Paperwork Hell

  1. have you ever felt like you were suffocating under a mountain of paperwork?

    at my hospital, pitt county memorial hospital, in greenville, north carolina, somebody just has too much time on their hands. the paperwork has become unbelievably atrocious. it is like a very bad joke that just isn't funny anymore. everytime i come to work, there is yet another new form hanging by the time clock. the latest round of paperwork diarrhea started when our hospital was recently audited for medicare/medicaid chart compliance and failed miserably. now our hospital is in danger of loosing all medicare/medicaid funding. so, tptb are frantic. result: we now have this "hot pink" monster of a form that has to be filled out on all new patients, either by the unit clerks or rn's. it has now become our job to police the doctors, to see that all orders are being signed off in a timely/legal fashion, history and physicals are on the charts within 24 hours of an admit, pre-procedure and post-procedure notes are on the chart, etc. etc. etc.--we have to call the docs to come in to fix what they didn't do, if the chart is found lacking we have the usual bothersome critical pathways, now with each carepath, also have an infection pathway and a skin care pathway, to fill out on each patient daily under the threat of a bad eval if not done. we have computer charting also, and our patient admission record has become a nightmare!!!! link after link, with sublinks literally being added daily to fill out on new admits. it has gotten so complicated and burdensome, that there is very little time left for patient care. we are supposed to be clocked out by 7:15 each shift, no exceptions. on a very busy day, there is absolutely no time to fill out all this paperwork. jchao is coming to audit the hospital in a year, and i foresee a very unhappy year as the frantic "suits" are trying to get everything in compliance. i don't know how much more of this i can stand.
    sorry for the down post; just need to vent
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  2. 19 Comments

  3. by   Joules
    Just curious, is paperwork this bad all over? How is the paperwork at your facility?
  4. by   Joules
    Actually, working conditions on my unit @ PCMH would not be that bad if it weren't for all the paperwork.
  5. by   adrienurse
    At my previous job, you had to fill out a form EVERY time you suspected a patient had symptoms of infection, so you could justify why tests were being done. I mean come on. It was a form that was filled out in triplicate and you had to file each copy in a separate place. As if we don't have better things to do -- like taking care of the people with the infection.
  6. by   labornurse
    When our hospital switched from paper charting to computers, administration touted this as a way to free us from paper. Everything would go into the computer and we would have a paperless system within 3 years. The charting would be stream lined and we would have more time for pt care. The amount of paperwork now and required redundant charting in this so called paperless system is staggering! This system alone must account for the disappearance of at least one rain forest per day
  7. by   h2ogoddess
    I hope you have a Unit Clerk for each Nursing Unit, we only have one fulltime and a parttimer and we just can not help much with all the extra forms and paperwork,although we try to do what we can,(which isn't alot, with only 1and 1/2 we cann't do our own).
  8. by   ratchit
    My current hospital has a nurse that does that for us. I suppose she has other things to do, too, but she comes around and leaves a form in the front of the chart that says- need something in progress note with a diagnosis for X procedure, need justification for XYZ....

    I don't know if it's true, but supposedly this nurse is paid out a fund created by the doctors. Yes, they PAY her to police their charting so they get paid.

    My hospital is in the black, I don't have to chase the docs ( for more than your usual patient care stuff ) and supposedly the docs pay her to make sure we stay financially healthy. She says they don't like her much, but they pay her... :chuckle
  9. by   elusive
    At the hospital in my city we also have a nurse per floor that does that. I think that she is there to make sure we properly cover our asses in our charting..espceially since it is all done electronically, and a lot of important information can be left out...She gets mad at the students.. (us)..if we dont do our charting right, which i think is insane, considering no one ever taught us how to properly use the system..i perfer long hand charting myself, even if it does take longer..
  10. by   Jolly
    Originally posted by Joules
    Just curious, is paperwork this bad all over? How is the paperwork at your facility?
    I feel nursing consists of doing your job twice - first, you do it, and then second, you write practically every detail about it; I understand the necessity of it to promote continuity of care, but beyond that (insurance reasons, JCAHO, blah,blah, blah) is a major time waster. What other career insists that this be done? Without it, imagine how much more time there would be for patient care. . .
    Last edit by Jolly on Jul 7, '02
  11. by   lindalee
    <<<I understand the neccesity of it to promote continuity of care, but beyond that (insurance reasons, JCHAO, blah,blah, blah) is a major time waster>>>But how else can the ivory tower folks justify their jobs. It seems they put on a new form or alter an existing one practically daily. I think that is a requirement of their employment.
  12. by   fedupnurse
    Let's see. There is the flow sheet, the teaching sheet, the problem list, clothing sheet, advance directive, latex allergy, admission form, med variance sheet, med sheet, patient care activites sheet....
    The problem is there are so many bogus regulatory agencies. Sorry but I think Jacho is a joke and a conflict of interest. If they would help improve working conditions then I'd have some respect for them but they will never do that because they are funded by the American Hospital Association. The vast majority of their rules are lame. Why can we not have one form for restraints instead of having to document it in 3 different places because the State and JCAHO each want it on THEIR form? I still think we should be able to wear a little headset and dictate all this crap and let a transcriptionist type it all up. Imagine the time we would save!!!!
  13. by   hoolahan
    Hon, if yout hink that is bad, you should see the paperwork in home health. We have a 218 question admit form, then write up orders, and an admit nurses note, a care plan, a home health aide care plan and HHA order/referral form, referrals to disciplines such as PT OT MSW, consent forms, consent to bill secondary insurance versus medicare (ABN) and various other forms, if pt has a wound, a wound care form and supply order form, if HMO, an special update form, one from our agency minimum, plus maybe a special form from the HMO, esp if it's a special program like asthma ed.

    I'm telling you, it's killing me! I have seen many nurses leave home care this year b/c the paperwork is ridiculous!!!

    These forms, if not filled out correctly, come back to you. Then when the orders have been inputted into the computer, typed orders come back, you have to make sure it matches what was written, as there are errors by the typists, each day a note, order forms. Supervisors leave us messages, the supply corrdinator tells us what we filled out wrong, like we know how many 4x4's a particular HMO will allow us to order per week, OASIS manager leaves messages, QA nurses leave you messages, I have 4 people calling me about the same pt's paperwork, and you can mulitply that by 25 or so pt's, it just never ends!!!

    Can you tell you have touched a raw nerve with me??? I am ready to scream!!!!!!!!!!!!!!!!!!!!!!!!!! Definitely looking for another job in nursing, or something else. I am planning to attend manicure cert school in the fall, already signed up. I will be doing manicures and pedicures, will travel to homes, on my own schedule and be my own micromanager. I will not be acting as a nurse, so no freaking insurances, no JACHO, no HCFA/CMS/whatever-they-call-themselves-this-week, just me and my own schedule. I am thinking I may not even renew my nursing license. I am praying for that day, but in this world, I don't want to give up that security, maybe I'll renew in inactive status!
  14. by   Nurse Ratched
    Wow - and I thought ours was bad. I have to say that since we got the computer charting my admissions DO go faster - all the data from previous admits comes forward and you don't have to spend time with pts dickering with their families about what year their tonsillectomy was, etc. .

    Because of the type of unit we are, we process our own admissions (rather than through the admitting dept) so there is all the usual crap that would typically be done downstairs added onto our stuff. PLUS, if they come in after normal business hours or on the weekend, we have to *precert* the patients through their insurance companies (assuming they have insurance.) HELLO????? Dammit, Jim, I'm a nurse, not a UR person.

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