state is threatening to go after license over precharting

chris_at_lucas_RN, RN · Nov 7, 2004

What are you in Chris, managment, educator or QA?

I am a nurse with a brain, the ability to know the difference between right and wrong and to do the right thing, no matter what the consequence.

Is this your best response to my statement? Good. Then I have made my point clearly and you obviously understand. You may not like it, but you understand.

mattsmom81 · Nov 7, 2004

Chris...luv ya...but you are a brand new nurse...I know what you say is what you've been taught...but 'doing things right' does contain shades of grey.

When you are in the real world of nursing and the cold reality of what we deal with hits you, and your patients need your time and interventions, and you're exhausted after a 14 hr shift and need to leave, and managers are breathing down your neck cuz you're OT...corners WILL be cut somewhere, sometime.This doesn't equate to incompetent care or 'bad nursing', its prioritizing in the real world. Where we prioritize is a choice we all make.

IME there is simply not enough time to 'do it all' perfectly, exactly like everyone would want it. We all decide where 'that line' is. I chart late all the time in the computer and my nurse attorney tells me THIS can also be challenged in court...well,geez, I cannot document exact times all the time!! I simply cannnot be a 12 hr slave to computers and documentation q 1 h on the dot...but that is what facilities seem to expect these days. If ALL I had to do all day was just document, with another nurse doing ALL the care, I could likely keep busy! Darn that patient care anyhow...LOL!!

SmilingBluEyes · Nov 8, 2004

Chris...luv ya...but you are a brand new nurse...I know what you say is what you've been taught...but 'doing things right' does contain shades of grey.
When you are in the real world of nursing and the cold reality of what we deal with hits you, and your patients need your time and interventions, and you're exhausted after a 14 hr shift and need to leave, and managers are breathing down your neck cuz you're OT...corners WILL be cut somewhere, sometime.This doesn't equate to incompetent care or 'bad nursing', its prioritizing in the real world. Where we prioritize is a choice we all make.
IME there is simply not enough time to 'do it all' perfectly, exactly like everyone would want it. We all decide where 'that line' is. I chart late all the time in the computer and my nurse attorney tells me THIS can also be challenged in court...well,geez, I cannot document exact times all the time!! I simply cannnot be a 12 hr slave to computers and documentation q 1 h on the dot...but that is what facilities seem to expect these days. If ALL I had to do all day was just document, with another nurse doing ALL the care, I could likely keep busy! Darn that patient care anyhow...LOL!!

Boy oh boy doncha know it. Computer charting has really thrown a wrench into it.....damned if you do, damned if you don't in some cases...sigh. Reality bites.

lee1 · Nov 8, 2004

Chris...luv ya...but you are a brand new nurse...I know what you say is what you've been taught...but 'doing things right' does contain shades of grey.
When you are in the real world of nursing and the cold reality of what we deal with hits you, and your patients need your time and interventions, and you're exhausted after a 14 hr shift and need to leave, and managers are breathing down your neck cuz you're OT...corners WILL be cut somewhere, sometime.This doesn't equate to incompetent care or 'bad nursing', its prioritizing in the real world. Where we prioritize is a choice we all make.
IME there is simply not enough time to 'do it all' perfectly, exactly like everyone would want it. We all decide where 'that line' is. I chart late all the time in the computer and my nurse attorney tells me THIS can also be challenged in court...well,geez, I cannot document exact times all the time!! I simply cannnot be a 12 hr slave to computers and documentation q 1 h on the dot...but that is what facilities seem to expect these days. If ALL I had to do all day was just document, with another nurse doing ALL the care, I could likely keep busy! Darn that patient care anyhow...LOL!!

And what have YOU all done to make your management MORE responsible???

Do you have a union???

Is your hospital Magnet??? It can be withdrawn !!!

Does your Board of Trustees know what is being done to save them money???

Does the State labor board know??

