New to nursing but arleady tired of freaking politics.

Ok so when did the papework became more important than the patient himself? Was I asleep or something? Is it always have been like this that the managers put so much emphasis on papework?

Ps.I had a very complex case yesterday and all my boss cares about is freaking papework.
Because, unfortunately, we live in a litigious society and a law suit is always ALL about the paperwork. The more complex the case, the more imporant the paperwork. It's sad but true.

i think it's happened in the last decade or so. where i work now, we have to chart blood sugars (hourly because we're on insulin drips) in four different places. once on the vital sign flowsheet to explain why our insulin drip is the rate it is, once on the poc testing lab sheet so that it can be compared to the glucometers when they're downloaded. once in a separate computer program where we're documenting drugs -- so the insulin drip rate is charted twice in two different computer programs. and once on another sheet for someone who is doing a study. i've asked why the study folks couldn't just pull it out of the chart, but no. we have to make it easier for them, nevermind how it adds to the workload of the bedside nurse. i think press-gainey had something to do with it -- all those satisfaction surveys have us documenting every time we offer the patient a drink or a bedpan. and the safety initiatives, which seem to have evolved in the past decade. there's more paperwork to fill out for each of the safety initiatives. sometimes i'm so freakin' busy filling out paperwork, there's no time to actually do the safety checks. it's a strange world.

Does anyone else ever think there is a imp somewhere dreaming up new paperwork. My work is moving to EPR except for the new pathways and any other paper type documents its hard to change(but no doubt they will. out new IV pathways (central and saline lock) are confusing we have to a least document per shift but we has clear shift boxes on pathway and it as easy to look and see how old and who inserted it. to do this now you have to bring up two different boxes and hope the insertion was documented(doc never do it). our care plans are paper but we do electronic notes, it a bit of a mess till it all goes.oh vital signs are on paper.

I always blame joint commission. It works for me. Lawyers are second.

It has definitely got to the ridiculous stage. Blame the lawyers - I am so sick of having to double chart things, sometimes triple charting. I refuse to do it now. I chart once then write 'see such and such a chart' or the chart number for them to refer to. I know a nurse who had to drive quite a long way home one night. When she got home, she was called back (this was b4 mobile/cell phones) to sign a chart or patient note or something and they said she had to do it that night, cos she was off for a few days and if she came back to do it after that, it wasn't legal. She was fuming and very, very tired the next day. And I always seem to be working back to finish charting. I mean how many forms do we have to complete to say the patient poos (there are usually 2 charts for this), observation charts and neuro charts where you have to transcribe the normal ob's onto the neuro chart, lists to complete to ensure O2 works, the bed works, the bed brakes are on, the patient has a jug, is psychologically happy - I could go on.I think it's also Drs who demand all this but nobody has done a time-in-motion study, to see how much time it takes to do it all. And it does take a lot of time away from the patient, which I find annoying and frustrating.There needs to be a separate body to look at al this charting - most of it probably unccessary. Maybe us nurses can start demanding that this happen.Only thing I can suggest is complain to management which I have done re this, but they go strangely deaf after you start and say they 'will look into it' - then nothing ever happens. We just seem to get more charts after that.

The fact of computor charting not being nurse friendly has been discussed here before.....it is end user friendly, not input user friendly.....and poorly designed....there should be no reason to input info more than once, the program should be designed to put that info where ever it needs to go. Paper charting, perhaps they need office persons to transcribe the info into different places? But, to the OP, the old nursing adage, "not documented, not done" may be the answer in this particular case.

Charting is how they justify your paycheck. It you don't chart it well or correctly, you can't get reimbursed for it. I would think this is particularly important in home health.

In my opinion,taking care of the patient comes first and paperwork second. Both are very important because both can lead to law suits.Unfortunately, paperwork is the best proof, sometimes it can be good proof or bad proof. I am sure some paperwork can be done when you have freetime(during your shift).

it is interesting to note that the institute of medicine has determined that a primary reason for the estimated annual 45,000 medical errors is complexity in the health care system. yet, nursing as a profession and nursing management seemingly do everything possible to overcomplicate the issue further. much of this is "interpretation" of regulatory requirements.there are in fact, a finite number of minutes in an hour, hours in a day, etc. we have reached a point whereby the documentation itself is often times conflicting with the needs of the patients themselves.how to deal with this while keeping you and your patients out of trouble?of primary importance on any given shift and any given ward, is that the appropriate and timely interventions for the current condition are in place whenever you hand off a patient. to do this, you simplify your approach by going back to basics and letting the record (chart) tell the story. simplification means that the following things (in order of priority) are always on your mind, abc's, vital signs, medications, treatment, and analysis.for example, i am about to take patient a to ct scan, when patient b suddenly breaks into a symptomatic svt. i suspend what i am doing to intervene on patient b to the maximum level of my clinical privileges, (i.e. call the md for orders and then implement same).well now, here is where most people go unnecessarily crazy charting, while after the implementation of the interventions, i go about my business calmly taking the other guy to ct.why?continuous monitoring (ecg strip) shows the svt beginning @ 08:30, documentation #1). i called dr. zhivago at 08:32 and entered the "telephone order" into the record (documentation #2). at 08:33 the pyxis record shows me removing the cardiazem gtt, (documentation #3). i hang the gtt and document on the mar @ 08:35 (documentation #4). one hour later the flow sheet shows the results (documentation #5).the record tells its own verifiable story, and i am free to go about my business with no need to sit down and write a redundant novel, (the bane of most nurses). later, if you have spare time, you can go back and "fluff" things a bit to make someone else happy if so inclined.

Quote from BluegrassRNCharting is how they justify your paycheck. It you don't chart it well or correctly, you can't get reimbursed for it. I would think this is particularly important in home health.

Well, face it -- we work for the lawyers now -- and the litigious minded public, and for everyone who feels the world "owes" them or that they are entitled to 100% perfection in all environments. It is truly a strange world ...I'm dead against this new health care thing coming, but if it gets rid of the entitlement attitude and the lawsuits, there will be some merit to it.

There's nothing wrong with keeping careful and detailed documentation; after all, it's what saves your butt if the paw-paw hits the fan. Now, if those who design the charts would stick to the KISS principle (keep it simple, stupid), we'd all get our work done quicker, our patients would have better care, and we'd probably all sleep better at night...Computer charting sounds great, but if the program doesn't cut it, it will end up as just being more time-wasting for the poor ruddy nurse. Why administrators throw money away on expensive systems that don't contribute to efficiency boggles my mind. If you're going to go electronic, get a decent developer and do it right the first time, otherwise go back to written charts and employ a few out-of-work data capturers, who will be very grateful for the work. Probably won't cost much more than some of those programs, either.