Psychiatrist’s false documentation

[psychrnadvocate]

I have been at my full time job as a psychiatric nurse for three years and I like it a lot.  I am in a dilemma and I could really use some good advice. I’m fearful of retaliation and I was very hesitant to start this discussion, but I am very bothered by what is happening.

A psychiatrist at my facility is doing some very shady things, and this isn’t the first incident.  A patient who was recently admitted to the unit has been doing very well.  Pt was admitted for feeling depressed and suicidal.  Several days later during med pass, I asked pt if there has been an improvement in pt’s mood.  Pt stated yes, and their behavior and actions reflected this.  Several days after that, pt inquired as to when pt may be discharged; it was revealed to the pt that when the Dr saw the pt that day, the Dr documented pt still has suicidal ideation.  Pt stated pt did not say that, and that the interaction between Dr and pt was about two minutes.  And I DO believe the pt, because this isn’t the first time an incident like this has occurred with this same Dr.  I can recall AT LEAST two other particular pts in which this has occurred.  In those incidents, as well as the one in which this post concerns, the Dr’s documentation was COMPLETELY CONTRADICTORY to what was documented by all other staff/disciplines.  All of the latter staff had documented that these pts’ mood/behavior was improved, they denied suicidal ideation, that they were accepting their meds, they were behaving appropriately, not experiencing psychosis, participating in group and all other therapies, etc.  In one of these previous pts, the Dr even documented that one of the pts had hallucinations and was to begin taking Haldol that day!  When pts dispute things like this, staff advises them to fill out a recipient rights complaint.  I know I probably shouldn’t tell them to report the Dr to the state or CMS, that would  cause a lot of trouble for me.

[hppygr8ful, ASN, RN, EMT-I]

There are lots of things in your post that are concerning but because nursing is a small world and you never know who might be reading I will refrain from extensive comment. One thing I will say though is that nurses are not (at least in our facility) supposed to be discussing the Physician's or anyone's progress notes with the patient. If a patient asks when they might discharge they are directed to discuss discharge with their physician or case manager.

Hppy

[B52, BSN, MSN, RN]

Unless you were present during the doctor-patient interaction, you cannot prove anything. 

[AZNurse13]

Remember who you represent.. you're the patient's advocate. I worked psychiatric too lots of shady practices going on eventually some nurses found the courage to report what they witnessed. The hospital was fined for multiply violations and the CEO fired. If you can't go along with all the followers that cover for this behavior will become another statistic  be better if you resign. 

[caliotter3]

There is little hope that this will end well for you.  Transfer, resign, or make up your mind to become deaf, dumb, blind, and mute when it comes to this doctor's actions. 

[verene, MSN]

It may be that there are shady practices going down. It may also be that patient presentation is different at different times of day and with different staff - which is not at all uncommon. I've had patients who floor staff think are bright and happy and playful give me detailed suicide plans. I've also had patients who've looked more stable when I've met with them then present totally hypersexual with staff a couple hours later.   If you are seeing things completely different from psychiatrist or don't understand their care plan, or have concerns - I'd recommend reaching out to them first - see what their thought process is and what they are basing their decisions on.  There is a chance they may appreciate the feedback that nursing is seeing something completely different from what they are in their meetings with patient.