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My nurse friend works in dementia unit of an assisted living facility. She said she documented bruise size and said appearance of handprints. The DON said she should never have documented that way. And the bruises looked consistent with person hurting themselves.
my friend said it’s known in that facility of a caregiver that is rough with residents and the place tries to cover it up. She’s afraid she will get fired now for documenting that way.
any idea I can give her to help?

Documentation by RNs is crucial in being descriptive and in being "non judgemental". No RN in my knowledge (I was one for my career) would document "bruises the size and shape of handprints". That is not objective reporting, but SUBJECTIVE which is something RNs don't do.
She should have taken photos (said photos could not be done without permission of family if they include picture of resident's face; photos should be of the bruising which should also be witnessed by others before it is gone). She should have reported to facility at once and made an "incident report with photo attached and her description of finding "bruising on bilateral arms between elbow and humerus meaures " blah blah blah. She would do followup with administration of what steps were taken in family notification and investigation.

The elderly bruise at a TOUCH. You likely know this. For instance, in trying to assist or catch someone near falling, the simple putting of a hand on either side of arm could leave such a bruise.

Now you say there is a history of abuse at this place. THAT is a problem and it is a problem for the administration.

This RN may or may not lose her job. One thing is for certain and that's that she needs a remedial course in how to document objectively.
I am thankful she is on the lookout for abuse and that she IS documenting (and the way to do this is an incident report). Abuse is awful. This may be abuse and this may not.

This RN knows the correct path of reporting and SHO ULD know how to chart. I think really it isn't your place to do much but listen, sympathize, and encourage this RN to speak with her administration, decide if she legitimately sees abuse and should report it higher up, and take a brief updating course on charting and how it should be done.
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Reply to AlvaDeer
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cwillie Aug 15, 2024
I've seem pictures of bruises that are clearly a palm, four fingers and thumb, is it really proper procedure to pretend otherwise?
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Just keep in mind that an elderly person can bruise extremely easily. Also, there are other residents who could have injured her. But as a nurse she is a mandated reporter, so maybe she takes it to an ombudsman? Not sure where she takes it from there, but will need to prove who made the marks and why.
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Geaton777 Aug 15, 2024
To clarify, she's not the one who needs to prove who did it, she just needs to report it (and that's where I don't know her next step but I'm sure she can find out for her state and county).
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Reporting the bruises is correct. As a mandated reporter should.

Yes, some elders bruise easily, it may be completely unintentional. Eg happened during an assisted transfer.

But (always a but..). Could be another resident, as mentioned by Geaton. I hope NOT.. but could be a rough staff member. That needs to be uncovered & stopped immediately.

Or even a fall/near miss. Where someone quickly grabs someone about to fall. I reckon my Mother has a new bruise where I had to steady her recently 😕
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Reply to Beatty
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My mom has skin tears and lots of bruises. She has Dementia, Depression and Anxiety. My mom is taking a blood thinner Eliquis. She has black hematomas on both arms and legs. My mom accuses her Aides of beating her, but it's not true. She refuses to wear arm and leg sleeves. My mom likes to pick her skin. Also, she rubs her skin constantly with her fingers. She developed Celulitis from touching her skin.
I am visiting my mom every single day. I know my mom is not being abused.
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Reply to Onlychild2024
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DEMENTED Aug 20, 2024
You might be supprised at what happens on short staffed overnight shift. Get a camera ASAP if you have loved one in a NH.
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A Nurse is a MANDATED reporter of abuse or even suspected abuse.
She reports what she has seen .
She should document her observations.
Side comment.. If the DON is telling her and other staff not to document bruises then that also should be reported that is falsifying medical records. great liability issue as well as a safety issue what else is not being documented.
If this is a problem at this facility then a call to APS, the Ombudsman's office and or a call to the State's Elder Abuse hotline number.
If there is a possibility that the resident is hurting themselves, self harm, that is also reportable.
If the possibility is self harm she should suggest to the DON that a camera be installed in the resident room so that they can document that it is self harm so family can not accuse the facility of abuse.
Then steps need to be taken so that the resident can not harm themselves.
If mittens are permitted (don't know if they would be considered a restraint) or making sure that the resident has clothing on that would not easily allow for self harm. (long sleeves, tucked in shirts)
And discussing with the doctor medications to reduce anxiety and possibly OCD tendencies.
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Reply to Grandma1954
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The DON is right about the documenting. Like Alva says in the comments, if your friend is an RN she would know how to properly and professionally document what she saw and the correct procedures and protocols on how to report it.

If she's worried for her job, that's a whole other story. She should be worried for it if she doesn't even know how to do proper documentation. She learned that in nursing school and it sounds like her work is very sloppy.

She should talk to the state's Ombudsman because that is the office that regulates nursing homes and other care facilities and who abuse is reported to.

Your friend being an RN already knows this.
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Reply to BurntCaregiver
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If she did not report as a mandated reporter she could have been arrested as an accomplice. Not many places make mandated reporting as a required education. Some places have incident reporting to bring the inqiury up a chain of command. But ALs sadly do not. Because she documented, it also legally protects her.
I did it 3 x in my career and 2 x got called by lawyers because family sued. One patient got several millions. Well good for him. I was not the only provider that documented that day.

As for worries about being fired. It becomes a long process, but many fired employees lawyered up and sued their employers. If she can, encourage her to save all documents. She can even copy her own document as evidence since it can match the record as long as she removes or redacts all HIPPA information
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Reply to MACinCT
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Jdjn99 Aug 22, 2024
You don’t get arrested as a mandatory reporter if you fail to report. At most, you’ll have a license inquiry and possible censure but that would be rare.
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She may need to consult a medical legal expert (lawyer) to get better advice. The facility is worried about a lawsuit coming from her documentation. Your friend also has an obligation to document clearly what she sees. I hope her facility allows photographs of wounds - which will help with documentation. If your friend suspects abuse, she needs to report it to the state - ask her to check her state's department of nursing for advice.
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Reply to Taarna
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The facility will have a set path and specific forms that is required for reporting concerns like this. If your friend did not do this then yeah the DON will have well placed concerns for this person employment at a facility which had both Federal and State licensing requirements.

A RN is a mandate reporter but it has to follow the protocol for the facility which is tied into how the State examines these very serious issues. Alva really is spot on in that your friend is doing SUBJECTIVE reporting and not OBJECTIVE reporting.

Should she be worried about her job??? well that imho depends on just how much she has talked this around, what her overall evaluation is, and how tight of a ship the administration runs. If she’s newish at the AL without deep loyalties with other staffers, and it’s a tight hierarchy, imo, she's toast.
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Reply to igloo572
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If your Nurse friend is a nurse, she knows exactly what she is supposed to do, she was taught in nursing school. Her place of employment has a policy regarding patient abuse and she, your Nurse friend had to sign it. From a nurse of 40+ years and a legal nurse consultant, this sounds like a "CYA" question. If you're not a nurse or an attorney, why would your nurse friend ask you? Maybe you need to speak to someone soon.
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