I know of 2 nurses in the facility where I work who change the accucheck numbers to lower numbers just so they wont have to call the doc. We have several residents who if their blood sugar is above 200 the doc has to be called. These nurses hate to talk to our medical director. This is falsifying medical records if I am not mistaken. The DON looks over it. Have any of you ever experienced such a thing in your line of nursing? Its very important that our residents are being monitored closely. I dont think its funny or amusing. These nurses tell me I am being too serious and shouldnt be so picky. I am sorry, but I didnt become a RN to make up things about our residents and not report it to the doc. Any one else with the same problem? or any suggestions?
What to think about nurses who make up accucheck
OMG- - - Nurses making up numbers! ! ! What's next falsified rectal temps????
Sometimes if the number comes up borderline I have seen the nurse not call the doc because they know the patient well enough to know they will drop and with the extra insulin they really drop at night. Not a good way fo doing thigs, this is where the DON should come in and talk to doc and get the level at which to call himm increased. Thats how it "should work" doc should also be aware of pts. condition, many times when some one else is on call and doesn't know the patient they will order too much regular insulin and the patient will bottom out. But, all this said no one should falsify records. I have done it accidently. Or, taken the accu check and didn't get to chart it right away and may have put the wrong number in. It would be lovely if we could go through our shifts nice and smoothly with everything falling into place. Very rarely does that happen. LTC isn't what it used to be, there are a lot more acute care patients, that probably should have never been sent there in the first place. Since the almighty dollar is what is important admissions are more profitable via medicare if they take the more complex patients. They used to have a skilled unit and all those difficult ones would be there with the RN, not most places have themscattered all over the facility so there isn't so much on one nurse. How do you know the accu checks are falsified?
are these accu checks that are uploaded with pt id numbers inthem? If they are and andything ever came up I think those numbers could be pulled up. I can't believe a doc wants to be called at 200 if it's a long term diabetic. I could see it if it's a new dx and they are trying to regulate dosage.
Absolutely appalling. We are patient advocates, should NEVER change facts for our convenience. Not to mention the harm this could potentially cause the patients. I would have to wonder what else they are making up!!!!
the question: how do I know the nurses are falsifying the accuchecks? These nurses are dumb enough to stand in front of me right before the narcotic count and change the numbers. One night the other RN who works with me on evenings had to call the doctor because the diabetic patient had an accucheck of 203. Yes, his orders are to call if its over 200. Instead of calling him, she paged him. He called back, I knew about the situation and told the doc that the accucheck was 203. He says "give him 2 units of Regular insulin." End of conversation. Other RN was relieved that I took the call. She hates talking to that doc, who by the way is our medical director. If a nurse is too scared to talk to the medical director, she/he needs to leave the nursing field, JMHO.
Anyway, she has on several occasions stood right in front of me and changed an accucheck. I guess she thinks that its ok to do that, and she finds it funny, only because she knows I am right there seeing this and I could have a field day reporting all this to the state. I have given up on even talking to the DON. She tells me to sweep it under the rug and let it go. I am totally frustrated. If I was the DON, I would be writing up nurses left and right. If I lost nurses, then I would be doing the extra shifts myself. That is the DON's job to make sure that things like this are not swept under the rug. I dont know how many times I have spoken with the DON about accuchecks being changed so the doc doesnt have to be called, neuro checks that couldnt have been done because the resident was NOT in the building. And so many other things that your hair would curl. And I am told to overlook these things. It sickens me that such things are happening. I am seriously looking into another line of nursing. LTC just isnt working out for me.
Anyway, she has on several occasions stood right in front of me and changed an accucheck. I guess she thinks that its ok to do that, and she finds it funny, only because she knows I am right there seeing this and I could have a field day reporting all this to the state. I have given up on even talking to the DON. She tells me to sweep it under the rug and let it go. I am totally frustrated. If I was the DON, I would be writing up nurses left and right. If I lost nurses, then I would be doing the extra shifts myself. That is the DON's job to make sure that things like this are not swept under the rug. I dont know how many times I have spoken with the DON about accuchecks being changed so the doc doesnt have to be called, neuro checks that couldnt have been done because the resident was NOT in the building. And so many other things that your hair would curl. And I am told to overlook these things. It sickens me that such things are happening. I am seriously looking into another line of nursing. LTC just isnt working out for me.
Guess she is getting away with it. All you can do is report her to the board of nursing. better have proof. Otherwise CYA. I worked at a place one time where all the CNA's took their lunch together, left the building gone for an hour. I was left with the activities person and 60 patients. When I spoke to the DON about this she said " Oh those girls" nothing done about it. This was the same place with stage IV decubes were not being treated, had to fight administration for supplies to do wound care. I was an LPN at the time, found the RN passed out on a bed and all the med. cabinets wide open. The stories go on. You alone will not be able to do anything but if you can get a few people on your side that would help the battle. If you want to continue the fight.
there is someone above the DON before the board of nursing. Document and give to the DON and if the DON is doint nothing then go the next step up. You can also notify the MD. Let the DON you expect some action and it won't be swept under the rug. If something comes of the problem and you don't report and you know about it I think you can be accountable as being in on it. We just had several nurses (good RN's) who found out about something going on and went for a walk after work to discuss what was going on and the person who had done the thing found out they knew and were thinking of going to the boss so she confessed first but the ones that went for the walk and knew but didn't report first all got fines from the board, didn't get their raises and had to pay $500 fines to the state and one who also had liscense that had expired 7 years ago in another state had to pay a fine to the other state even though she's inactive.
I think we can chalk this conversation up to "bad habits" nurses pick up while working in Long Term Care.
It is one of the reasons, nurse managers are hesitant to hire nurses from nursing homes into acute care settings.
Andrew Lopez, RN
http://www.nursinga2z.com
It is one of the reasons, nurse managers are hesitant to hire nurses from nursing homes into acute care settings.
