state is threatening to go after license over precharting

tanna1022 · Mar 18, 2005

I have just been fired for precharting, but, I am not sure I ever actually did prechart.

I never charted anything like a dressing change or procedure ahead of time. I did write out a lot of assessment things that I noted at the beginning of the shift. If I wrote independent bed mobility at the beginning of the shift, 7pm, and they still had independent bed mobility at the end of the shift, I often timed it for 4am or 6am when I signed off my notes at 7am. Is this precharting?

bloke53 · Mar 18, 2005

I'm sorry for you. I see this kind of thing done all the time. While not speaking for others, i do what i can to survive in this jungle whilst still doing the best i can to provide compassionate, timely and informative care, with little help from those above, who often make the burden heavier than can be safely managed for most Nurses today. But when we come up short, we are made to PAY for it. The Board of nursing live in another world. Whilst i dont condone pre-charting, this and other "offences" that the BON take a long hard look at illustrates the the shortcomings of the BON. Patient safety is of paramount importance, no argument there. Whilst investigation is warranted at times, it is done unfairly and important issues are often overlooked or ignored. Those above need to provide us with a safe environment in which to work, without which, what we do to survive will invariably be frowned upon, and the BON are right there ready to pounce, without mercy. Don't hold your breath because nothing will change soon. Their world is sanitized and with all due respect it's not real world. Frequently, it's the innocent that suffer when all around us are doing it too and getting away with it. Times have changed, the burden is heavier. The Board needs to wake up and look long and hard at the bigger picture. Remember who you are and why you are. The BON are not always right, (but that's a given), although they think they are. Stand up for who you are even though it may not be the best solution. Retain your sense of dignity most of all, because they like to dish it out!

UnewmeB4 · Mar 30, 2005

Can anyone who precharts give me an idea of work settings?

I have been doing this for 30 years, and never felt the need to prechart.

Yes, I have worked in various settings, Rehab, NH, med-surg, antepartum,tele,ortho,stroke,resp, oh yes, almost forgot, detox.

What kind of charting system do you have?

Learn something new every day.

NightNurseKathy · Apr 6, 2005

I guess there is something to be said for computer charting which we do where I work. You CAN'T prechart as you CANNOT chart ahead with the computer. Now MED sheets that is another thing. I have seen nurses do that. Me I keep out all my med sheets UNTIL I GIVE the med, then chart it. Have always done that, GOOD practice!

LearningRN · Apr 16, 2005

What does the "OT" stand for in OT charting. Thanks :)

RN4NICU, LPN, LVN · Apr 16, 2005

What does the "OT" stand for in OT charting. Thanks :)

OT = overtime, referring to having to stay after your shift (on the clock) to finish charting.

NancyJo · Apr 27, 2005

Once worked in a LTC facitlity where our major med passes were between 6am and 8am. On my night off the nurse who was to pass meds the next morning had actually prepoured all her meds(a big no-no there) and signed all the mar's. Unfortunately she somehow tripped over a geri-chair(don't remember the details) and broke her arm through the night and had to leave. The night superviser had to take her place and was not happy to find all this. This caused a huge stink, and reminded us that you just never know what can happen. Miraculously she kept her job, but she had an unpaid suspension and was put on some type of probationary period.

BETSRN · May 1, 2005

This is not me I am talking about. They could get me on same charges if they searched enough charts but lucky I have not done it in a while. I know two nurses who were found to have charted things before they did them and state inspectors called it fraud and are threatening to bring them up before the board. The facility has gone to bat for them and stated such extreme measures are not necessary. All they say that is necessary is a education program. The facility is right because half the nurses I know would lose their license(including me) for precharting on one occasion or another. For instance, say it is 1pm and the patient is on a q2 hr treatment. I know it is very hard to get back to chart something at 3pm so I will sign off on the thing I know I will do at 3pm. I don't think I have ever signed off on anything in advance that I did not do. In the future I will take the risk that it never gets signed off rather than sign it off ahead of time. Apparently, presigning is a much more serious crime.

I cannot fathom why as an RN you would EVER chart before you do something????? That was about the number 1 thing they taught us. It is not only illegal BUT unethical as well. Chart AFTER the fact: even if you have to write an addendum. An addendum is no big deal but precharting is.

You should know better. I'm sorry is that sounds harsh, but I guess I mean it to be. The fact that you prechart is bad enough. he fact that you state it right out here and act as if it is no big deal is even worse!

What an absolutely STUPID way to lose your license. You deserve to be disciplined.

BETSRN · May 1, 2005

Chris you are right you never really regret doing things the right way..i have seen things that would curl your hair..we had one nurse who would chart everything before 12mn and then go to sleep till 4a....one time one of his patients who was awake and taking meds at 6a was found dead at early am rounds..usually between 4:30 and 5a...talk about egg on the face
at another facility state walked in at 5a and there was insulin charted for 6:30...there was also meds in cups with names on them...also charted..they got a BIG write-up

These are blatant safety concerns. I am glad the state walked in. It's a sad day when the state has to watch out for the patient's safety as opposed to the nurses that are there.

Why was that guy allowed to SLEEP? He should have been turned in by one of his peers.

I'm sorry, but to me, this pre-charting issue is everyone's concern. It should never happen.

allnurses Guide · May 1, 2005

I guess I don't understand taking the risk. Not only unethical but dangerous. The story about the nurse who pre-poured and pre-charted and then broke her arm reminded me of a story told to me by a nurse who pre-charted that she gave a narcotic and the patient died 15 minutes before that med was charted "given" . . . that caused kind of a big stink. The patient is dead and 15 minutes later you give the patient a narcotic?

If there is a problem with staffing, address that. If you have to give meds late due to the volume of patients, just give them late and chart why they are late. Just be honest. Especially in LTC the state will not be happy with your facility and that can be an impetus for change.

Instead of tryng to work with a system that is broken, fix the system. Don't allow yourself to do something unethical. Your job isn't worth that and your patients and your integrity are worth protecting.

steph

BETSRN · May 1, 2005

I guess I don't understand taking the risk. Not only unethical but dangerous. The story about the nurse who pre-poured and pre-charted and then broke her arm reminded me of a story told to me by a nurse who pre-charted that she gave a narcotic and the patient died 15 minutes before that med was charted "given" . . . that caused kind of a big stink. The patient is dead and 15 minutes later you give the patient a narcotic?
If there is a problem with staffing, address that. If you have to give meds late due to the volume of patients, just give them late and chart why they are late. Just be honest. Especially in LTC the state will not be happy with your facility and that can be an impetus for change.
Instead of tryng to work with a system that is broken, fix the system. Don't allow yourself to do something unethical. Your job isn't worth that and your patients and your integrity are worth protecting.
steph

Excellent post, Steph!

Sheri257 · May 3, 2005

Those nurses who like to judge others, I say this: you don't work my area, it isn't YOUR practice, its mine. I think its so so sad how quick nurses are to place judgment on another nurse and are so self righteous. It is a huge problem in our profession IMO.

Maybe that's true in other circumstances, but I don't agree with this characterization when it comes to precharting. It's supposed to be a legal document, and an accurate record of what happened. If precharting is caught, like in cases where the patient already died, etc. then no court or regulatory authority is going to side with the nurse. You would automatically be "judged" as doing the wrong thing.

So, I'm not sure nurses are really being judgemental or self righteous in this case. The entire system is counting on nurses to provide accurate documentation. If you don't follow the rules, which are there for good reason, it's just plain wrong. It goes far beyond being "self righteous," IMHO.

:coollook: