How long can a nurse wait to document?

Documentation is communication between you and any other provider who reviews your documentation.   So, if the documentation is not in place you are not communicating.  Standard practice is to document as soon as you finish the task you were performing.  Realistically, shifts are super busy to the point that the first time a nurse is able to document is when the shift is over and another nurse has assumed care of that nurse's patients.  If that is the case, the best you can do is to document then.

The exception to waiting till the end of the shift to document is the Medication Administration Record (MAR).  Documentation of medication administration occurs immediately AFTER the medication is given. There is no waiting and also you do NOT document before administering the medication.  Actually, all documentation is to be done after the task is completed and never before.  I like to say "There is no Fixing-To documentation."  

Some nurses have the mistaken belief that they can leave the hospital and then document when they come back for their next shift and that is untrue and a habit that if caught will result in disciplinary action by the Texas Board of Nursing/BON.  Think about what documentation is used for; it is used to communicate to others when you are not present to tell them in person. So, if you are gone and the documentation is missing then no communication is happening and patient care is impacted.

The best practice is to do the task then document.   You are also likely to remember more important facts if you document timely. So, not only is it nursing standard, best for patient care, but is also more likely to protect you and give  you documentation you can rely upon in case something comes up later.

Closing eyes while at work - DANGER, DANGER

You are tired, or sick, or just resting our eyes so you close your eyes for a short time period at work.  Of course right then is when another staff member, or management or a family member comes by and sees you "sleeping."  You are most likely about to be terminated and reported to the BON for sleeping.  You think I will explain that I just had my eyes closed for a short time period, but that explanation does not make the termination cease or the BON stop from taking disciplinary action.  The assumption always is if your eyes are closed, you are sleeping. So be very careful!!

A nurse passed on what she encountered when she started a new night job:   she was told by nurses who had been working at the facility for a while that if it was slow at work they would take turns watching each other's patients and take turns sleeping.  They assured her it was acceptable.  She said she thought it sounded off, but she wanted to check with an attorney that represented nurses.  I told her that it was not EVER acceptable and also she may want to reconsider working in a place like this where nurses thought it was acceptable behavior to be paid for sleeping on the job and ignoring their patients.

Timing for Giving Medications including Narcotics

 Nurses have said there is a  policy that you have an hour leeway to give medications. So, if a medication is ordered at 9 am you can give it as early as 8am and as late as 10 am.  First there is no national policy  supporting this practice. Second, you need to see with your own eyes that such a policy is in place where you work otherwise you are not protected by following this belief.  Do not rely on what others tell you.  Some hospitals do have policies that give 30 min to 1 hour either side of the selected time of administration.. You just need to be sure the hospital/clinic/prison/LTC etc  where you work has that policy.

If the medication in question is a narcotic you can end up being charged with giving a controlled substance outside the timing set by the prescribing physician.  If a physician orders a narcotic every 4 hours and you give it one hour early or even 30 minutes early, the Board of Nursing/BONs are saying you have failed to follow the physician order and gave a narcotic outside what was ordered by the physician's order.  When it comes to narcotics nurses need to wait until the stated time has occurred before giving the medication so that you are never too early and can avoid that complaint with the BON..

The same applies to scheduled medications that are tine specific.  You need to know what your facility's policies are and what the requirements are for that specific medication ( an example are antibiotics) and give the medication appropriately.  If the medication is strictly scheduled there is no time leeway.  

Texas Board of Nursing (TX BON) moves

 Moving day is finally here and the Texas Board of Nursing/ BON has moved to a new location.  Hopefully the new offices are nicer although I have heard they are still too small.  Here is the new address:  

                                   Texas Board of Nursing    
                  1801 Congress Avenue, Suite 10-200    
                  Austin, Texas    
                  78701  

You've Been Asked to Give a Urine Screen

 Your manager asks you to come to his office and tells you he has received a report you smell like alcohol and look impaired so they would like you to give a urine screen. Or maybe you were in an accident while working and a screen is part of the policy.  Or there are drugs missing so everyone is required to provide  a drug screen. There are various possible outcomes and below are helpful hints other nurses have utilized that you may want to.  ***This is not legal advice and I am not working as your attorney in any capacity, these are just an accounting of steps other nurses have used when they were in the same situation and are intended to be for information only***:

You give the screen:  even if you know the screen should be negative does not mean that a mistake may  not be made and the negative screen is now a positive and now evidence against you. So, make sure you then obtain your own screen as well.  There have been nurses who did this and had a screen that showed negative while the one obtained at work showed up as positive. Getting your own screen can help you have evidence to prove  your innocence.  

You refuse to provide a screen:  the biggest problem with this choice is the assumption that if you had obtained the screen it would have been positive. So it becomes an automatic assumption that the screen is positive and any argument is countered by "You would have given the screen unless you knew it was going to be positive, so we believe it to be positive."  It doesn't matter if it is not true, you do not have the proof to show the screen was negative.  So, if you refuse a screen at work for any reason, immediately obtain your own screen so you have something to support your assertion that the screen would have been negative. A nurse has obtained their own screen by use of a private physician or even a walk-in screening site.  Be sure the drug in question or alcohol is included in the screen or else the screen is useless.

Type of screen to get: Make sure the screen covers the drugs in question or get a minimum of a 10 panel screen (tests for 10 different substances).

What to watch for:   When providing a screen make sure the person obtaining the screen handles it correctly.  They should wash their hands.  The sample should be sealed in front of you with a strip across the specimen jar and this strip is signed by the nurse. The sample is then sealed in a sample bag that is signed.  If the sample is poured into another specimen container it must be done in front of you prior to the sealing of the specimen.  DO NOT sign the paperwork unless the sample is sealed in front of you.  DO NOT LEAVE AN UNSEALED SPECIMEN!!   When you sign the paperwork, you are confirming all fo this was completed.

Make sure you let the collector know any medications, prescribed and OTC, that  you have taken and make sure it is all documented on the form. If the test is positive, the Medical Review Officer (MRO) will contact you to go over any medications you may have ingested.

Sometimes, the collector tries to take the position that no, you cannot write on or list anything of the requisition form.  Insist on the ability to list medications and OTC substances you have taken because that is part of the collection policies.  As an alternative, make a notation of any substances you have taken on the a piece of paper and get the collector to sign it confirming that you showed it to them for your records.  

 ***This blog provides general information and a general understanding of the law, but does not provide specific legal advice. By using this site, commenting on posts, or sending inquiries through the site or contact email, you confirm that there is no attorney-client relationship between you and the Blog/Web Site publisher/author. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.***