Our unit is doing charting audits for JCAHO standards. One of the things we are expected to do (and have fallen short in doing) is chart education on a pt each shift. The sheets for doing this are kept in the chart, so needless to say, not alot of ed charting is done. I originally made the suggestion to allow the nurses carry the sheet so it's not an out of sight, out of mind kind of situation. This was not acceptable because the manager is afraid we will lose them. Also, she states that all disciplines are supposed to be charting on them as well, so if the nurses keep them, noone else will have access. Keep in mind the other floors let the nurses keep the ed record with the flowsheet, I&O record, etc.

Ok, so I performed my own little audit and found that of the 12 pts we currently have, only 2 of them have been charted on by non nursing staff. Also, I believe each and every one of you day shift nurses can agree that you hardly ever get your hands on the pt's charts.

So my first thought is shot down; back to the drawing board. So I come up with plan B: make a second page of the education sheet and put it in the binder which holds the pt's MAR. This way, a copy stays in the chart for the non nursing staff (to not chart on) and a copy is easily accessible to my fellow nurses.

When I woke up this evening I had a message from my manager. She was upset with me for "removing the education sheets from the chart and putting them in the MAR". The end of her message was "I'm very upset about this. Goodbye."

I promptly called her office and left a message letting her know she was "misinformed" that I did not remove anything from the chart, I just made a second copy and put it with the MARS--won't get lost, and nurses will have easy access.

I have managed to stay under the radar up until this point, but I am very, very upset that it took a blatant lie to put me on the screen. Now, let's say that noone is able to find any fault with my "plan B", who wants to bet I will never hear any apology from anyone. Also, I go soooo above and beyond for these day nurses by staying late to start IVs on ECT days and priming IV bags, filling out parts of the discharge summaries (meds pt is being discharged on and a few non assessment items) and doing anything else I can. The day nurses are basically performing 2 jobs at once (caring for a full load of inpatients and being a PACU recovery nurse), so they are being abused to say the least. All I am trying to do is help. In fact, I am most helping the specific one who lied to rat me out. I'll bet ya next Wednesday morning, those bags won't be primed if she is the actual ECT nurse. I'll probably still do the IVs because that affects the poor inpatient/recovery nurses.

I am going to stew on this all weekend, and I'm already coming down with something, so the added stress is not welcome. I'm already thinking that if I get written up for disobeying a direct order, I will probably refuse to sign. I've said this soooooo many times, but why do nurses do this to fellow nurses?

You didn't remove the sheet, you just added another for your convienence. I don't see anything wrong with that, and probably she didn't look, just took the other nurse at her word. Some people just like to stir the pot.

Sounds like a good idea.

We keep our education sheets in the MARs as well (we keep our nurses notes there as well, each patient has a chart). It is no big deal for the resp. therapits, physical therapists, etc. to go to the nureses chart and chart their teaching.

They are all trained to use this sheet, it is part of their job expectations. Everyone used to chart their teaching separately, but now everyone charts on the one sheet in the nurses bedside chart. Nurses do the majority of the teaching day-by-day and it needs to be more accessible to nurses, duh.

But it probably wasn't a good idea to make up your own rules and use your brain like that. Managers don't like that you know. :)

Every nurse is responsible for doing their own charting,education and otherwise. Don't EVEN worrry about other disciplines. This is their problem. I've said it before and I'll say it again...the hospitals only give a rats behind about JCHAO when they are just around the "corner" of their survey. Let the big guns sweat this one out. OR(a really out there idea....), the nurses could protest to being "abused". There are no victims only volunteers.

GOOD LUCK!:)

Everything I do is to try to help my fellow nurses. I could care less about what dietary, RT, etc. chart or don't chart. Unfortunately my manager does, so I came up with a reasonable solution. All my actions did was benefit my fellow nurses and myself. And for my efforts I get lied about by a fellow nurse, and rebuked by another. Lord knows this happens probably in every hospital. Ahh well, I start traveling in January. After this little incident passes, I'll just get back under the radar.

You tried your best !

it is not the plan you came up with, it is how you went about doing it. if you have ran this idea in a way that was thought to be the others person's doing, it probably would have been just fine.

sometimes even if the idea is mainly yours, let it be the other person's who gets it off the ground or at least let it be a mutal doing. i learned this the hard way years ago with my first nursing job ever!

(((((hugs))))).

You shouldn't ever change any procedure or process without getting the ok from your manager first! Making a second copy of a form and placing it in another location for documentation is changing a procedure.

I am a manager and as a manager I am responsible for every thing that goes on on my unit. If one of my nurses did what you did without my knowledge I would be pretty angry too!!!!

