The facility is under immense stress because it is due for its annual state survey. It's a surprise visit, but certain dates can be ruled out while others are likely for the visit.
Today was such a date because the particular survey team finished with another facility on Thursday. They would write their reports on Friday and then visit the next facility on Monday. They vary their targets; for example, they don't hit facilities in the same town consecutively and they don't visit facilities owned by the same company back-to-back.
To prepare for this expected visit, everybody was in the facility by 7:00 a.m., running around, "fixing" things to comply with state regulations that they have not even read.
The unit manager of the short term unit rammed me before 7:00. She went off on me for writing an order for heel lifters for a resident. The handwriting did not even resemble mine and I told her so. She said, "I know you didn't write it. But you must have. You worked the 24th and this was written on the 23rd." I pointed out that it was signed off on for the entire month, starting on the first. She replied, "I know that. Somebody just filled it in." I said that I didn't do that. She replied again, "I know that. We fixed it." So then I had to ask, "So what exactly is it that I did wrong?" She said, "You wrote '7-3.' She is not in bed on the 7-3 shift, so that is why it was left off, but you wrote it in. We fix things certain ways for certain reasons, and then you come along and mess it up." I asked, "What shift is it now?" She replied, "7-3." I asked, "And where is this resident right now?" She replied, "In bed." I replied, "So why is it so bad that 7-3 signs that she has heel lifters in bed, not that I wrote it." She said, "Well, it's not. It's just that you had no business adding 7-3." I reiterated that I added nothing to the order. I pointed out that "7-3" was not squeezed in, but rather given plenty of space in between "11-7" and "3-11." She gave up. But she'll be back.
She wants a perfect unit, but knows on some level that she can't have it. She needs people to blame, and I'm one of the chosen scapegoats. I don't know how to fix this. If I found something wrong and was convinced that I had the culprit, but the person denied it, I would not continue insisting that the person was the real culprit. I would continue with the explanation of what was wrong, but rephrase it such as, "If you see this . . ." or "If you are in the same situation in the future, please don't write the order like this. This way is better." But I don't seem to do much right, so this can't be the correct approach.
I would also like to point out that it is ridiculous that the unit manager feels that 7-3 should be exempt from signing off on the "when in bed" orders. The residents are in bed on 7-3; it is that shift that gets them out of bed. The 11-7 shift has to sign off on "when out of bed" orders, even though most residents are not out of bed overnight. If I check off that the order was not met and explain "not out of bed tonight," it's a big deal. Yet every now and then they like to come after me for signing off on a "when out of bed order." I'm damned if I do, damned if I don't.