[Nurse Karen]

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?

[Old_School]

OMG- - - Nurses making up numbers! ! ! What's next falsified rectal temps????

[lam]

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?

[cassioo]

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.

[BADRN1992]

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!!!!

[Nurse Karen]

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.

[lam]

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.

[cassioo]

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.

[nursinghumor]

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

[lam]

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.