Andrew Lopez, RN
http://www.nursinga2z.com
Falsifying records are not bad habits they are fraudulant activities. What you consider bad habits are more than likely related to over work and trying to take care of more than is reasonable. If Hospital managers are doing that then they are losing a lot of good nurses. To judge some one that has worked in LTC as not as good is over looking a lot. I have worked with nurses that came from the hospital and I can tell you that they are no better then the nurses that have been working in LTC. In fact some times they are even a hazard as they are not used to the work load. While they are spending forever in a room doing a dressing change the other residents are screaming for pain meds, looking to go to the bathroom. I would love the oportunity to work in a hospital again so that I can feel that I have done my best when I leave. The ideal situation isn't nursing homes, but they are taking care of a part of our society that is in need of LTC. In LTC I have passed meds up to 35 pt's, did wound care, pt assessments, IV therapy, NG tubes, suctioned, supervised LPN's, CNA's and RN's, did admissions /discharges, transfers, doctor orders, charting, care planning. with the med pass we assessed pain levels, mental status, answered the phones, provided comfort to dying pt, did MDS's, assisted pts. to BR/DR, helped feed. This list can go on. This is just a sample of what we as LTC nurses routinely do in an 8 hr period. So to say that we pick up bad habits is unforgivable.
I have also heard management tell nurses to copy what the day shift wrote. yes charting is done, but how accurate is it? these are the people that give nursing a bad name. The reason for the skilled charting is to assess the resident for your shift and then chart accordingly. So how the heck can you chart in the beginning of the shift? But that is exactly what is being done. How do you prove this? You don't because you end up in the situation that I am in if you do. and if you are the one doing it the right way everything doesn't get done. Then you are the one that gets in trouble, because management either doesn't care or are clueless.
you see that coping charting everywhere. I see staples CDI then you look and it's sutures because most of the time our docs use staples so someone assumes and never looks and the next does the same. Or charts incision CDI but the dressing is still on...how do you know what the incision is with a dressing on it? Or skin intact and you find some decub that is far enough it didn't start in the last 8 hours when it's already got necrosis. Everybody needs to do head to toe when you should chart what you do when you do it, let the doc, management know when there is something they need to know and chart what you did, write it up. If everyone would play nice it would be a much better place... isn't that how it should be in your whole life anyway?
It was so bad in one place I worked that I would have spent the whole 8 hrs writing people up. these CNA's were rough and one actually threatened me. I don't need that crap.
I've worked in both acute care and long term care and I stand by my statement. The frequent corners cut by long term care nurses fall into my definition of "bad habits" and hospital nurse managers tend to agree when deciding who hire.
When do you cross the line into where falsifying records is illegal vs unethical? The line becomes blurry when you're given an impossible workload.
Andrew Lopez, RN
http://www.nursinga2z.com
When do you cross the line into where falsifying records is illegal vs unethical? The line becomes blurry when you're given an impossible workload.
Andrew Lopez, RN
http://www.nursinga2z.com
Sorry but like I said before bad habits? do you mean cutting corners by assessing what is a real nursing function as apposed to doing things to passify management who has over compensated for the state regs. Or are you refering to charting facts as apposed to page long notes done to impress and have no more power than to hide the actual data? Because when I go to suction some one I do it the same way that it would be done in the hospital unless a resident prefers it done another way and this is charted. Please be a little more specific with what you consider to be bad habits. a habit is something that is done repeatedly and is difficult to change. As far as I know there really are no instances in LTC where you would be doing the same thing over and over to the point of becoming a bad habit. Falsifying is fraud and that makes it illegal. Ethics is a whole different ballgame. and what do you call it when hospitals send our patients back to us with stage IV decubes. Give me a break.
[ QUOTE ]
lam said:what do you call it when hospitals send our patients back to us with stage IV decubes. Give me a break.
[/ QUOTE ]
The same thing as when a patient who started with no decubiti ends up with a stage IV and is sent to the hospital after they go septic.
Andrew Lopez, RN
http://www.nursinga2z.com
lam said:what do you call it when hospitals send our patients back to us with stage IV decubes. Give me a break.
[/ QUOTE ]
The same thing as when a patient who started with no decubiti ends up with a stage IV and is sent to the hospital after they go septic.
Andrew Lopez, RN
http://www.nursinga2z.com
you mean the one that came from the hospital in the first place. My point is nursing is nursing. and to use what you are claiming as a criteria for hiring a nurse is silly. you can keep your views/opinions, but it is that attitude that is keeping some good nurses from working.
how about when the hospital sends a patient back to us who is septic and we have to turn around and send them right back because the hospital didn't recognize that the pt. was septic in the first place. lol we can go back and forth like this for ever.
how about when the hospital sends a patient back to us who is septic and we have to turn around and send them right back because the hospital didn't recognize that the pt. was septic in the first place. lol we can go back and forth like this for ever.
[ QUOTE ]
lam said:
you mean the one that came from the hospital in the first place. My point is nursing is nursing. and to use what you are claiming as a criteria for hiring a nurse is silly. you can keep your views/opinions, but it is that attitude that is keeping some good nurses from working.
[/ QUOTE ]
Nope, I mean the patients that have perfect skin to start with, and then through lack of turning, poor nutrition, poor hydration and general neglect start to develop bedsores while in the nursing homes.
These types of conditions are rampant in nursing homes and nurses (as well as nursing assistants, etc) play a major role.
If I were a nurse manager in an ICU or other hospital unit, I'd need to decide if I wanted to spend the orientation time I'd need bringing a LTC nurses assessment skills, organization and acute care skills up to speed.
You can't take a LTC nurse and put them into a hospital unit with acute patients without a major refresher/reorientation.
If it's a choice between a LTC nurse and a nurse with recent acute care experience, the LTC nurse is at a major disadvantage.
Andrew Lopez, RN
http://www.nursinga2z.com
lam said:
you mean the one that came from the hospital in the first place. My point is nursing is nursing. and to use what you are claiming as a criteria for hiring a nurse is silly. you can keep your views/opinions, but it is that attitude that is keeping some good nurses from working.
[/ QUOTE ]
Nope, I mean the patients that have perfect skin to start with, and then through lack of turning, poor nutrition, poor hydration and general neglect start to develop bedsores while in the nursing homes.
These types of conditions are rampant in nursing homes and nurses (as well as nursing assistants, etc) play a major role.
If I were a nurse manager in an ICU or other hospital unit, I'd need to decide if I wanted to spend the orientation time I'd need bringing a LTC nurses assessment skills, organization and acute care skills up to speed.
