PATIENT DOING WELL – CARE CHARTED
50% of all nursing records create an illusion that care was given.
They might contain various lies:
A patient was given daily physical therapy – documented by nurses and assistants who were not at work on those days.
Medications are documented as being given when they are not.
A patient dies or is injured, and the nursing home staff rewrite the records to minimize blame or liability.
Overworked or lazy staff fill in charts en masse, not knowing whether treatments took place, or if the information is accurate. (I have seen this many times; a nurse writing ‘good diet taken’ when not even able to recognise the patient by name; the fraudulent filling in of fluid balance charts, or of enteral feeds given. You knew damn well that the feeding tube had not flushed, but, of course it was, for it was recorded and signed for on that ‘tablet of stone’ called a nursing record.
Medications are ticked off as being given, but I often found unopened boxes or discrepancies with pharmacy records, and patients obviously not receiving the benefits of prescribed medication. The number of faecally impacted patients I came across on regular doses of (not given) lactulose could have filled a football stadium. One lady’s chart ‘showed’ that she had been having bowel movements in the days before her death, which was very unlikely according to doctors, given the severity of her condition.
In a case in California, a week after being admitted, a patient was found with gaping ulcers on both heels, indicating he had not been consistently repositioned. His legs were amputated to save him from advanced bone infection. In the ensuing lawsuit, the chief nurse of the facility testified that she had been ordered by a corporate representative to alter medical records to ‘show’ that the patient had arrived at the nursing home with ‘softened heels’.
Dearhearts, how many times have you suspected that ‘repositioning’ had not been carried out. Have you ever been guilty of this yourself? Have you ever suspected that many nurses you have followed on shift were more likely to give birth to an elephant than be able to carry out a basic nursing procedure properly?
Californian studies show that fraudulent charting is often linked to understaffing, where care can not be given. When I was in hospital as a patient, the ‘night nurse’ had a medication round of 56 patients spread over two wards, on which there were four nursing assistants. Care was not given. I might have understood this more if they had not sat down at 3 am eating pizzas, bleating: “we have rights, too”. I retorted that if I had been in charge of the hospital, I would have asked them to work twice as fast (about half the speed I and others worked at in bygone days), and would have told them to stuff their pizzas where the sun does not shine in Africa. To cut this story short, I discharged myself, telling them to …. off you little …..; God help you if they ever bring in camaras!
When I was in charge of a nursing facility, I well recall an agency nurse telling me that Mrs. Green had a settled morning”; “I hope so”, I replied, “it would scare the …. out of the mortuary staff if she hadn’t”!
Phantom nurses. Suspicious entries in medical charts. Phony paperwork, hurriedly produced after an injury or death.
It is the untold story of nursing home care.
This is despite the fact that a medical chart is an integral aspect of patient care. Doctors and nurses rely on its accuracy to determine care or revise treatment. An accurate chart leads to care. An inaccurate one can cover up the lack of care.
A problem is that charts have become an Everest. Nurses are required to chart everything from food and fluid input to bowel movements, to bumps, and bruises, and falls, and visits, and ….
The point is this, surely, good care can be given in a nursing home or hospital if the person in charge will tolerate nothing less, and is skilled in picking up signs of care not being given, and is absolutely ruthless about bringing negligent staff to justice, i.e. dismissal.
A trouble is this, also surely; it is very difficult to attract hard working and kind people to nursing today, because it is often a wearisome and thankless job, and there are softer aternatives elsewhere, which require less discipline, and are more in tune with those who bleat about their rights whilst vulnerable and sick patients are uncared for.
You can not expect to nurse the sick by recruiting too many selfish, lazy bastards.
We recruit too many selfish, lazy bastards, who are allowed to get away with the charade of filling in charts, at the same time as persecuting good, hard working nurses who are reported to the NMC by the same selfish, lazy bastards.
If you can not bring back discipline, at least make cameras compulsory in all nursing facilities. Yet, then again, if all the selfish, lazy bastards were flushed out of nursing (50% of all staff, I suggest), then how could the charade of nursing care being given continue?
There were brilliant nurses then, there are now, and there will be in the future, but there were selfish, lazy bastards then, there are now, and, I fear, there will be a majority of this category in the future.
God help nursing.
God help patients.
Few others will.
lenin nightingale, 2015