Tech falsified vitals

[Presbynurse12345]

There was an incident at the hospital I work at where many nurses noticed that she wasn't getting up to do vitals after bringing it up to our director she investigated and the tech admitted that she did make up vitals. Our director suspended her for 3 days and when she came back she told the charge nurse she had only made up vitals for 2 weeks which is 6 shift at 12 patients a shift times 3 is 216 made up vitals .. I feel she has done this longer and don't want to work with her for fear of my patients.. can I go above my director and call our compliance line... not sure what steps I can take but I know I can't trust her to do her job. Not to mention all of the falsification on these charts. Any advice would be helpful

[PiperLambie, MSN, APRN]

I completely see the frustration and distrust this has fostered in you based on the post. That said, as someone that has managed large groups of employees at various levels, I want to second the idea that you schedule to meet with your NM and/or director and raise your concerns, rather than jumping the chain of command. I can almost assure you that nothing good comes from escalating something beyond your leadership that isn't a direct problem with that individual above you. There are always reasons why leadership makes a decision about a certain employee/issue, whether policy, legal, or otherwise, and without having the director's rationale available (or a transcript of their conversations with HR/legal/CNO), it is tough to fully understand how that determination was made- whether the result is agreeable or not. It's just a spotlight you don't want on yourself for overstepping boundaries.

In the mean time, keep that NAP on a short leash when it comes to your patients. After all, when you don't have a license you cannot lose a license. If that person gives you the business for holding them accountable then follow the procedures to help your charge/NM/director to be able to initiate progressive improvement plans, and (potentially) disciplinary action, against that employee.

[Have Nurse, ADN, RN]

If you don't trust her, then do your own vitals. And chart them. YOu, ultimately, are responsible for your patient. And if you are giving meds that you need an accurate set of vitals, you really need to trust what is charted is accurate. You're going to be better off getting them yourself.

I agree that nurses are responsible, however, this aide needs to be reported to the State Registry's office and have her certification yanked. In addition, I would report this to the Administrator of the facility. This is a patient safety Risk Management issue.

[ComeTogether, LPN]

I would say you'll need to get your own vitals when she has some of your patients. She should be fired for this, not suspended. Otherwise, I'm not sure what more you can do since it's already been investigated and dealt with. I would bet she has one foot out of the door by now.

[psu_213, BSN, RN]

I agree that nurses are responsible, however, this aide needs to be reported to the State Registry's office and have her certification yanked.

I would agree that it is not a bad idea to pursue this, if possible. Where I have worked, we had patient care techs who were not in anyway certified by the state, yet some people still referred to them as CNAs, even though they were missing the C part.

[Possum_RN]

Yikes. I echo the other's who are horrified she kept her job. I worked on a floor where it was standard to take every patient's VS every 4 hours, and many doctors put in orders for VS more often. I really wonder how prevalent falsifying VS is... not something as blatant as this, but here and there. More than once, I stood outside of a difficult patient's room, cursing the need to wake them up 15 minutes after they had FINALLY gone back to sleep...but then, taking VS was probably the most important task I had as a CNA. How can you not take it seriously?

Now, respirations......

[ATTACH=CONFIG]27139[/ATTACH]

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[caliotter3]

Yikes. I echo the other's who are horrified she kept her job. I worked on a floor where it was standard to take every patient's VS every 4 hours, and many doctors put in orders for VS more often. I really wonder how prevalent falsifying VS is... not something as blatant as this, but here and there. More than once, I stood outside of a difficult patient's room, cursing the need to wake them up 15 minutes after they had FINALLY gone back to sleep...but then, taking VS was probably the most important task I had as a CNA. How can you not take it seriously?

Now, respirations......

[ATTACH=CONFIG]27139[/ATTACH]

E

Never thought of it this way (referring to picture).

[dlkj413]

I had this issue at a LTC facility I worked at. I knew my patient's HR usually ran low and her Coreg was usually held 9/10 times. One of the CNAs would check her HR and told me it was 100. (It was usually around 40-50) I was skeptical so I checked it and sure enough it was too low to give the med. I asked the CNA if she checked it and she said yes. I told my supervisor and the other nurses so they were aware of this too. I decided then I would always check my own vitals just to ensure my patient's safety.