You can't take a LTC nurse and put them into a hospital unit with acute patients without a major refresher/reorientation.
If it's a choice between a LTC nurse and a nurse with recent acute care experience, the LTC nurse is at a major disadvantage.
Andrew Lopez, RN
http://www.nursinga2z.com
Falsifying records is never blurry.. Falsifying records is an intended violation of nursing standards. It has nothing to do with work load. And would never hold up in court of law. "I was so busy I had to put down the wrong number in the chart"??????? If you can't remember the number do it again.. There is always your left hand to write on if you have to.
Unacceptable.
WR,,, three commas for Becca
Unacceptable.
WR,,, three commas for Becca
[ QUOTE ]
WRRN said:
Falsifying records is never blurry.. Falsifying records is an intended violation of nursing standards. It has nothing to do with work load. And would never hold up in court of law. "I was so busy I had to put down the wrong number in the chart"??????? If you can't remember the number do it again.. There is always your left hand to write on if you have to.
Unacceptable.
WR,,, three commas for Becca
[/ QUOTE ] agree but why are we not trying to rectify the real problem?
WRRN said:
Falsifying records is never blurry.. Falsifying records is an intended violation of nursing standards. It has nothing to do with work load. And would never hold up in court of law. "I was so busy I had to put down the wrong number in the chart"??????? If you can't remember the number do it again.. There is always your left hand to write on if you have to.
Unacceptable.
WR,,, three commas for Becca
[/ QUOTE ] agree but why are we not trying to rectify the real problem?
[ QUOTE ]
nursinghumor said:
[ QUOTE ]
lam said:
you mean the one that came from the hospital in the first place. My point is nursing is nursing. and to use what you are claiming as a criteria for hiring a nurse is silly. you can keep your views/opinions, but it is that attitude that is keeping some good nurses from working.
[/ QUOTE ]
Nope, I mean the patients that have perfect skin to start with, and then through lack of turning, poor nutrition, poor hydration and general neglect start to develop bedsores while in the nursing homes.
These types of conditions are rampant in nursing homes and nurses (as well as nursing assistants, etc) play a major role.
If I were a nurse manager in an ICU or other hospital unit, I'd need to decide if I wanted to spend the orientation time I'd need bringing a LTC nurses assessment skills, organization and acute care skills up to speed.
You can't take a LTC nurse and put them into a hospital unit with acute patients without a major refresher/reorientation.
If it's a choice between a LTC nurse and a nurse with recent acute care experience, the LTC nurse is at a major disadvantage.
Andrew Lopez, RN
http://www.nursinga2z.com
[/ QUOTE ] Boy are you lost, I have been in nursing for 25 years, and no matter where you are working there are only 24 hrs in a day, the human body and mind can only do so much in that time frame no matter who says other wise. I worked in a nursing home one time and I had every one document for an 8 hr shift on my unit exactly what they did for every minute of the 8 hr period and as I expected there was no way that everything could possibly get done. I took this info to management and yes some changes were made that helped, but guess what in a matter of a month or 2 management had come along and everything was right back to the way it was before. I don't think any one would disagree with your statement that if a LTC nurse was up against an acute care nurse for a position in acute care that the acute care nurse would get it, but that doesn't automatically mean she is a better nurse just that the hospital would not have to orient her as long. and I am not talking about such cases, I am talking about hospitals in areas with a big shortage, and I don't mean that they should disregard safety of residents. I do object to your blatant generalization of all LTC nurses, that show's a deficiency in logical thinking, which I am sure that you were not intentionally doing. Now do you want to get into ethics, Is it ethical for a nurse to follow a doctors order knowing damn well that by following that order she is putting that patient in jepordy? There are many situations as you well know that in nursing you are damned if you do and damned if you don't, in these situations I go with what is best for the patient. As the patient is my reason for being there, next step is covering the facility in which houses such patient, then comes CYA. Sometimes you just can't do all of that either. I have only had a couple of bad apples in nursing school, how about you, that means that the majority of students that graduated where decent nurses. Now if LTC is turning them into such bad nurses that they are so bad that no one else would hire them shouldn't we be shutting all LTC facilities down. What about the all the nurses that get addicted on demerol and morphine, that does not happen in LTC?
nursinghumor said:
[ QUOTE ]
lam said:
you mean the one that came from the hospital in the first place. My point is nursing is nursing. and to use what you are claiming as a criteria for hiring a nurse is silly. you can keep your views/opinions, but it is that attitude that is keeping some good nurses from working.
[/ QUOTE ]
Nope, I mean the patients that have perfect skin to start with, and then through lack of turning, poor nutrition, poor hydration and general neglect start to develop bedsores while in the nursing homes.
These types of conditions are rampant in nursing homes and nurses (as well as nursing assistants, etc) play a major role.
If I were a nurse manager in an ICU or other hospital unit, I'd need to decide if I wanted to spend the orientation time I'd need bringing a LTC nurses assessment skills, organization and acute care skills up to speed.
You can't take a LTC nurse and put them into a hospital unit with acute patients without a major refresher/reorientation.
If it's a choice between a LTC nurse and a nurse with recent acute care experience, the LTC nurse is at a major disadvantage.
Andrew Lopez, RN
http://www.nursinga2z.com
[/ QUOTE ] Boy are you lost, I have been in nursing for 25 years, and no matter where you are working there are only 24 hrs in a day, the human body and mind can only do so much in that time frame no matter who says other wise. I worked in a nursing home one time and I had every one document for an 8 hr shift on my unit exactly what they did for every minute of the 8 hr period and as I expected there was no way that everything could possibly get done. I took this info to management and yes some changes were made that helped, but guess what in a matter of a month or 2 management had come along and everything was right back to the way it was before. I don't think any one would disagree with your statement that if a LTC nurse was up against an acute care nurse for a position in acute care that the acute care nurse would get it, but that doesn't automatically mean she is a better nurse just that the hospital would not have to orient her as long. and I am not talking about such cases, I am talking about hospitals in areas with a big shortage, and I don't mean that they should disregard safety of residents. I do object to your blatant generalization of all LTC nurses, that show's a deficiency in logical thinking, which I am sure that you were not intentionally doing. Now do you want to get into ethics, Is it ethical for a nurse to follow a doctors order knowing damn well that by following that order she is putting that patient in jepordy? There are many situations as you well know that in nursing you are damned if you do and damned if you don't, in these situations I go with what is best for the patient. As the patient is my reason for being there, next step is covering the facility in which houses such patient, then comes CYA. Sometimes you just can't do all of that either. I have only had a couple of bad apples in nursing school, how about you, that means that the majority of students that graduated where decent nurses. Now if LTC is turning them into such bad nurses that they are so bad that no one else would hire them shouldn't we be shutting all LTC facilities down. What about the all the nurses that get addicted on demerol and morphine, that does not happen in LTC?
