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?

I'm a little conflicted about this. On one hand, I completely agree that pre-timed documentation is wrong for a number of reasons, the specificity of which depends on what kind of pre-timing's done.

On the other hand, overwhelmed grads often think they've hit on a way of saving time that nobody's thought of before, and don't have the perspective or experience to see a bigger picture.

Though I agree nobody ever told me not to steal, lie, divert drugs, kill patients etc, I can see how an inexperienced nurse struggling to cope with an overwhelming workload could frame this as time saving and purely technical, unlike those other examples.

So they see the time saving nature of, for example, pre-initialling, but not that the seconds saved are more than outweighed by the potential problems of having documentation on a patient who may crash, die, abscond, be transferred or sent off for a procedure during the pre-signed period.

Though significantly more serious and with ramifications, it's not unlike newbies who think they've come up with a better way to post, that nobody on boards has ever thought of before, and write in all caps because it's "easier to read."

Depending on the document etc, I'd be more inclined to give a warning, accompanied by an explanation that included a dire scenario (eg patient absconds mid-shift and dies outside the hospital). If the pre-documentation continued then there'd be a problem.

Thank you for your measured response, I just wonder about these people that are so harsh. Have they really never done anything foolish? It is hard for me to believe they haven't. I worked with a nurse that was very hard on other nurses that made errors. For years she wrote nurse after nurse up for minor infractions that could have been handled with a word to the wise. She wrote me up for writing notes in green ink for instance. This went on for years and she was widely dispised. Then one day she hung blood on wrong person and nearly killed them. How anyone as fussy as she was ever blew off all the safety proceedures I will never understand. I wondered later when she suffererd disabling stroke if perhaps she had a TIA and was mentally muddled, she was a heavy smoker. You should have seen all the nurses who were supportive to her. She recieved more support that day than she ever gave in her whole career. My word to the perfect people is "beware" even if you have been perfect up until this point tomorrow may be a bad day.
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Okay, I am not a nurse yet. I was a caregiver at a facility and have seen this type of "pre-charting" run rampant, and indirectly encouraged by management.

We used to have to do fifteen minute checks on a particular patient. What this meant, every fifteen minutes someone had to get a visual of what the patient was doing and write on this sheet of paper what/where patient was. Example would be :

11:15 dining room prepping for lunch

and then sign off on it.

The problem? This job wasn't assigned to anyone in particular and was supposed to be completed amongst the team of caregivers that day...who already had eight kajillion things to do and were already pressed for time. The result was that there would be gaps in these checks at the end of the shift, and we would hand them in to management with the gaps.

Weeks later, I would sometimes get that piece of paper in my mailbox with a sticky on it to 'finish charting.'

Excuse me? I do NOT remember what, let's call him Joe, was doing at 4:15 ten days ago. In fact, I looked at MY schedule from that day of work and at 4:15 ten days ago, I was assigned to be off facilty with another client at a dr.appointment. So how the heck was I supposed to know what Joe was doing at that time? I brought my concerns up to management, who told me they would figure something out. A few days later, that SAME EXACT PIECE OF PAPER was in a coworkers mailbox...who was also in a similar situation of not knowing what the heck Joe was doing at that time.

I think it was utterly ridiculous. If you made a big deal of it to management/refused to do it, they would 'find reasons' to pick on you/write you up/make your life pretty miserable.

The result? A lot of people would succumb to 'guessing' what joe had been doing based on the time. If that isn't falsifying documentation, I don't know what is. But we were indirectly forced by management to do so. No manager ever said to me 'just guess' but what else were their actions indicating?

Looking back it was probably a terrible place to work. I know better now. But I didn't at the time. And I needed to pay rent.

I am not taking the nurse in question's side here...all i'm saying is that it is POSSIBLE that there is a whole other side to this story, so before everyone attacking this person's ethics, again, remember, things aren't always so black and white.

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Thank you for your measured response, I just wonder about these people that are so harsh. Have they really never done anything foolish? It is hard for me to believe they haven't. I worked with a nurse that was very hard on other nurses that made errors. For years she wrote nurse after nurse up for minor infractions that could have been handled with a word to the wise. She wrote me up for writing notes in green ink for instance. This went on for years and she was widely dispised. Then one day she hung blood on wrong person and nearly killed them. How anyone as fussy as she was ever blew off all the safety proceedures I will never understand. I wondered later when she suffererd disabling stroke if perhaps she had a TIA and was mentally muddled, she was a heavy smoker. You should have seen all the nurses who were supportive to her. She recieved more support that day than she ever gave in her whole career. My word to the perfect people is "beware" even if you have been perfect up until this point tomorrow may be a bad day.

It's not a case of not ever being wrong, it's the credo that if you commit, or see someone else commit an error, then you are bound to report and fix it. Nurses generally have no one looking over thier shoulder. Unless we take to heart our credo of admitting, and fixing our mistakes; then where is your honor? Apparently, your arch emeny was a pretty good nurse for many years, and I guess she was not so "widely despised" as you thought, if THAT many staff people came to her aid and succor.

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That' s nothing compared to where I work: We are required by policy to chart medications as "Given" in the computer before even walking into the patient's room with the meds, we've questioned this and been told it's ok, it's policy.

I was taught to "sign off" the med, and then give it. If the med was not given for some reason (had a patient die on me in those few minutes!) it was circled and documented.

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Thank you to all for your input. She merely just documented her initials before her actual assessment on the flow sheet. She never falsified assessments, vitals signs, care given, etc. She didn't steal, lie, kill, or neglect her patient. I agree that a warning would have sufficed and it does put her integrity into question. Since she was in orientation, no one really knew of her integrity, I guess. I think her preceptor should have said something to her as she checked her documentation, but she really didn't think of it as falsifying documentation.

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Something similar happened here, but at a psych facility. Staff had initialed their checks for the whole shift. The only problem was, there was a resident who self-harmed pretty badly and ended up dying between half hour checks. The staff still DID the checks, don't misunderstand. But in between the phone calls and the securing the other residents, they forgot to grab the check sheet so that they could fix it... not that there was really any way they could. When they came back to the day room from doing what they had to do to handle the situation, the ADON had already gathered the evening paperwork.

Of course, they were fired... not for not doing their checks, because they had. Not for not keeping the patient safe, because NO one knew that resident had anything that could cause that much harm. For falsifying documentation.

Don't sign your sheets that far in advance. It's just bad practice.

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At my facility there was a lawsuit several years ago about a purported wrongful death.

The Nurse had prechecked MARs and TARs...unfortunately the pt had been sent to the hospital midshift. As a part of the lawsuit the plaintiff cited a lack of assessments/care based upon presigned MARs and TARs.

The plaintiff nullified the Nurse's charting by discrediting her through presigning.

$850,000 later and a BON investigation (do not know the outcome) the Nurse learned not to presign...

It's in NSO's case studies online BTW. :nuke:

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It's not a case of not ever being wrong, it's the credo that if you commit, or see someone else commit an error, then you are bound to report and fix it. Nurses generally have no one looking over thier shoulder. Unless we take to heart our credo of admitting, and fixing our mistakes; then where is your honor? Apparently, your arch emeny was a pretty good nurse for many years, and I guess she was not so "widely despised" as you thought, if THAT many staff people came to her aid and succor.
I think the fact that they couldn't kick her when she was down was a reflection of the fact that they were basically very nice people. I never said she was my arch enemy. I remember spending half the shift listening to people complain about her and thinking it was more of a burden than she ever was.
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This situation can be open to interpertation. A nurse pops a med, signs the flow sheet, the patient spits it out and states that he adamantly refuses (which is his right), then the nurse must circle her initials (which signifies not given) and offers an explanation on the back of the MAR. In an ideal world the nurse would put a dot next to the medication, watch the patient swallow it, have the patient open his mouth to make sure, if he spits it out try to encourage him then try again and so on and so on -- you'll end up getting fired for poor time mgmt. The key word here is "falsification". You either gave the med or you didn"t; and if you should ever make a med error (the most common form of error in healthcare) you should have the integrity of reporting it and writing yourself up. Your accusers of such pettiness are with-out a doubt creating a cloud concerning their own falsifications of a much more serious nature (not uncommon with management). Hang in there girl, you are just learning the politics of the CYA healthcare profession. You will need to become tough.;)

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Specializes in Management, Emergency, Psych, Med Surg.

Well, don't believe everything you hear from your friend. I would bet you that if she had been doing this all along, someone told her to stop. Plus, I hate to say this, but common sense tells us not to do this. Never document anything before it happens and if you forget to chart something, then you must go back and enter it into the record as a late entry. The late entry should note the time you are making the late entry and then the actual time the even occurred and then your regular notes. If something happened to a patient and there was advanced charting before the time of the event, one would have a hard time explaining this to an attorney or a jury. It is perfectly legal to make a late entry, but to chart ahead of time is just not good form.

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I'm an RN and one of my co-workers (an LPN) has falsified a hand written charting entry and altered my own entry in doing so. She crossed out the entries on a MAR where I had charted that I gave medications and charted that she gave them at a later time.

I'm quite certain the alteration is not only unethical but criminal. What about falsification though? Is that a crime as well? Is it a separate crime? Am I making a bigger deal of this than it really is? No harm came to the patient and it didn't alter any outcomes but doesn't it speak volumes about the character of the Nurse involved?

I informed the manager and to my knowledge nothing whatsoever has been done about it. I am trying to reach my state's Board of Nursing to get more information about it but unfortunately I have just been able to leave messages and no one has returned my calls. One person did tell me anyone with knowledge is obligated to report this (meaning me!). This leaves me in a quandry because it puts me in a position where I may have to go above and beyond my Superior, when she clearly didn't think the incident warranted any further action. I'm trying to contact the BofN so I can get more details before I go forward (or not).

I have copies of the MARs that she falsified and altered. Could this put me in violation of HIPPA laws? And also I'm wondering if the same laws apply to all Nurses regardless of the setting? I work for the government of the state in which I reside. If it's against state law to alter charting entries, is this law going to apply regardless of the health care setting we work in or regardless of the employer? Do the same laws apply to LPNs?

I need more details about the specifics of the law and I don't know the proper channels for obtaining them. Any suggestions out there???

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Specializes in ER, progressive care.

A lot of great examples in this thread.

We have hourly rounding sheets and we once had a nurse who came in and put her initials next to every hour at the start of the shift. Our CEO of the hospital was visiting with this patient and saw the nurse do this. She got fired for falsifying documentation.

Falsifying documentation is unethical. It can be very serious, as stated by previous posters in this thread.

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