[parolang]

I was a CNA for three and a half years. I do think a lot of readings were fudged/made up, but I also think that nurses are complicit with this. You are supposed to supervise. The job of nursing aides isn't just to do your work for you.

I say this because the perspective of the nursing aide is this: If there is no accountability for this kind of thing, then you are going to know which nursing aide is actually doing honest work. He or she will be the one who is behind schedule compared to the other aides, is having trouble finding an accurate BP monitor or is doing them all manually, and is getting chewed out by the next shift or the RN for not getting as much done.

I'm just a little surprised at how shocked the OP and many of you guys are about this, and now you want to get her fired? So no one has ever double checked her work until this time? I don't know how other facilities run, but as a nursing aide I was busy *all of the time*, and the time I spent doing vitals was precious time that I could have been doing something else, which the next shift would then quickly expect on a regular basis.

So here's the consequence: You don't supervise your aides, and so you end up rewarding the aides who aren't doing their jobs correctly, and punishing the ones who are trying to do it right.

I highly doubt that this is the only aide in your facility who is either making up vitals or fudging the numbers. This might be the only aide who is got caught, or the only aide who was honest about it.

My only thing is that if you want to fire this aide, I think a nurse needs to be fired with her. There is no authority without responsibility, and a nurse needs to be held responsible. If you are just accepting the vitals from your aides at face value without any supervision of the task, or at least the hard earned trust of these aides, then you are abdicating your responsibility for the work that was done on your behalf.

This is the only way to fix this perverse-incentive structure that I saw all the time at nursing homes. You are far more likely to get in trouble as an aide for doing your job right than for taking shortcuts, as long as no one finds out about it. Generally, the only thing people really cared about was the workload, and doing the job right takes longer than taking shortcuts, which means you had less time for doing other things. Everyone is greedy at a nursing home, and not just in a nursing home, and everyone expects more from you than what you have time for. So shortcuts are taken.

That's what I mean when I say that the nurse is complicit in this. Heads need to roll in pairs.

[Neats, BSN]

Wow although this was hard to read and digest there is a ring of truth to this.

With that said....

We all come with a moral compass, we all know right from wrong. Doing your job and being honest to me is I figure when I hire someone a given. I just assume you will be honest until I find out there is something going on, there is an issue, someone says something, I find unclear documentation or a patient/family has said something to me directly or it has been reported to me.

When I find out there is something amiss I investigate, communicate to all the need to do a task a certain way/time/whatever it may be and then it is audited by all those who are involved in it. It can be self audit/post audit or concurrent review audit. All are involved and this will include the NA-C. The audits become part of our QA plan and are in enforce for at least a year if not longer.

Your statement about "Everyone is greedy at a nursing home, and not just in a nursing home, everyone expects more from you than what you have time for. So shortcuts are taken."

I can honestly say if I ever felt a BP was not taken I would ask the NA-C to retake it, if I felt the patient has some sort of change I would take it myself-manually. Not everyone takes short cuts when it comes to patient safety.

I encourage you to not work in Skilled Nursing Facilities, your heart clearly is somewhere else. I am not saying you are a bad person for feeling the way you do, but the way you feel is conducive to a working environment I try so very hard to improve.

False documentation is a illegal act and the fines, loss of license/certification, loss of your ability to not be in the medical field or other employment opportunities where your documentation is needed far outweighs the 5 mins extra time to take the BP rather than not take it.

As a Manager my expectations are you do your job well without lying, cheating. I should not have to baby sit an adult in the work place setting, we do not work in a day care and my staff are over age 18. Own what you do or not do.

[JKL33]

My only thing is that if you want to fire this aide, I think a nurse needs to be fired with her. There is no authority without responsibility, and a nurse needs to be held responsible. If you are just accepting the vitals from your aides at face value without any supervision of the task, or at least the hard earned trust of these aides, then you are abdicating your responsibility for the work that was done on your behalf.