just so that we are on the same plane, are you refering to nurses that have only long term care experience? I have gone through a few of the check lists and I have done and have experience in most that are on these check lists except maybe the ICU experiences. I would have no problem going to work on a med surge unit. Every hospital has their own thing going on and may be a little different then from other hospitals. I wouldn't do it right now with out getting some of my health issues taken care of first. But then again since I have had to deal with such narrow minded people that they are willing to let me die to prove their point.
[ QUOTE ]
lam said:What about the all the nurses that get addicted on demerol and morphine, that does not happen in LTC?
[/ QUOTE ]
What about them? If you follow state board license suspensions for drug diversion, drug use, it happens in all care settings.
Andrew Lopez, RN
http://www.4nursing.com
lam said:What about the all the nurses that get addicted on demerol and morphine, that does not happen in LTC?
[/ QUOTE ]
What about them? If you follow state board license suspensions for drug diversion, drug use, it happens in all care settings.
Andrew Lopez, RN
http://www.4nursing.com
[ QUOTE ]
WRRN said:Falsifying records is never blurry.. Falsifying records is an intended violation of nursing standards. It has nothing to do with work load. And would never hold up in court of law. "I was so busy I had to put down the wrong number in the chart"??????? If you can't remember the number do it again.. There is always your left hand to write on if you have to.
Unacceptable.
[/ QUOTE ]
Unacceptable huh? Like any nurse that says they've never made a medication error, a nurse that says they have not ever "cut corners" is telling stories.
Signing your name for medications never given, treatments not done, orders in a chart not noted?
These types of things happen on a daily basis, does that mean all nurses that do it are criminals? Or are they pawns in a game that is stacked against them?
Andrew Lopez, RN
http://www.4nursing.com
WRRN said:Falsifying records is never blurry.. Falsifying records is an intended violation of nursing standards. It has nothing to do with work load. And would never hold up in court of law. "I was so busy I had to put down the wrong number in the chart"??????? If you can't remember the number do it again.. There is always your left hand to write on if you have to.
Unacceptable.
[/ QUOTE ]
Unacceptable huh? Like any nurse that says they've never made a medication error, a nurse that says they have not ever "cut corners" is telling stories.
Signing your name for medications never given, treatments not done, orders in a chart not noted?
These types of things happen on a daily basis, does that mean all nurses that do it are criminals? Or are they pawns in a game that is stacked against them?
Andrew Lopez, RN
http://www.4nursing.com
[ QUOTE ]
lam said:I do object to your blatant generalization of all LTC nurses, that show's a deficiency in logical thinking, which I am sure that you were not intentionally doing.
[/ QUOTE ]
The generalization that LTC nurses (without prior acute care experience) cannot provide safe patient care in hospitals without lengthy orientations, training?
You can object all you want, I'm quite comfortable making that statement having worked on both sides of the fence (Hospital & LTC) and knowing a good deal about the hiring process.
Andrew Lopez, RN
http://www.nursefriendly.com
lam said:I do object to your blatant generalization of all LTC nurses, that show's a deficiency in logical thinking, which I am sure that you were not intentionally doing.
[/ QUOTE ]
The generalization that LTC nurses (without prior acute care experience) cannot provide safe patient care in hospitals without lengthy orientations, training?
You can object all you want, I'm quite comfortable making that statement having worked on both sides of the fence (Hospital & LTC) and knowing a good deal about the hiring process.
Andrew Lopez, RN
http://www.nursefriendly.com
Putting 199 in a chart instead of 210 is falsifying a medical record and so is every other thing you mentioned.
WR,,, three commas for Becca
Better to leave the chart empty than falsify it.
WR,,, three commas for Becca
Better to leave the chart empty than falsify it.
When was the last time you worked LTC????
WR,,, three commas for Becca
WR,,, three commas for Becca
It doesn't happen in nursing situations where there are no morphine or demerol available.
WR,,, three commas for Becca
WR,,, three commas for Becca
[ QUOTE ]
WRRN said:
Falsifying records is never blurry.. Falsifying records is an intended violation of nursing standards. It has nothing to do with work load. And would never hold up in court of law. "I was so busy I had to put down the wrong number in the chart"??????? If you can't remember the number do it again.. There is always your left hand to write on if you have to.
Unacceptable.
WR,,, three commas for Becca
[/ QUOTE ]
I'm left handed so I have to write on my right or on the pants leg of my hospital supplied scrubs
WRRN said:
Falsifying records is never blurry.. Falsifying records is an intended violation of nursing standards. It has nothing to do with work load. And would never hold up in court of law. "I was so busy I had to put down the wrong number in the chart"??????? If you can't remember the number do it again.. There is always your left hand to write on if you have to.
Unacceptable.
WR,,, three commas for Becca
[/ QUOTE ]
I'm left handed so I have to write on my right or on the pants leg of my hospital supplied scrubs
[ QUOTE ]
nursinghumor said:
[ QUOTE ]
lam said:What about the all the nurses that get addicted on demerol and morphine, that does not happen in LTC?
[/ QUOTE ]
What about them? If you follow state board license suspensions for drug diversion, drug use, it happens in all care settings.
Andrew Lopez, RN
http://www.4nursing.com
[/ QUOTE ]but how long have they worked in a hospital before they get caught. it is much harder to get the drugs in LTC and not be noticed. and I agree that if a nurse has only worked in LTC for many years she would have more of a problem then say some one like you or me that has had both experiences. problem is that if unit managers are only looking at the fact that a nurse has worked in LTC there fore she/he has developed bad habits is limiting.
nursinghumor said:
[ QUOTE ]
lam said:What about the all the nurses that get addicted on demerol and morphine, that does not happen in LTC?
