breast... but you can coverup medication errors that cause harm... you can coverup incidents where the mistakes were made in judgement... you can coverup incidents where machines malfunctioned and caused harm. Speaking of machines malfunctioning... how many of you have seen machines mess up and YOU got the blame. Do you need an example? Take the monitors in the rooms for instance... Most monitors are set to record vital signs on a regular time frame. So answer this question... How does a monitor that has been checking the blood pressure every hour suddenly stop checking the blood pressure? How many of you have gotten swamped and had to later go back and pull up the history on the monitor to get the last 3 or 4 hours of vital signs so you can write them down? Have you ever went back and seen that for some unknown reason the BP cuff did not blow up and check the pressure? What would you do if you went back to review vitals and record them into the record only to discover that the DANG MACHINE did not check the blood pressure? Obviously depending on where you work... where the patient is at, and what protocols are in play, you, the nurse, are faced with a decision to make..... Do you create some vitals out of "thin air" or do you just leave a great big, HUGE, gaping hole on the vitals sheet for someone to see and you know what is coming next right? You're going to get into trouble. Yes... you messed up. You could easily avoid getting into trouble by writing anything down to fill in the blanks. No one would know... but you would know. What you would do? The truth is.... we've all done it. I have... you have, and anyone saying they haven't is probably not telling the truth right? When a patient is sitting there walking and talking... from 12 o'clock to 5 o'clock and he or she is getting stronger, walking farther, and eager to get turned loose, what harm would it do to fabricate a few hours of vital signs? We've all heard that you won't get into trouble. That self reporting, or even telling on your coworkers won't have repercussions... that reporting is so important to the learning and training process that the system wants you and encourages everyone to fess up... you'll be OK. Your job is not at risk.... go ahead.... do it. I dare you to believe that lie.

Just a general question about this. I saw this where I work and at first I thought a doctor had logged in and forgotten to log out, but then his practicianer came out of the patient's room and continued to use the open, logged in, charting system to document the visit and enter orders. My gut tells me this is ILLEGAL. After all, any person be it the hospital staff, the insurance company, medicare medicaid, etc etc... paying the bill or auditing the chart or carrying out or reacting to the physician's signed documentation would believe it came directly from the physician when in reality the doctor has given his log in information to his practicianer and she was entering data under his name. I am troubled by the potential problem this could present and it's obvious that it's being done as an acceptable standard of operations for this physician, his staff, and perhaps even the hospital knows about it. Someone please advise.....