Each individual has a duty to be honest in the work they're doing.

In many healthcare settings RNs have exceedingly little of the authority of which you speak. Heck, were it up to me I wouldn't hire half of these people to begin with - which is where it all begins. We have been told multiple times in recent years (as RNs on a staff) that we aren't there to "judge" others' work - we do ours, they do theirs. I can't really imagine what kind of wrath I'd be bringing upon myself if I asked to directly observe assistants doing procedures for the purpose of vetting the work they do (and whether it is done according to my standards). Think about urinary catheterizations. In my department NAs may do these according to protocol/policy that has completely taken me out of the loop - but someone will still be there to say it was officially a "delegated" task. It's a joke to say things are "delegated" - the description of the RN role as delegating certain tasks has been completely exploited by RN employers whose business plan is contingent upon no one but them having any authority. No fair saying that they can assign an NA to do anything they think they (employer) can get away with, and then saying all of those things are de facto "delegated" by each individual RN.

You say there is no authority without responsibility. I'm telling you that when talking about this particular topic, there should likewise be no responsibility [for a particular thing] without the authority that should go along with true delegation. There is someone who does have the authority; that is the employer.

That's my (possibly unpopular) take, since you bumped the topic. :)

I have no idea why more RNs don't say "Uh....wait a minute...." about stuff like this. Since I actually have zero authority over assistants in my workplace, I delegate very little. But, I think this topic is something that should be more publicly discussed/debated in the nursing world. It's a problem to supposedly have responsibility without the authority to go with it.

[Susie2310]

We have been told multiple times in recent years (as RNs on a staff) that we aren't there to "judge" others' work - we do ours, they do theirs. I can't really imagine what kind of wrath I'd be bringing upon myself if I asked to directly observe assistants doing procedures for the purpose of vetting the work they do (and whether it is done according to my standards). Think about urinary catheterizations. In my department NAs may do these according to protocol/policy that has completely taken me out of the loop - but someone will still be there to say it was officially a "delegated" task. It's a joke to say things are "delegated" - the description of the RN role as delegating certain tasks has been completely exploited by RN employers whose business plan is contingent upon no one but them having any authority. No fair saying that they can assign an NA to do anything they think they (employer) can get away with, and then saying all of those things are de facto "delegated" by each individual RN.

I have no idea why more RNs don't say "Uh....wait a minute...." about stuff like this. Since I actually have zero authority over assistants in my workplace, I delegate very little. But, I think this topic is something that should be more publicly discussed/debated in the nursing world. It's a problem to supposedly have responsibility without the authority to go with it.

I'm thinking this is something that the BON should know about.

[parolang]

Neats, I've never misreported a blood pressure reading or vitals.

As a manager, this is exactly one of the things that you can profoundly change if you find it among your staff. But you won't get there by assuming that everyone is honest, or that your staff isn't self-serving.

Is your facility understaffed? Have you dealt with your low-performing employees? There was a link on this forum somewhere proving that the majority of nursing homes have been underreporting their staffing levels by actually "getting by" with less staff than necessary on a regular basis.

Look, it is *easy* to blame the front-line person for problems that drip down from the higher ranks in the organization. If you are understaffed, but your expectations match the ability of a fully staffed facility, something *has* to give somewhere. I don't agree with fabricating numbers, and at the time had contempt for the practice. Experience and maturity gives me a better perspective on what *was* happening though. I never knew what it was like to be fully-staffed until our state audit.

I know this isn't on purpose by management either. Most long-term care facilities are operating on a tight budget. But if you are already writing up or even terminating aides for performance issues, you are likely to overlook the aide who is fabricating vitals. You say it takes five minutes to take a resident's vitals. But that's for *each* patient. If an aide has 10 patients, then that aide is taking 50 minutes just doing vitals. Without proper supervision, you and the other nurses are likely to think that the aide who takes significantly less time is a top-performer. How many times have you criticized a nursing aide's "poor time management"? I've even been told to "work smarter, not harder before." I didn't know about the vast array of shortcuts available that can make you look like a genius.