[/ QUOTE ]
What about them? If you follow state board license suspensions for drug diversion, drug use, it happens in all care settings.
Andrew Lopez, RN
http://www.4nursing.com
[/ QUOTE ]but how long have they worked in a hospital before they get caught. it is much harder to get the drugs in LTC and not be noticed. and I agree that if a nurse has only worked in LTC for many years she would have more of a problem then say some one like you or me that has had both experiences. problem is that if unit managers are only looking at the fact that a nurse has worked in LTC there fore she/he has developed bad habits is limiting.
You would Cass... At least you got my drift..
WR,,, three commas for Becca
WR,,, three commas for Becca
[ QUOTE ]
nursinghumor said:
[ QUOTE ]
WRRN said:Falsifying records is never blurry.. Falsifying records is an intended violation of nursing standards. It has nothing to do with work load. And would never hold up in court of law. "I was so busy I had to put down the wrong number in the chart"??????? If you can't remember the number do it again.. There is always your left hand to write on if you have to.
Unacceptable.
[/ QUOTE ]
Unacceptable huh? Like any nurse that says they've never made a medication error, a nurse that says they have not ever "cut corners" is telling stories.
Signing your name for medications never given, treatments not done, orders in a chart not noted?
These types of things happen on a daily basis, does that mean all nurses that do it are criminals? Or are they pawns in a game that is stacked against them?
Andrew Lopez, RN
http://www.4nursing.com
[/ QUOTE ]I would have to agree with you on this one. I have signed meds and then gone into the room and the patient wasn't there or wouldn't take them and forgot to circle the med on the Mar. I have also missed signing some of those little blocks, and yes it is because of the pace and the distractions. When I went to school we were told that we were not to be bothered when we were passing meds yet in LTC they expect you to watch what the CNA's are doing, answer call lights, answer the phone etc. Some days everything runs smoothly and everything gets done the way it should, other days you have patients falling, new admits come at the time you need to do accu checks and meds, families are upset, pharmacy sends the wrong meds, or they don't send the meds for the new pt., sundowner sets in and pt's are not the sweet people they were at 3pm and during all of this you have an aide refusing to do her job. lol not to mention that at this time the 2 patients in seperate isolation rooms wants something for pain. (full isolation) lol the tube feeding in rm _ _ _ is out, so and so in rm _ _ _ wants her MOM now because she is going out, the pt. in rm _ _ _ colostomy bag fell off and the aides refuse to learn how to put a new one on, I have days that were just like this with out exageration.
nursinghumor said:
[ QUOTE ]
WRRN said:Falsifying records is never blurry.. Falsifying records is an intended violation of nursing standards. It has nothing to do with work load. And would never hold up in court of law. "I was so busy I had to put down the wrong number in the chart"??????? If you can't remember the number do it again.. There is always your left hand to write on if you have to.
Unacceptable.
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Unacceptable huh? Like any nurse that says they've never made a medication error, a nurse that says they have not ever "cut corners" is telling stories.
Signing your name for medications never given, treatments not done, orders in a chart not noted?
These types of things happen on a daily basis, does that mean all nurses that do it are criminals? Or are they pawns in a game that is stacked against them?
Andrew Lopez, RN
http://www.4nursing.com
[/ QUOTE ]I would have to agree with you on this one. I have signed meds and then gone into the room and the patient wasn't there or wouldn't take them and forgot to circle the med on the Mar. I have also missed signing some of those little blocks, and yes it is because of the pace and the distractions. When I went to school we were told that we were not to be bothered when we were passing meds yet in LTC they expect you to watch what the CNA's are doing, answer call lights, answer the phone etc. Some days everything runs smoothly and everything gets done the way it should, other days you have patients falling, new admits come at the time you need to do accu checks and meds, families are upset, pharmacy sends the wrong meds, or they don't send the meds for the new pt., sundowner sets in and pt's are not the sweet people they were at 3pm and during all of this you have an aide refusing to do her job. lol not to mention that at this time the 2 patients in seperate isolation rooms wants something for pain. (full isolation) lol the tube feeding in rm _ _ _ is out, so and so in rm _ _ _ wants her MOM now because she is going out, the pt. in rm _ _ _ colostomy bag fell off and the aides refuse to learn how to put a new one on, I have days that were just like this with out exageration.
I would have to agree with you on this one. I have signed meds and then gone into the room and the patient wasn't there or wouldn't take them and forgot to circle the med on the Mar.
that's why you take the MAR in the room with you and initial it when it's in. It's not just long term care where families come and peopel want things now and people don't do their job it's everywhere. Here's mine fetal demise delivering in one room so other nurse busy in there with doc then his next pt delivering in next room ok I catch that one and it's a premie so once mom stable nursery nurses all busy with that one then next room delivering so play nursery nurse there and get the baby then mom crashing and emergency c/s in next room...so 4 moms 3 babies in 20 minutes....it's everywhere the busy busy busy we staff by some wonderful grid now that tells us how many nurses we "need" with no accounting for the outpatient clinic we play with 7-8 non-stress tests that get admitted, observed for an hour then discharged but those don't count as patients needing nursing hours.
that's why you take the MAR in the room with you and initial it when it's in. It's not just long term care where families come and peopel want things now and people don't do their job it's everywhere. Here's mine fetal demise delivering in one room so other nurse busy in there with doc then his next pt delivering in next room ok I catch that one and it's a premie so once mom stable nursery nurses all busy with that one then next room delivering so play nursery nurse there and get the baby then mom crashing and emergency c/s in next room...so 4 moms 3 babies in 20 minutes....it's everywhere the busy busy busy we staff by some wonderful grid now that tells us how many nurses we "need" with no accounting for the outpatient clinic we play with 7-8 non-stress tests that get admitted, observed for an hour then discharged but those don't count as patients needing nursing hours.
The GRID!!!!! I can't stand that word. I had to use a GRID when I was charge in CCU. It did not take in consideration the number of IABP's or fresh MI's from the cath lab. I would send my staffing sheet to the nursing supervisor. Next thing I know they would call back, "Your staffing is not according to the grid." 