Does the Dept of Health know?

chris_at_lucas_RN, RN · Nov 8, 2004

IME there is simply not enough time to 'do it all' perfectly, exactly like everyone would want it. We all decide where 'that line' is. I chart late all the time in the computer and my nurse attorney tells me THIS can also be challenged in court...well,geez, I cannot document exact times all the time!! I simply cannnot be a 12 hr slave to computers and documentation q 1 h on the dot...but that is what facilities seem to expect these days. If ALL I had to do all day was just document, with another nurse doing ALL the care, I could likely keep busy! Darn that patient care anyhow...LOL!!

Charting late is not illegal or unethical, it is messy. So what. A lot of things are.

This thread was started--and someone correct me if I'm wrong--because some nurse charted she had done something that she hadn't done (yet) and she was caught and her license is in jeopardy.

When she charted she had done something she had not done, she lied. Further, she lied in a legal document. I don't care how old you are, or how long you've been a nurse, or whatever, a lie is a lie is a lie.

I may be a new nurse, but I have been a licensed (master's degreed--not a CMA or something) professional for many years--we also have to chart, we often have to testify in court, our licenses can be challenged for these same sorts of things, and, amazingly, right and wrong are the same for psychotherapists as they are for nurses, doctors, morticians, journalists, real estate agents, teachers, you name it.

Yes it's a heavy load, but don't think it's just nurses that have this sort of challenge.

Where does it say that right and wrong are different if you are a new nurse, and old nurse or whatever?

Right is right. Charting before you do something is wrong. (How much time do you save, doing it wrong? Enough to make a difference? I doubt it.)

Ask me again in a year or two. I wont' be a "new nurse" then. I'll lay you odds my answer will be the same, and you'll be able to ask anyone I work with, and they'll know I don't "prechart."

Bill Levinson · Nov 8, 2004

Charting late is not illegal or unethical, it is messy. So what. A lot of things are.
This thread was started--and someone correct me if I'm wrong--because some nurse charted she had done something that she hadn't done (yet) and she was caught and her license is in jeopardy.
When she charted she had done something she had not done, she lied. Further, she lied in a legal document. I don't care how old you are, or how long you've been a nurse, or whatever, a lie is a lie is a lie.

In industrial situations, lot travelers (documents on parts that show which operations have been performed on them) are checked off exactly when the operation is performed. If someone pre-checks them (similar to pre-charting), it is possible that the parts will be sent on before the required procedure is done to them. In a hospital, I assume that the person who pre-charted might forget and the next person would assume that the required procedure had been done, so this is indeed extremely dangerous.

On the other hand, it would also seem that charting late is an exposure. (I have seen parts double-processed in a factory for this reason; the lot traveler was not checked off as soon as the process was completed.) If something is done but not recorded on the spot, it is conceivable that one might forget that it was done or that another person might assume that it needed to be done, so a patient might conceivably get two doses of medication.

If the system in which you work encourages or requires people to pre-chart or to chart things late, the system is deficient and needs to be corrected. I suspect very strongly that nurses do not pre-chart because they don't want to do the job correctly but because the hospital requires them (for example) to walk from the patient to a central location to do the charting or something stupid and inefficient like that. (Henry Ford said that pedestrianism is not a highly-paying line of work.)

Furthermore, if hospital administrators are pressuring nurses to violate accepted procedures (e.g. by reprimanding them for staying late to finish paperwork), it would be my inclination (not a legal opinion, I am not a lawyer) to hold the administrators at least equal in guilt to a nurse who is caught pre-charting, with action being taken against the hospital's own license or accreditation.

NurseFirst · Nov 10, 2004

"House of God" by Samuel Shem.

Someone just put the "rules of the House of God" up here on the board somewhere.

It's many years old. but explains a lot--a lot about the kinds of pressure that medical professionals can be under. It is--as said--the "somewhat fictional" account of the author's internship year. (Samuel Shem is a pseudonym.) I'm sure you can get more of a feel by reading some of the reviews on Amazon or elsewhere.

