Forced to Engage in an illegeal Act!

4 Many of us have had our share of horror stories. Well here's another.
Over the past several months we have switched over to a RAI coding system that many nurses have used in various jurisdictions. As part of this switch over, we have a RAI Co-ordinator that many staff view as nothing more than a Tyrant.
As part of this RAI coding there's a sheet that is generated where staff fill out called a Resident Assessment Protocol Summary. At the bottom of this summary there's an area for signatures. One signature area says "Signature of RN Coordinator for RAP Assessment Process". She indicated to me today that I had to sign this area to indicate the RAP's that I had done. I indicated that I will not sign that section because I'm not a RN, nor am I the Coordinator (I'm a Practical Nurse). She was very upset and reminding me that this form needs to be signed off because it's part of the Resident's chart. I reminded her again that I'm not signing that section. She indicated that no one else has a problem signing that section of the form but me and no one in our jurisdiction has a problem with it. I indicated that if government officials want me to sign that form, then the form needs to be changed. She stated that the form will not be changed and left the unit.
Moments later one of the nurse managers arrived on the unit carrying one of the forms and instructing me to sign that area of the form. I indicated to her the same facts that I relayed to the coordinator. The nurse manager indicated that the form is part of a computer program and that they are not going to change the form to suit our facility. She further instructed me to sign the form and put my professional designation beside my name. I indicated that I will not sign that section of the form and reminded her of a similar incident about a year prior where she tried to force me to sign a section of a different form which clearly had "RN Assessment" on it and I refused back then (that form was eventually changed). I indicated to the nurse manager that I will be contacting our regulatory body. The nurse manager left the unit and sent out an e-mail instructing all the staff that when they complete the RAPs on the form, that they are required to sign that section and include their professional designation. In essense, the nurse manager is instructing all the staff to commit an illegal act.
This has clearly devided a few of my co-workers today. My stand is that, if that form was ever called into evidence in a court of law and I was questioned about signing that section of the form, my proverbial butt will be on the line because I'm signing a section of a legal document that is beyond my professional designation. I told my co-workers, that it would be like an RN signing a form where it says Signature of Physician. Unless that form indicates Signature of Physician or designate, an RN (or anyone else for that matter can not complete and sign that section of a form, regardless if they put their own professional designation down or not.
I explained this incident to my wife this evening (who's also a nurse) and she indicated, "You're going to get yourself fired". She said this because she know's the long history of ongoing crap that goes on in the facility that I work at. I told her, that I will not knowingly break the law just to please this tryrant and the nurse manager. I also indicated to my wife that once I contact our regulatory body, I'll know more with regards to where I stand.
Has anyone else had an experience where they were instructed by the powers that be, to do something that was clearly illegal?
Yeah off and on throughout the years, people wanted me to sign various pieces of paper. Like you, I have refused. I'm no MD and won't pretend to be one. You can bet your sweet bippers that if you get in trouble, those same people that are making a fuss and wanting you to sign, will run like rats on a sinking ship if all he$$ breaks loose and not be supportive of you.

Although you are right, I agree with your wife, you will be looking for a new job sooner or later. You should go on your own terms before they decide to fire you. Employers will approach individuals to change charting, usually it has to do with errors of omission or adding essential information, but sometimes the individual is asked to change their description of what really happened. In that case, I can see the person, at some point, looking for a new job. Unless, of course, they don't care about compromising their integrity and the consequences.

It will be interesting to see what you hear from regulatory - but one suggestion: if the facility creates an SOP that clearly states who can sign the form in the physician section, (even without changing the form to say designee) ie RNs - then I could accept signing the form. Until then I agree with you, and your wife. You may need to evaluate staying at a facility that you believe is unethical.Good luck and let us know what happens.

Out them with a written letter of complaint to JACHO.

You can also send complaint to Joint Commission online

In my facility they have been trying to get me to do things that are out of the scope of the LPN. I said I will not. I was told "well all the other LPN's do it". I simply replied that this LPN would not be .. I don't see my current job being a long lasting one either..

Another point: if the signee is supposed to be an RN and someone other than an RN signs, the facility can be denied reimbursement, if my understanding is correct. I am not an MDS/Care Plan nurse so take that for what you will, but I am fairly certain I am correct.

Good for you for standing up for basic honesty and ethics. There are numerous ways in which nurses violate the law, nearly always at the urging of their employers and especially involving practicing beyond the limits of their license. Most of this is about the employer wanting to save money by getting a lower-paid worker to do something that is legally reserved for a higher paid person to do.In California, to cite one example, every patient in an acute hospital must be assigned to an RN. But it is common practice to assign patients to an LVN and have an RN "cover". A little research determines that the concept of "covering" has no existence in the law. Those patients are the RN's patients, period. But we have a governor who does not believe in enforcing those laws, so it's left to the nurses to enforce them. In some hospitals, nurses, with the help of our union have taken a stand and put an end to this practice, but it still persists in plenty of places.

I was hired for my first LVN job by a DON who was tickled pink that I was in an RN program. She was glad to have another RN-to-be for the night shift to sign off on paperwork and such. I did not stick around long enough to find out if I was going to actually move into an RN position and receive RN pay. After all this time in the field, I suppose I would have been encouraged to continue as an LVN at LVN pay and only sign RN to "help" them out. I am glad I never found out one way or the other. I guess that technically that would not have been illegal as I would have held the license, if not the position.

LPNs cannot legally assess (yes, I kow it is done all the time) and to sign off that you did so where it expressly requires an RN to have done the assessment will ultimately land the facility and you in a world of hurt.Start looking.

Run, Forrest, run!Regarding LPN/LVNs who are asked to work outside the scope of their practice by their employers, I wonder how many of those employers will throw the LPN/LVN under a bus when something goes wrong.Protect your nursing license. It is your most precious asset as a nurse.

I am an MDS coordinator in NC and here is how the RAPS done by an LPN are handled. The LPN can collect the info, put it on the RAP, sign the actual RAP, then on the front page of the RAP the RN must sign that she coordinated the collection of the info. Are they asking you to sign in this spot or the actual RAP? An LPN must not sign where the RN coordinator sig should be.