I had a time where my assistants were not following the care plans I wrote and were pretty much falsifying their notes since they were documenting how the patients were doing on things they had never done with them. I talked to them. I talked to my manager. I was told to write it down and make them sign it whenever they didn't do it. It continued. I was getting ready to quit when I was fired. The company I worked for had a reputation for firing experienced therapists to replace them with cheap new grads so I think that was part of it and part of it was they didn't want to hear about the ethical thing because it was more time productive to not do the plan of care (yet the plan of care was appropriate for the patients). Edit: What they were doing was legally and ethically wrong and since I supervised it was wrong for me as well. The buck stops here kind of wrong. I did get them to not document they did things they hadn't. Most of the time. So I couldn't have been disciplined as easily. But they still were very wrong and I let them be.

What I learned is that pretty much you have to do what you can live with. 2 years later I had a patient who had been treated by those same assistants while in the nursing home; I was seeing her for home health. She was doing well but one day said "I just don't understand why the OT in the nursing home never did this. I should have done this before I came home alone". And she was right. But because I didn't make enough fuss (and didn't report it to the state) the bad therapy went on. That makes me sad because good therapy from the outset makes a huge difference in recovery.

It's hard to take risks like that but it's also hard to live with knowing you let something happen that shouldn't have.

(Having said that, whatever you do document well so you can use it to fight should you need to)