Yeah I know nursing is crazy all over, but I have tried everything when it comes to that med pass the only thing that I found that worked 100% of the time was the old way way you poured the meds and took the tray and gave the meds, meds left in tray didn't get signed for, plus the med cards were checked before you passed meds and again after when you signed them out. I have done this in hospital and LTC and it works and less likely to miss a new order as long as it was on the Mar. When I was pouring the meds I was in a closed room away from distractions and most people respected that. Unless there was an emergency no one would bother me. and if there was a problem with an order you could just take care of it right then. some times old is better
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WRRN said:When was the last time you worked LTC????
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LTC, last week. Subacute Rehab - Yesterday.
Andrew Lopez, RN
http://www.nursinga2z.com
WRRN said:When was the last time you worked LTC????
[/ QUOTE ]
LTC, last week. Subacute Rehab - Yesterday.
Andrew Lopez, RN
http://www.nursinga2z.com
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WRRN said:It doesn't happen in nursing situations where there are no morphine or demerol available.
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In what world are you nursing in? Any LTC or Acute care environment that deals with live patients, deals with pain management.
Andrew Lopez, RN
http://www.nursingms.com
WRRN said:It doesn't happen in nursing situations where there are no morphine or demerol available.
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In what world are you nursing in? Any LTC or Acute care environment that deals with live patients, deals with pain management.
Andrew Lopez, RN
http://www.nursingms.com
It is a lot easier to control the drugs in LTC, one place I worked there was only one person on Demerol Im and we had 3 unit vials of it, a new nurse came to work and " accidently knocked the cap off" Right, a couple of days later same nurse "accidently knocked the cap off the second vial" Double right, she was caught right away. came with the problem.
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lam said:It is a lot easier to control the drugs in LTC
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I think you're dreaming. Narcotics are heavily regulated in hospitals shift to shift. In nursing homes, you're dealing with much larger numbers of patients/narcotics, much less accountability. LTC has Percocet, Darvocet, Vicodin, MS Contin, Oxycontin and everything oral that a hospital does.
How are you going to catch a nurse that is pocketing narcotics she says are intended for a confused, disoriented or hospice patient?
Andrew Lopez, RN
http://www.jocularity.com
lam said:It is a lot easier to control the drugs in LTC
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I think you're dreaming. Narcotics are heavily regulated in hospitals shift to shift. In nursing homes, you're dealing with much larger numbers of patients/narcotics, much less accountability. LTC has Percocet, Darvocet, Vicodin, MS Contin, Oxycontin and everything oral that a hospital does.
How are you going to catch a nurse that is pocketing narcotics she says are intended for a confused, disoriented or hospice patient?
Andrew Lopez, RN
http://www.jocularity.com
I work Hemodialysis. The biggest narcs we have is lomotil and darvocet...
WR,,, three commas for Becca
WR,,, three commas for Becca
Drug diversion doesn't happen in all care settings.. How does it happen in private duty cases. I took care of a wealthy lady with COPD. Inhalers aren't worth diverting really.
WR,,, three commas for Becca
She really needed a maid but opted to pay for an LPN.. Didn't hurt my feelings.. I work 1900-0700 She went to bed at 2100. And slept the nite.
WR,,, three commas for Becca
She really needed a maid but opted to pay for an LPN.. Didn't hurt my feelings.. I work 1900-0700 She went to bed at 2100. And slept the nite.
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WRRN said:
I work Hemodialysis. The biggest narcs we have is lomotil and darvocet
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If you have access to controlled substances at all, drug diversion and abuse is potentially a problem isn't it?
Andrew Lopez, RN
http://www.4nursing.com
WRRN said:
I work Hemodialysis. The biggest narcs we have is lomotil and darvocet
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If you have access to controlled substances at all, drug diversion and abuse is potentially a problem isn't it?
Andrew Lopez, RN
http://www.4nursing.com
If is a much different word than all...
WR,,, three commas for Becca
And this topic was never about diverting drugs was it? OH only until you made it one..
WR,,, three commas for Becca
And this topic was never about diverting drugs was it? OH only until you made it one..
there are ways to tell if a nurse is taking drugs, usually in LTC the confused pts. are not on heavy duty stuf and they get routine meds. only time I saw a problem in LTC was when an agency nurse came in and everyone needed pain meds that really did need them. I am sure it does happen but I still think it is a bigger problem in hospitals and more damgerous. I think the post was referring to falsefying medical records. I am not an expert in this just what I have seen over the years.
Wow. Here I am deciding that I want to spend the ret of my life doing long term care after I complete my nursing school. It's really sad that most of the rest of the medical profession sees LTC as a horrible thing. I wish I could change all of that on my own, but I can't. What would help would be if all nurses supported all nurses, you know? I don't think it would be so bad if LTC nurses didn't feel like they were being made out to be the scum of the earth.
I am told that if I choose LTC as my profession, that it is professional suicide. I suppose that might be true if my chosen profession weren't to stay in LTC. But it is. I like it here. I like knowing my residents. It feels like another family.
No matter where I have ever worked, I have always made it a point to do the best job that I know how. LTC doesn't make me want to do any less than that.
I am not offended, just hurt, I suppose.
I am told that if I choose LTC as my profession, that it is professional suicide. I suppose that might be true if my chosen profession weren't to stay in LTC. But it is. I like it here. I like knowing my residents. It feels like another family.
No matter where I have ever worked, I have always made it a point to do the best job that I know how. LTC doesn't make me want to do any less than that.
I am not offended, just hurt, I suppose.
Going into LTC off the bat is not professional suicide, it does limit the types other types of nursing you can go into later.
One of the best things about nursing is the ability to switch to a different type after you start to get bored/burned out where you are.
I'm biased in that I started out doing Med/Surg/Telemetry. With that basic experience (2 years) you can go to home health, travel nursing, LTC, doctors offices, clinics, public health. You'll find that employers in acute care settings share that same bias to an extent.
Sorry if we painted the picture that LTC nurses cannot go anywhere career-wise, they can specialize in legal nurse consulting, wound care, case management, become nurse practitioners specializing in Gerontology, etc.
As opposed to acute care, options are greatly reduced if your experience is in LTC.
Andrew Lopez, RN
http://www.malenursemagazine.com
One of the best things about nursing is the ability to switch to a different type after you start to get bored/burned out where you are.