NurseFirst

Thunderwolf, MSN, RN · Nov 10, 2004

Regardless of reasons or rationale, if you chart it...you did it. If you chart it, but didn't...you know it's wrong. Bad practice. In court, you will not have a leg to stand on. Court really doesn't care how bad or how rushed the environment is or how bad your day was. You charted that you assessed and/or intervened, the evidence says contrary. Depending on your state, you could kiss your license good-bye. Don't do it.

leslie :-D · Nov 10, 2004

holy God!

i cannot believe the defensiveness of those who prechart.

do you know how many nurses that i have seen precharting then do not do the work?

precharting is fraudulent delivery of care, period.

while precharting putting on teds would not be comparable to administering a scheduled narcotic, by putting your initials on that sheet states such care was rendered.

and it hadn't been.

that simple.

so chris sweetie, i'm with you 100%. to me it's very black and white.

and when i have been overworked and stressed, i did the charting accordingly but also was unable to finish my work for the shift and passed that along to the oncoming shift.

then when mgmt. tries to chew your butt out, it is reasonable to state that you cannot fulfill all said duties within said frame of time...that it is humanly impossible. of course, you look like an idiot when you say that for the rest of your colleagues have finished, only because they precharted.

i would much rather tell the truth and not finish the work rather that risk my license for delivering care that was deemed unrendered. many many implications to this.

the only thing i acknowledge is the severity of what is being precharted.

but then that starts a slippery slope in which you could lose your license.

leslie

Bill Levinson · Nov 10, 2004

Does your state have an anonymous tip line where you can report your hospital for pressuring RNs to prechart? It seems to me that RNs don't prechart because they want to do the job wrong, but because the hospital administration pressures them to do so (e.g. by reprimanding them for overtime).

What is being discussed here is similar to ethical issues that come up in engineering. As an example, a company's engineer is told or pressured to do something illegal or unethical, like discharge pollutants illegally or overlook a safety problem. He is required to try to resolve the issue with his employer first. If that does not work, he may be obliged to report the problem to the authorities ("blow the whistle") and many states have anonymous tip lines for doing this. The same applies to workplace safety violations, if the employer refuses to correct them.

Rather than risk one's professional license by giving in to an employer's pressure to cut corners, it would seem that a better course of action is to go to the state agency that accredits hospitals and report the hospital management for doing this.

leslie :-D · Nov 10, 2004

Does your state have an anonymous tip line where you can report your hospital for pressuring RNs to prechart? It seems to me that RNs don't prechart because they want to do the job wrong, but because the hospital administration pressures them to do so (e.g. by reprimanding them for overtime).
What is being discussed here is similar to ethical issues that come up in engineering. As an example, a company's engineer is told or pressured to do something illegal or unethical, like discharge pollutants illegally or overlook a safety problem. He is required to try to resolve the issue with his employer first. If that does not work, he may be obliged to report the problem to the authorities ("blow the whistle") and many states have anonymous tip lines for doing this. The same applies to workplace safety violations, if the employer refuses to correct them.
Rather than risk one's professional license by giving in to an employer's pressure to cut corners, it would seem that a better course of action is to go to the state agency that accredits hospitals and report the hospital management for doing this.

there are nurses who prechart at the start of their shift then basically do as little as possible.

the precharting described in this thread is secondary to time limits and being overworked.

mgmt. does not give a damn about nsg workloads; they just want it done, period.

and that is why that nsg is in crisis mode today.

the only thing i am proposing is rather than prechart, do your job by the book and if you don't finish treatments and/or meds, then you report that to the nm and to the oncoming shift.

if all the nurses who prechart did this, there would be more evidence in the burdensome workloads that nurses are forced to encumber.

but with precharting, not only is it technically fraudulent, more important (to me) is that nurses are demonstrating that they can indeed, get their work done. and if that is the case, why should or would there be any changes?

i've seen nurses come in on their days off, just to finish work (w/o being paid). i am flabbergasted when i see this, and it merely adds to the image of nurses being martyrs.

leslie

pickledpepperRN · Nov 10, 2004

We became nurses to care for patients. Documentation, as important as it is, is NOT direct care.

We write on a form anytime we can't give safe, effective, therapeutic care.

Write an incident too. I would try to invite my coworkers to attend a CE class on documentation or legal aspects. I would ask a question about pre charting. The answer may frighten them.

With unity on the unit you can achieve a lot.