jigi888

So it's been a few months since this has occurred. Here is what has happened since... Another nurse has been bitten by the dog, had to present to ED as a result of it. Management finally decide that the patient needs to come into our clinic to be seen however this is short lived as the patient complains that it is too hard for him to get in there. My manager then says 'this is your last chance, make sure the dog is locked away when the nurse visits' (note that the dog has already bitten 4 nurses previously). Another nurse visits and gets bitten again last Thursday (management had implemented a risk mgt plan of contacting patient 30 minutes prior to Lock the dog away after the initial incidents, obviously it isn't working as patient locks the dog away but then still will let the dog out when the nurse is there). The acting manager then says, call 30 mins prior, make sure the dog is locked in the garage and if it isn't then leave. My question is "why the hell are we still even going to this patients home, they are obviously non compliant with what we put in place, how many nurses need to get bitten before this madness ends? Why is management not managing this properly? ARGHhHHHh. So I have contacted the next manager up to tell her of the WH&S risk and inadequate management of the situation and detailed every incident which has occurred, her reply seemed somewhat defensive and I suspect that she may have played a role in the some of that decision making process. Finally got the result which should have been implemented from the start - no more home visits for that patient but... Let's see how long it lasts for this time.... Rant over

Hi but you have misunderstood me. I dont want to hear 'My manager needs to fire her" I wanted to know, according to the original post whether this was considered falsification of documentation. I then wanted to hear opinions of those whom have been in management positions to see how they would deal with this in their institution as I have seen inadequacies with the management in my institution. It is actually my business as I have a duty of care to not only this patient but to others, if there is a nurse continually causing harm to patients then are you asking me to just turn a blind eye and ignore it? Copied and pasted from our standards: "Recognises and responds appropriately to unsafe orunprofessional practice:• identifies interventions which prevent care beingcompromised and/or law contravened identifies behaviour that is detrimental to achievingoptimal care, and• follows up incidents of unsafe practice to preventrecurrence."

Hi CaffeinePOQ4HPRN, First and foremost I would like to say that no, there was no 'relationship with this nurse'. The reason which I am so 'emotionally invested' in this is because I am truly concerned about the patients safety. I have personally seen the consequences of her actions before with a previous incident, there was no open disclosure to the patient by management and he was not told why the skin on his entire bottom extending up to his back had broken, he was under the impression he was allergic to tegaderm which the nurse involved in the incident told him! I had to continually remind management and monitor to ensure that he was told the truth and not made to believe he was allergic fo something he was not. Now there is a second incident in which I have discussed in my original post. We have a duty of care to our patients and I am truly one to believe that we are their advocates as in my workplace, I have seen that management would rather ignore the issue and sweep things under the carpet than actually deal with them instead of participating in open disclosure which they profess to practice. The competency standards where I work also state that we have a duty of care and recognise the ability to prevent harm, I do take my role seriously and due to the nature of community health, where we are often the only one seeing that specific patient for long periods of time with no other review by colleagues, things happen which are absolutely unbelievable with consequences to the patient. Also, unfortunately, the place I work has had a high turnover of staff from the top to the bottom. Junior staff acting in senior roles resulting in inadequate follow up of incidents, hence the reason why I am always asking for the outcome of incidents which I report. It is also why I am asking for the opinions of those in management positions on this forum to see how other institutions deal with these issues to improve their service and prevent further issues from happening. I dont want any more patients to be harmed, and I see the patients as someone who could by my mother, my father, a family member. If we dont advocate for them then who will? (especially in the environment I work in). I dont want my inaction to result in harm to the patient especially when I know about the inadequacies of my organisation.

Each wound has its own form. She completed all 3 of the forms. She also documented in the computer that she did all 3. The issue here is not that she may have had a lapse in concentration and forgot to do something (we all have those days), the issue is that the patient told her that she had missed the wound, did nothing and continued to document that she did them. The patients wound significantly deteriorated after the event. The patient is a diabetic and has PVD. I had been spending a lot of time on his wounds prior and was seeing improvements. If his wounds were not looked after and deteriorated then he may need to have an amputation which would mean he would be a bilateral amputation (already had one leg amputated before) and result in him placed in a nursing home. After providing the above information, would you still have the same opinion?

She said that she did do all 3 dressings. Management did not even bother to contact the patient as the regule manager was away at the time. I was told to tell the patient next time I saw them that the nurse would not visit again, and the nurse was told not to visit them again and that was how my workplace dealt with the incident.

Hi, The wound deteriorated significantly after the incident, each wound has its own form to complete and she had marked and signed them all as being complete. She also documented on the computer as having done all 3. She even came up to me later and said she put all 3 dressings on, 'maybe the other one fell off'. There was no chance that was possible as his foot was wrapped in pads, webril, crepe then tubifast. All of those were firmly intact when I arrived the next visit.

Hi, that's true but for the duration of time I have been there, it seems that dealings with incidents is inadequate and appear to just be brushed under the carpet. Caught in an ethical and moral dilemna, feels like I dont have any more left in me to advocate for the patients anymore.

Thanks caliotter3, thats exactly what I did.

Patient is A&O - wife was also present and witnessed it all. Also, when people mention that I need to talk to the nurse first, can they give me an example of what they would say? In my head, due to the seriousness of the issue, I believe that this is not in my scope to deal with. The only thing I could think of saying the nurse is 'Why did you falsify the documentation' which is not appropriate for me to say. If others suggest that I try to ask questions to investigate the issue, once again, that is not in my scope of practice to do, but rather managements. I could say to her that 'Patient x made complaint that you did not do x dressing' but due to the past history this would give her an excuse to make up prior to management approaching her. Your suggestions are all welcome and helpful to give me other perspectives/points of views on the matter. Also roser13 - I absolutely agree with you. Also of note, the wound deteriorated significantly after the event.

Hi Sour Lemon, Yes I was involved and the incident was in regards to the nurse attending a procedure she knew she should not do, and had not been signed off to do resulting in harm to the patient. She also then tried to cover up the incident by asking the nurse who picked it up initially to not tell management. What would you have done in this situation?

Hi llg, just wanting to pick your brain as you have had loads of experience in the field. Have you had previous management experience as that is not my forte. If you have, what would your action be in regards to the above nurse, also knowing that there was a prior incident in which she attended to a procedure which she was not accredited to do, and she knew she was not meant to do, resulting in harm to the patient and also tried to get another nurse who picked up the incident to try and cover up for her?

I have reported it and the nurse denied it, and it appears that management has done nothing except to tell the nurse no longer sees that specific patient. This particular nurse also has a history of trying to cover up a serious incident in the past.

The reason which I didnt directly approach the nurse first about this issue is because there is a history of her being dishonest and trying to cover things up in the past. If you were in this situation, what would you do?

Hi, A patient of mine whom has multiple foot wounds whom I see for wound dressings made a complaint to me that one of the previous nurses had attended 2 out of the 3 wounds on his foot only. The nurse was bandaging up his foot and when the patient realised that she had missed the other wound, pointed it out to her. She continued to bandage up the foot and did not attempt to dress the remaining wound. The nurse then documented that she had attended all of the dressings and left. When I went in for the next visit, the patient advised me of this, I took the bandaging off and there was indeed no dressing on the wound in question. Is this considered falsification of documentation and what would the consequences be? Thanks

Riskmanager, would you have an expectation that the nurse who had been attacked to bring this up with the nurse who made the breach?