Yep, that's right. Today an RN I work with forged a pathology requisition slip. I don't know why he did it, but if I had to hazard a guess it would be that he didn't want to wait for the doc to sign it. Immediately after, that particular RN left for the evening.
About the same time the doc returned the procedure room asking where the slip was because he hadn't completed and signed it yet. The specimen and path request were already gone- picked up by the lab.
So....what could I do when the doc asked me about it? I told him the other nurse signed it. I don't know how upset the doc was because he simply completed a new slip and asked me to make sure the correct path request made it to the lab and replaced the forged one.
I am furious with the RN. I had to fix what he did wrong, and it felt awful explaining to the doc what happened. What should I do now? Do I inform our manager about what happened? I don't know if the doc will talk to the manager. I do not want to work with this nurse ever again as he clearly can be way out of line.
If this were your situation how would you follow up with the doc, the RN and the manager?
Nobody was harmed and everything got done the correct way, eventually. I don't see any need to be dramatic and/or report happy, but I would mention to the other nurse that the doctor came looking for the unsigned slip.
You're precepting him? He's on orientation? That's an important detail and changes your responsibility.
I don't think that's what OP meant. I think he was saying that the RN's actions of potential forgery were witnessed by OP and the (3rd) RN that OP was orienting.
I still don't see how anyone can be 100% positive that this was forgery. I sign for docs all the time with the /myname, RN signature. Unless there is a specific facility policy against that type of procedure, I would treat lightly as to how big a deal you try to make this.
How do you know he didn't sign it as a verbal order. The dc would still be required to co-sign and most likely it would be there when he completed his charts with medical records. They would flag it and have him co-sign it in order to receive payment. If you didn't see him actually sign the physician's signature then you are going to look foolish. If the doc had a problem with it then he would certainly bring it up. Didn't sound like he was concerned to me.
Actually you probably need to report that to the compliance officer at your hospital. It is a big no-no and if you are aware of fraud then you should call the compliance line. You probably have an ethics committee at your hospital that you can turn to for advice.
Let the compliance officer investigate the situation, if he co-signed it or didn't forge a signature then no big deal. But if this is the RN's practice then they need to rectify any order that has been forged. It could become a big deal and you would want to go through the proper channels.
Instead of trying to go behind his back as RNs in the workplace usually do. Why don't you bring it up to him and tell him to clarify what/why he was doing?
Obviously the doc didn't care as it was a simple pathology slip but clarification is necessary.
It's like in the ICU, technically the docs have to reorder restraints but we sign their name anyway. You would have to be insane to think I would call a pulmonologist for a restraint renew at 3am. But people have done it and gotten their ass chewed out......
Right off the hip . . . one has to assume, as a nurse, that one's coworker nurses are fully aware that FORGERY is a felony, and that one can them assume that it is very unlikely that a fellow nurse, similarly trained and educated, would not FORGE a doctor's signature. Of course it could happen, but just being reasonable, the chances are fairly low.
Long, long before assuming a fellow nurse is GUILTY of a felony offense from your witnessing a single act, one ought to just be curious and concerned, and that's about it. We are not our fellow nurse's keepers, in the biblical sense. We all have equally valid and cherished licenses we individually worked so hard to get and keep. It's fair to assume this is true for other nurses in spite of what appears to be some kind of violation. A nurse has enough trouble to keep his/herself focused on his/her own heavy work load, and if one's nose finds itself concluding things like 'felony!' one ought to reduce one's self-important indignation and withdraw said nose to a more proper length Yeah, whatever Gooselady What I mean to say is don't be so quick and willing to throw your brother nurse under the bus.
At least WAIT until you see with your own eyes "Dr Yaddayadda" scribbled in that nurse's handwriting without /Nurse Felon, RN anywhere near the 'forged' signature :)
Any discomfort/embarrassment you experienced in front of the doctor asking for the path slip is NOT caused by the other nurse's behavior. It comes from within you, as it is empirically impossible for someone else to reach inside your brain and change things around in there.
One thing that's always bugged me about nurses is how willingly we 'see' the behavior of other nurses in it's WORST possible context and how quickly we conclude we've witness BAD NURSING and then roll around in it like a dog in horse pee. Everyone of us has been on the wrong end of THAT, and it sucks, so why do it to someone else?
One thing that's always bugged me about nurses is how willingly we 'see' the behavior of other nurses in it's WORST possible context and how quickly we conclude we've witness BAD NURSING and then roll around in it like a dog in horse pee. Everyone of us has been on the wrong end of THAT, and it sucks, so why do it to someone else?
Because sometimes our eyes ARE wide open to wrong-doing and we choose not to take the "meh" approach to our life's work. Perhaps those so "bugged" are too often finding themselves on the receiving end of scrutiny. Go back and consider the tone of your post. Then think about how you would feel if you truly witnessed something wrong and subsequently received the reply you provided. Think about how unbelievably pompous your "... reach inside your brain and change things around in there..." comment might read.
I can't really add to any good advice you have received by PP. However, I would suggest to you that going forward, instead of watching this happen, I would interrupt and say "Hold UP, don't sign that, I will be sure that the MD signs when he comes in".
Because now, nurse in question can truthfully say that you were present, that you watched him sign the slip, you watched as he left the unit to deliver the sample, and never said one word that it was incorrect procedure. And the MD may say "why would the more senior nurse just let THAT happen?!
This could get hugely misinterpreted, and at your expense.
I can't really add to any good advice you have received by PP. However, I would suggest to you that going forward, instead of watching this happen, I would interrupt and say "Hold UP, don't sign that, I will be sure that the MD signs when he comes in".
Because now, nurse in question can truthfully say that you were present, that you watched him sign the slip, you watched as he left the unit to deliver the sample, and never said one word that it was incorrect procedure. And the MD may say "why would the more senior nurse just let THAT happen?!
This could get hugely misinterpreted, and at your expense.
Very true. Different hospitals have different policies regarding RN's signing path forms. I was allowed to at my old job, if I did it at my current job it would have the same consequences as me ordering and signing for a medication on the med chart. If this is your hospitals policy, you need to report this nurse because as someone mentioned earlier, what else is this person happy to forge a signature on? You also need to CYA, I have heard of a nurse forging a doctors signature on a number of different occasions and when there was a patient incident, she got in first and blamed the junior staff member that had witnessed her doing it more than once but had not ever reported it. As jadelpn mentioned, in the future you need to say something at the time as well.
Yeah, whatever Gooselady 
Pangea Reunited, ASN, RN
1,547 Posts
Nobody was harmed and everything got done the correct way, eventually. I don't see any need to be dramatic and/or report happy, but I would mention to the other nurse that the doctor came looking for the unsigned slip.