We're supposed to take care of the pt 1st, right?

[shug1539]

I have been reading alot of the discussions and can't seem to find someone with a similar situation. You see I was recently terminated from my employer at a nursing home for what I was told was "blame charting". In this instance, a woman was discharged before my shift that evening to home under the care of a home health agency. The woman was IDDM and had frontal lobe atrophy and was definately not able to care for herself. I recieved a phone call later eve (naturally 15min prior to 5pm on Fri eve) stating the home health agency had not been there to see her or had even checked in. We had known for 2 weeks that she would be leaving, and were not instructed to do any pt teaching, which made sense because of her memory. Of course the home health facility she was going to was did not provide the extensive care she required and happened to close at 5pm that day and did not open again untill mon. 9am. Long story not so long, her Dr. and I decided the best thing would be to bring her back and readmit her and then, with appropriate pt teaching to her husband and sending her medications, under facility policy we could allow her to go home. Which is what I did, all amazingly done within an hour and a half! She left smiling and thanking me (she very much wanted to go home) I contacted the facility administrator, and notified him of the decision-which he said was ok and then I requested an alternate phone # for my DON when she could not be reached on her home phone (of course there was not one, but we're supposed to call her for emergencies). At the end of the shift I did finally get a hold of her after and notified her as well. I expressed my concern that she was not contacted by her home health, and the DON stated that the social worker had told her that the resident was supposed to have set it all up because they would not let her (the Social worker) Which seems like a bogus excuse due to the fact we are transferring care. So I documented roughly a page and a half, including a complete reassessment with VS and details of the "transaction" complete with quoted statements from all parties involved. I also did enter the fact that no home health could be contacted and that assessment by the home health should be done to assess her needs before discharge.Figured I made everyone happy and still kept everything in the legal realm. Well apparently not because I recieved a call from the DON terminating me because I was deemed a "liability" by the corporate consultant reviewing the chart. I have worked there for 5 years and not once recieved any reprimands and had recieved outstanding evaluations. I know it's a right to work state but can they really terminate you for being honest? Another nurse I worked with stated a week before that they made her re-chart something 4 times to "get it right" And now I'm concerned because this goes on my employment record as a termination. I have never been terminated before ever in my entire life. What do I do? I am trying to find employment now and don't know if I should tell them if they ask why I was terminated.

[purple1953reading]

ITnever fails, that the people who actually try and go out of their way for the sake of the patient,get punished for it. As house supervisor at a town about 60miles from Kansas City, I had a patient show up at the ER and say she was there to be admitted. She had been discharged from large Kansas City hospital, when she felt she was not ready, and somehow got the idea, from a nurse,social worker or somebody that wanted her out of there, without taking the responsibility for her welfare, etc. , that she could come back to her hometown hospital and just be admitted. She was , in fact , able to go home, had there been the appropriate arrangements made, as you tried to do. BUT they just sent her home. She had had a cardiac complication following a surgery, so had been in a week longer than the hospital expected, or allowed anyway. She lived alone, it was 10pm, on a Saturday, and nobody, family or otherwise wanted to help out. HER RIDE just left her at our door. There was no medical criteria to make her an acute admit, and I had to spend about an hour talking with her, and then the hospital nurse who discharged her. I had to contact her family physcian, and then the DON, and the Medicare qualifying RN, and in the end, they took me at my word, that she should be admitted for a 24 hour hold . To show her and her demo back to us, the cares she had to for herself, to set up home health or visiting nurse, to get meds, ( they had given her scripts, no pharmacy open till Monday) etc. Whether thehospital got paid I don't know,but wish your DON had backed you up and thanked you for the extra mile. I do not ever chart subjectively, and only state and QUOTE if I can what happened. The blame thing is a long reach. Perhaps she thought it made herself, and others look bad, who had not made sure arrangements were in place. I would bet you don't want to go back,I would ask for serverance pay,and in the meantime, your experience and time at the one place should speak for itself, and there is always a longterm SHORTAGE> Get another job, and forget about her, but you are entitled to compensation. IF you don't want to go right out, make them pay you unemployment for awhile, but then you have to go COBRA for benefits. where as you go right out and you have been insured for thepast year, then you are immediately covered in a new job. IT just depends what your present needs and priorities are.

[Susan9608]

I was once counseled for doing the same thing, for putting accusatory things in my charting. I had a family who made all kinds of outrageous accusations against all the nursing staff; when some one higher up on the food chain would come in to address the issues, the family would claim they never said anything. I started quoting in my charting exactly what the family was saying; the things they were saying were along the lines of, "the night nurse never checked my baby's diaper. The night nurse never assessed his pain." My floor "educator" at the time called me aside to talk to me about this.

She said you never chart in such a manner that makes another health care professional seem at fault for anything. According to her, I should have stated something like, "Mom reports dissatisfaction with pt.'s pain management." Or "Mom reports dissatisfaction with I/O calculation."

During my couseling session, I just smiled and nodded, but continue to chart what I feel is appropriate. I feel like quoting what a family member says is not the same as me accusing them in my charting. I no longer work for that facility. You should feel lucky you no longer work for your facility as well. :)

[PrivateDuty]

The thing that hits me in the face most from your post is about the other nurse havig to chart 4 times to "get it right". That is "illegal" in our profession. You cannot alter charting, even if administration does not like what you charted.