Your idea was a great one. The problem was it was your idea, not the HN/CNM idea. Did I read that you are going to travel in January? Don't be surprised if you get hit again. Sounds like a case of Jealousy. Try not to let this bother you too much. Just don't make yourself a target in the next few weeks. I know and so do others who have been there, leaving always causes the claws of some to come out, got to get a lick in while they can. Be at rest in your own mind that you do for the patient and that is what is important. These people will not be around much longer. Enjoy the holidays and get ready for the new travel position.

I don't think you guys are being fair to the manager. It probably wasn't the fact that the manager didn't think of it that was the problem. I am a manager, and I love it when my staff come up with solutions on their own! It's just that as has already been said, I'm accountable 24/7 for what goes on. Whenever you want to change something about the medical record, keep in mind that the medical records department may have to get involved and approve the change (at least that's true in my hospital). Also, sometimes upper management gets a little crazy if you make a change without running it by them first (not all changes, but major ones like changing the chart format). It may seem like no big deal to you, but unfortunately we have to operate within the confines of organizational policies, procedures, etc. Anyway, the idea was great- we actually implemented this change at our hospital- one sheet in the main chart for other depts and one in the nurse's chart for nursing. But it was done by following the correct protocol for making changes to the medical record's format, not by one person. The fact is, JCAHO does require interdisciplinary patient care (including teaching), and really that makes sense- all disciplines contribute to the patient's care, it's not all about nursing. If everyone charts their teaching on the same sheet, all members of the care team know what's been taught and can reinforce/add to it.

Having said all of that, I don't think the manager should have called you at home- it could have waited until she saw you at work. I seldom call staff at home about work things unless I really need the information immediately.

PsychRN: I hear ya. the manager had NO business calling and leaving a message. It's a CONTROL thing.

I hear your radar point. That is the issue. I always stay under the radar. It is why I choose agency/travelers/ temps.

ANYTHING to avoid all these "committees."

Your mistake: Taking the chore to heart and attempting to do a good job. They - management- don't want a "good job."

They want all the blanks filled in.

Under education:

We do it on the computer...we choose one of five topics.

the computer fills in the details. It takes 15 seconds to document one "problem." Everyone is happy. JCAHO, management, nurses.

Don't take this teaching business so seriously.

It is the same as the old care plan tasks.

Remember how easy it is when you have prewritten problems and solutions?

Same deal with education . Choose a topic:

medications,

nutrition

activity

Choose a discussion and document pt was educated on nutrition and how to meet daily nutritional need, pt understood, needs reinforcement/ doesn't need reinforcement, sign your name and title.

Your're finished.

It is all relative...it is all B.S.

You just took it to heart and got too involved.

Don't let it go and ruin your weekend. Go in Monday and tell the boss..."I'm sorry, I should have asked YOUR OPINION first. Yes, you are right. "

Don't you read Dilbert?? You need a dilbert book....Yesterday...to know how to handle management and "committees " such as yours....

Thanks for the responses. While I do understand that I should have taken this up directly with the clinical manager instead of the assistant clinical manager, my displeasure with the situation is not whether or not the manager is upset with my actions. It is that the assistant LIED to the manager and told her I removed the ed sheet from the chart which she specifically said not to. If I had removed the ed record from the chart, then I full well deserve to be in trouble. Yes I did something without permission, but I did not disobey a direct order.

I have been a manager as well, so I understand how to go about making change. Because of my experience, I'm inclined to agree with those who imply this is a pride issue. It really isn't that I did anything to the detriment of the patients, their families, hospital nor fellow staff. In fact, what I did was not a change from anything the hospital says. Remember, every other floor allows the nurses to have a copy of the ed record.

Truth be known, I think ed charting is a waste of time. It is just another thing JCAHO has come up with to justify their existence. Unfortunately we have to write something down, so I tried to make it a bit easier for all involved. Lesson learned.

Three things.

One, pt ed is super important. As a home health nurse, I can tell when a pt has had any teaching or not and I always marvel when they have been well prepared, and wonder how on earth the busy hospital nurses find time to do it w all the other things going on. Jacho sucks, worthless papertrail. BUT, it is important for you to take credit for what you do, it truly truly DOES matter and makes a HUGE difference to the pt's, so charting it is important for maintaining the value of nurses to. Look at it from that perspective and hopefully it will be more bear-able.

Two, I APPRECIATE YOU taking that time to write the pt's meds like you cannot imagine!! When I get to the pt's home, many times the Rx's are at the pharmacy being filled, and the referral says under meds "see d/c instructions" and if that isn't filled out, I am doomed, and we have to make another visit the next day just to be sure we can cover the med teaching. Best I can do the first visit is say please carefully read the material the pharmacy sends w your meds, write down your questions, call us or the pharm if you have any questions before we come back.

Just wanted you to know, your hard work is greatly appreciated

by me!!

Third, lying is never acceptable. What goes around does always eventually come around, I've been in this field long enough to see it a few times, she'll get hers....and she'll hang herself, I promise.