I'm biased in that I started out doing Med/Surg/Telemetry. With that basic experience (2 years) you can go to home health, travel nursing, LTC, doctors offices, clinics, public health. You'll find that employers in acute care settings share that same bias to an extent.
Sorry if we painted the picture that LTC nurses cannot go anywhere career-wise, they can specialize in legal nurse consulting, wound care, case management, become nurse practitioners specializing in Gerontology, etc.
As opposed to acute care, options are greatly reduced if your experience is in LTC.
Andrew Lopez, RN
http://www.malenursemagazine.com
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WRRN said:When was the last time you worked LTC????
[/ QUOTE ]
Today, spent the first 1/2 of the day doing an admission (among other things) in a subacute unit, the second 1/2 passing meds, etc on a long term care section.
Andrew Lopez, RN
http://www.jocularity.com
WRRN said:When was the last time you worked LTC????
[/ QUOTE ]
Today, spent the first 1/2 of the day doing an admission (among other things) in a subacute unit, the second 1/2 passing meds, etc on a long term care section.
Andrew Lopez, RN
http://www.jocularity.com
You already answered my question once.. I didn't know dementia was contagious?
WR,,, three commas for Becca
And working a half day doing an admission,passing meds etc, IMHO, is hardly working in LTC.
WR,,, three commas for Becca
And working a half day doing an admission,passing meds etc, IMHO, is hardly working in LTC.
I have worked in LTC for many years and if that is where you want to be that's fine. I like the elderly but I can't stand the other nonsence that goes on. There are also a lot of regulations put on the facilities and were much needed. It can be a great place to work if every one would work together. My ideal job would be to be a DON in a small facility where I could run things the way that it could and should be run. Thats not happening and for my own health it is time to move on. Trouble is that it is now difficult to get back into some thing else. Thats why they say it is career suicide.
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WRRN said:And working a half day doing an admission,passing meds etc, IMHO, is hardly working in LTC.
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So I guess I don't qualify for the "committing career suicide" category, huh? So sad. What pray tell would qualify me?
Andrew Lopez, RN
http://www.nursingdiabetics.com
WRRN said:And working a half day doing an admission,passing meds etc, IMHO, is hardly working in LTC.
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So I guess I don't qualify for the "committing career suicide" category, huh? So sad. What pray tell would qualify me?
Andrew Lopez, RN
http://www.nursingdiabetics.com
I have to add to this post. I have to answer to the post about hospital nurses are better equipped with dealing with patients. I work in LTC. I have a resident with an IV, vancomycin q 12 hours and invanz q 24 hours, we have peg tubes, admits, discharges, doctors in the facility giving new orders, psychiatric patients, and there are 58 residents and on night shift I am responsible for ALL of them. I have 2 cna's, 3 if I am lucky.
During the evening shift there are 2 nurses. We answer the phones, do the admits, send residents to the hospital if needed, we deal with family members calling and coming into the facility. We have residents walking out ALL doors whom we have to keep an eye on, we have charting to do on a medicare hall, which is an acute care wing. Please do not say that LTC nurses dont do anything and that hospital nurses are the only ones overworked. I do 12 and 16 hour shifts, am expected to be on top of every residents plan of care and expected to pitch in if we are short staffed. Tell me how I can get anything done in an 8 hour shift? Sorry to vent. This wasnt meant as a post to the last poster here, just went to the end and posted my gripe. Ok, I vented. Sorry if I am out of line, but please dont put down the LTC nurse, she/he is just as overworked as a hospital nurse.
During the evening shift there are 2 nurses. We answer the phones, do the admits, send residents to the hospital if needed, we deal with family members calling and coming into the facility. We have residents walking out ALL doors whom we have to keep an eye on, we have charting to do on a medicare hall, which is an acute care wing. Please do not say that LTC nurses dont do anything and that hospital nurses are the only ones overworked. I do 12 and 16 hour shifts, am expected to be on top of every residents plan of care and expected to pitch in if we are short staffed. Tell me how I can get anything done in an 8 hour shift? Sorry to vent. This wasnt meant as a post to the last poster here, just went to the end and posted my gripe. Ok, I vented. Sorry if I am out of line, but please dont put down the LTC nurse, she/he is just as overworked as a hospital nurse.
Everyone has their passion, and I say thank god for nurses who enjoy LTC. I know that one day I want to be in a level I trauma facility in the middle of it all. I could never do LTC, but that is what is so great about nursing...everyone can pick the speciality they want, and as long as they are happy that is all that matters. So thank you to those that do b/c you are needed just as much as everyone else.
And to start a new gripe...it seems like everyone bashes CNA's. I know I am a student nurse - CNA, (only 9 months till graduation :)), and we are just as busy too. I had 21 patients in the ER the other day and was responsible to 3 nurses, did q2 hour vitals on everyone, all the EKG's, Blood draws, changing of patients, blood sugars, transport, and the day wouldnt be complete without a code in the middle of it all, but the point is everyone is busy and we all need to help eachother out and stop putting everyone else down. There is nothing we can do to improve the staffing shortage, but if we keep bashing eachother it will only get worse. I want to be a nurse for the patients, so i know i will never leave this field.
And to start a new gripe...it seems like everyone bashes CNA's. I know I am a student nurse - CNA, (only 9 months till graduation :)), and we are just as busy too. I had 21 patients in the ER the other day and was responsible to 3 nurses, did q2 hour vitals on everyone, all the EKG's, Blood draws, changing of patients, blood sugars, transport, and the day wouldnt be complete without a code in the middle of it all, but the point is everyone is busy and we all need to help eachother out and stop putting everyone else down. There is nothing we can do to improve the staffing shortage, but if we keep bashing eachother it will only get worse. I want to be a nurse for the patients, so i know i will never leave this field.
I know this post was not originally about addicted nurses and sort of got off track but as a nurse in recovery who BTW never diverted from the workplace. I have to state that current statistics show that 10-15% of all working nurses suffer from some form of addiction. This means that if you know 15 nurses chances are at least one of them has a problem. In my support group I meet nurses from all care settings and can tell you it happens everywhere. Acute,LTC,L&D, ER, homecare etc.
