What constitutes falsifying documentation?

Nurses General Nursing

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I know of a nurse who put her initials on a flow sheet for her entire shift ahead of time. She was in orientation and was never told by preceptor or coworkers that this constituted falsification of documentation. She was terminated for doing it on 3 occasions. She never falsified assessments, v/s, outcomes, plans of care, only initialed her flowsheet for her entire shift before it was actually that time. She'd been complaining of coworkers being viscious, making false accusations, and tattle telling about non-nursing related matters. She'd had felt like she was being watched closely to get fired and now it came true!! Can she really be terminated for this? Is this really falsification if she did the actually charting at the real time, but only initialed ahead of time?

she was in orientation and was never told by preceptor or coworkers that this constituted falsification of documentation.

please take this with all due respect but back up and think about the situation objectively just a minute. there are probably 10 billion things that no one specifically tells us while we are in orientation,school, or while training for a new job but that should be basic common sense

.:idea:

no one specifically tells us:

1. do not steal,

2. do not lie,

3. do not divert drugs,

4. do not misappropriate money, meds, dentures, or anything else a patient gives us to lock up,

5. do not pick our nose,

6. do not scratch out in public,

7. do not run from a code no matter how scared you are ..... etc

why should anyone really have to "tell" another adult to not sign anything before it is done?

patients wander off, go off the unit for procedures, crash and get transferred into icu, not to mention code.

if you initial something because it is "just easier to do it this way" and not because it is right, then how do i know they have "done" the wound care or whatever that is charted?

most schools drill into your brain and to the backs of your eyelids

1. if it isn't charted, it wasn't done. and

2. document it as soon as you can and as close to the time it was done after you finish _____. (insert task skill intervention here.):twocents:

i worked at an insitution where precharting by a small number of nurses was identified by the state during an inspection. instead of carrying on as if the nurses that were doing it were evil incarnated, both the state and the instituion agreed that some re-education was in order. in addition, warnings were given that any further instances would result in dismissal. while i am sure you have never done anything illegal or stupid in your life the rest of us are less than perfect and sometimes all we need is a reminder. i wasn't one of the people involved but i was quite comfortable with the way it was handled and didn't mind that fact that every nurse in the hospital had to sit for reeducation classes even the innocent. i didn't think burning anyone at the stake was necessary, especially i knew several of the people involved and thought they were really good nurses who had slipped in to bad habits. honestly, if precharting was the worst mistake they ever made they were living very clean lives in deed. this was quite a few years ago and no back when the nurses involved were students charting wasn't stressed at all. it certainly wasn't tatooed on the backs of anyones eyelids.

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Specializes in Med/Surg, Ortho, ASC.
I'm sorry to hear about your coworker. I don't see how just putting your initials on the flow sheet constitutes falsifying documentation. I may be wrong.

Yes, you are wrong. Please take yourself back to school with regard to truthful documentation. You will be thankful one day that you took the time to understand the issues involved.

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Specializes in Med/Surg, Ortho, ASC.
I'm just surprised she wasn't told the first time she did it, that it was wrong. I am sure if she were told she was not to do it, they could have avoid firing her.

A nurse that needs to be told that falsifying documents is wrong?

There is something very wrong with that picture.

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Specializes in Med/Surg, Ortho, ASC.

"Honestly, if precharting was the worst mistake they ever made they were living very clean lives in deed."

PRE-CHARTING? Seriously?

As can be seen by the number of my responses, this thread just blows my mind.

And has been said....how many of life's ethical/moral/legal issues have to be mandated as "DO NOT DO's"? Can't we assume an understanding of basics, such as....

Actions cannot be charted until they are actually performed.

Meds cannot be charted until they are actually given.

While I don't remember actually being taught these things in nursing school, I apparently integrated the thought process all the same.

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Specializes in Med/Surg.
Yes, you are wrong. Please take yourself back to school with regard to truthful documentation. You will be thankful one day that you took the time to understand the issues involved.

Well thanks for educating me. Sometimes it's okay to admit you are wrong.

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hmm what flow sheets are we talking about, what was actually being signed for?

MAR...i sign when i go to give the med, not after.

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Specializes in Med/Surg.
I know of a nurse who put her initials on a flow sheet for her entire shift ahead of time. She was in orientation and was never told by preceptor or coworkers that this constituted falsification of documentation. She was terminated for doing it on 3 occasions. She never falsified assessments, v/s, outcomes, plans of care, only initialed her flowsheet for her entire shift before it was actually that time. She'd been complaining of coworkers being viscious, making false accusations, and tattle telling about non-nursing related matters. She'd had felt like she was being watched closely to get fired and now it came true!! Can she really be terminated for this? Is this really falsification if she did the actually charting at the real time, but only initialed ahead of time?

What kind of flow chart was it?

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i know of a nurse who put her initials on a flow sheet for her entire shift ahead of time. she was in orientation and was never told by preceptor or coworkers that this constituted falsification of documentation. she was terminated for doing it on 3 occasions. she never falsified assessments, v/s, outcomes, plans of care, only initialed her flowsheet for her entire shift before it was actually that time. she'd been complaining of coworkers being viscious, making false accusations, and tattle telling about non-nursing related matters. she'd had felt like she was being watched closely to get fired and now it came true!! can she really be terminated for this? is this really falsification if she did the actually charting at the real time, but only initialed ahead of time?

i have to agree with the posters who said that some things shouldn't have to be spelled out. initially treatments or medications you haven't given is wrong -- there's no excuse for not knowing that. it really is falsification. you really can -- and should be -- fired for that. if you'll chart ahead of time, how can your preceptors or co-workers know if you've actually done a thing or not? how can anyone trust you?

i suspect that the complaints about viscious co-workers, tattling and being closely watched were because she was being closely watched -- as she should have been. a nurse who will sign off a flowsheet for the entire shift at the beginning of her shift lacks integrity. no wonder she was being watched.

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Specializes in Flu clinics, Med/Surg, Acute Care.
A nurse that needs to be told that falsifying documents is wrong?

There is something very wrong with that picture.

One she is new, and two she may have been stressed and trying to save time. I was suggesting they could have easily re-educated her to that fact. Not everyone is perfect and I doubt that she would have done it, if she thought it was falsifying documents. I mean I know not to do that. But when you are new, stressed and trying so hard not to make mistakes. We as HUMANS sometimes might make them. What's wrong with that picture? :idea:

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Specializes in Pediatric Critical Care, Cardiac, EMS.

It is entirely possible that she was a new nurse, given less than sufficient orientation, overwhelmed with a large amount of paperwork and patient tasks, and effectively thrown to the wolves.

While I do agree that we generally know that one does not chart ahead of time, it depends on what was being initialed on the flowsheet as to what was being "falsified" or not. I'll explain:

I personally know of a new nurse, just off orientation (and doing well, I thought) who was taken out of a patient room by three "senior nurses" after she had initialed her safety check on her patient's flowsheet. They proceeded to grill her about what side of the bed the Ambu bag was on, where the suction was located, what mm suction setting the oral suction was on, the expiration dates and times on all her lines (not meds, lines) and where the patient's iv sites were and when dressing changes were due. When the girl couldn't answer all of that, they marched her down to the supervisors' office and had her written up for 'falsifying documentation', because she "didn't really do her safety checks".

I'm not saying that it is ever right to 'pre-chart', because it isn't (though I suspect it's done more often than anyone admits or recognizes.) I am saying there is often more than one side to every story, and while some ethical issues are black and white - some are less so.

My :twocents:.

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They proceeded to grill her about what side of the bed the Ambu bag was on, where the suction was located, what mm suction setting the oral suction was on, the expiration dates and times on all her lines (not meds, lines) and where the patient's iv sites were and when dressing changes were due. When the girl couldn't answer all of that, they marched her down to the supervisors' office and had her written up for 'falsifying documentation', because she "didn't really do her safety checks".

This kind of thing is simply "Witch Hunting" on the part of petty tyrants with a perceived superiority complex.

Both the profession and the patients, would be much better off if the focus of initial training was the timeliness and appropriateness of interventions for the current status of the person lying in that bed.

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Specializes in Med/Surg, Academics.

Ok, I'm going to ask something about the flow sheet. Was the flow sheet one of those that is set up as a table, with the assessment area across one axis and times on another axis, with one space for initials? Did she just put her initials in the space for it, but leave all assessment areas blank until she actually did the assessment?

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