You do see more nurses with substance abuse problems in acute settings but that is just an example of the statistics. If you work in a large county hospital that employs 1000 nurses then there's a good likelyhood that 100 of them have a substance problem. If You work in a small ltc that has 10 RN's (Wouldn't that be nice) statistically there would only be 1. So when you look at the numbers it all comes out equal in the end. Impaired nursing is a very serious problem as is understaffing. Seat polishing nurses occur everywhere and we all face the same challanges when trying to provide safe and compassionate care for our patients and their loved ones. It is never acceptable to falsify a patient's record no matter what is happening on your unit. If the DON of the facility is not doing anything then you need to go over her head and let the medical director know. Just be sure you have kept records of your conversations with the DON. so you can back -up your complaints. Also be aware that legally a "Wistle Blower" can't be fired under federal laws so this is another reason to keep documentation to back up your complaints.I believe that most nurses work really hard and provide good care to their patients. That's what makes a "Bad Nurse" stick out like a sore thumb.
While I do not work in LTC my own personal experience with family members who have been in LTC one for Lou Gerigs and one for terminal brain cancer, That a lot of things were overlooked even when I as a nurse had to go in and
basically care for my loved one's. I understand what nurses face and I'm not complaining but when I mention to my Mother's nurse that while bathing her I noticed some skin breakdown (And I know her skin was intact on admission) I at least expect the nurse to look at it and document it. The next day the reddened area had become a stage 1. Nothing was done until I called her physician.
I work in in-patient psych and often have 20 or more psychotic dangerous patients with two aids. If I'm lucky I get a med nurse whose competant. So My situation is not so different from yours. Some days I go home knowing I did not do everything I could have for my patients. Other days I know I kicked A&& and took names and the patients got excellent care. That's the nature of the BIZ.
nuff said
Peace and Namaste
hppygr8ful
You do see more nurses with substance abuse problems in acute settings but that is just an example of the statistics. If you work in a large county hospital that employs 1000 nurses then there's a good likelyhood that 100 of them have a substance problem. If You work in a small ltc that has 10 RN's (Wouldn't that be nice) statistically there would only be 1. So when you look at the numbers it all comes out equal in the end. Impaired nursing is a very serious problem as is understaffing. Seat polishing nurses occur everywhere and we all face the same challanges when trying to provide safe and compassionate care for our patients and their loved ones. It is never acceptable to falsify a patient's record no matter what is happening on your unit. If the DON of the facility is not doing anything then you need to go over her head and let the medical director know. Just be sure you have kept records of your conversations with the DON. so you can back -up your complaints. Also be aware that legally a "Wistle Blower" can't be fired under federal laws so this is another reason to keep documentation to back up your complaints.I believe that most nurses work really hard and provide good care to their patients. That's what makes a "Bad Nurse" stick out like a sore thumb.
While I do not work in LTC my own personal experience with family members who have been in LTC one for Lou Gerigs and one for terminal brain cancer, That a lot of things were overlooked even when I as a nurse had to go in and
basically care for my loved one's. I understand what nurses face and I'm not complaining but when I mention to my Mother's nurse that while bathing her I noticed some skin breakdown (And I know her skin was intact on admission) I at least expect the nurse to look at it and document it. The next day the reddened area had become a stage 1. Nothing was done until I called her physician.
I work in in-patient psych and often have 20 or more psychotic dangerous patients with two aids. If I'm lucky I get a med nurse whose competant. So My situation is not so different from yours. Some days I go home knowing I did not do everything I could have for my patients. Other days I know I kicked A&& and took names and the patients got excellent care. That's the nature of the BIZ.
nuff said
Peace and Namaste
hppygr8ful
Nurse Karen wrote:I know of 2 nurses in the facility where I work who change the accucheck numbers to lower numbers just so they wont have to call the doc. We have several residents who if their blood sugar is above 200 the doc has to be called. These nurses hate to talk to our medical director. This is falsifying medical records if I am not mistaken. The DON looks over it. Have any of you ever experienced such a thing in your line of nursing? Its very important that our residents are being monitored closely. I dont think its funny or amusing. These nurses tell me I am being too serious and shouldnt be so picky. I am sorry, but I didnt become a RN to make up things about our residents and not report it to the doc. Any one else with the same problem? or any suggestions?
At my facility we use EMAR for our medications. When we check a patient's blood sugar we have to scan their armband and have it entered into the system. If there are nurses that falsify accuchecks it makes me wonder what else they might falsify. Nurses like this are unprofessional and a danger to the patients they are caring for :(
This is wrong. A nurse should never make-up information he/she documents in a patient's record. I agree with the post that said you should document what you have seen and go up your chain of command. In my state we have a 1-800 number to the state. If you can not get actions by going up the chain of command I think I would call the state and report the situation. This pasted year a nurse that had worked at a local nursing home was arrested and charged with falsifying medical records because he charted he gave medications (in a NH) that infact he had not given. No nurse should turn a blind eye this type of situation. I say speak up loudly
Oh my god!
Are you afraid to report this because your fellow colleagues might torture you? If this is the case,let me know. " i hope this comes out correctly,i'm not a devious person but i have a unique ability of attacking things from different angles. I can help you get the info of what you are dealing with out without them knowing a thing. It's hard working with in a medical facility where people will stab you in the back the first chance they get.
Cat16
Are you afraid to report this because your fellow colleagues might torture you? If this is the case,let me know. " i hope this comes out correctly,i'm not a devious person but i have a unique ability of attacking things from different angles. I can help you get the info of what you are dealing with out without them knowing a thing. It's hard working with in a medical facility where people will stab you in the back the first chance they get.
Cat16
I worked with a nurse on my first LTC job who didn't change accucheck numbers, she made them up, totally, because she was too lazy to do her job. If it didn't involve her sitting at a desk, with her head down, sleeping soundly, she didn't want to get involved. One night one of her residents went south and needed to have an IV started. The RN supervisor and I worked with the resident and got the IV started. The assigned nurse didn't go anywhere near the room, even to just look at her resident. I remarked to the other RN supervisor, that Nurse Lazy would have been up a creek if neither the other nurse nor I did any charting on HER resident. But then, both of us would have been in trouble and she would continue her routine of sleeping at work. :nurse-butt: