Thinking of leaving bedside nursing due increasing documentation, short staffing, etc

[JordanRose]

I have been a nurse for 17 years. I have worked both med/surg and ICU in a CAH (critical access hospital) my whole career. For the most part, I have really enjoyed my job. The past few months though, I find myself becoming more dissatisfied with my job. I still enjoy taking care of patients. It is the relentless, mind boggling, idiotic, double and triple charting that I am starting to despise. The charting is starting to really cut into my direct patient care time. I am a very organized, usually have all my ducks in a row. I can get my first assessment done, my meds passed, update the rounding doctor on the pt's condition, review the orders, and sit down to chart in a reasonable amount of time. (Our charting is computerized). I just can't seem to keep up anymore.

For example, now it isn't good enough that we chart "NKA" on a chart. We have to chart "NKDA", No Known Food Allergies, No known environmental allergies. We have to chart pain assessment every 2 hours, around the clock. If a catheter is in longer than 2 days, we have to document why the catheter is still in place. All kinds of new documentation requirements for vents and central lines. Flu/pneumovax vaccine sheet needs completed. Valuables sheet completed. Med Reconciliation form filled out on the computer. Pt receiving blood or blood products? That form needs completed. New admission? Then you get to start a whole new slew of paperwork/computer work. Oh, let's not forget the DVT prophylaxis order form. The list goes on, and on, and on, and on. It keeps getting longer too.

When will TPTB (on all levels...hospital administration, Joint Commission, state board of healths, insurance company, etc) realize that nurses are getting frustrated with all the forms and assessments we have to fill out with each pt? Even a 40 year old pt in with an uncomplicated case of pneumonia, the documentation is unreal anymore.

I don't see this easing up at all for bedside nurses. I am in my mid 40s with an ASN degree. I am seriously consider starting back to college to obtain my BSN, and possibly my MSN so I will have more job opportunities available to me other than bedside nursing. I am even considering leaving nursing all together. Not sure what area in would venture into though. Definitely have to think that one through.

I know good nurses are being driven away from the bedside because of various reasons. My sore point with nursing @ the moment is the excessive charting and documentation that is required of us.

Anyone feeling the same way as me?

[JordanRose]

I thought I would just update this thread. Four weeks after my original post, I was terminated from my job that I had mentioned in the original post. When that happened, I thought my world was over! Bedside nursing was the only thing I knew in my career as a nurse. After 2 months of doing some agency work (in nursing homes...God bless those of you who work in LTC!), I landed in an office job. I loved it immediately! I leave at the end of the day not concerned about whether I may have missed something that would lead to a pt's decline. No more working holidays or weekends. Still have crazy patients and families, but contact time with them is very limited! I come home at night not feeling like i have been through a war zone. I actually have the energy to stop by the grocery store or a department store and shop! My husband says I am a whole different person when I come home from work now. Even though I took a huge paycut, my benefits are much better and so is my health insurance!

As our office is owned by a large hospital that uses EMR, we started using the EPIC system last year. It makes CPSI look like it was designed by kindergartners. Of course the charting in an office is nothing like the charting for acute or LTC, so I can't make a fair comparsion there. I do know that EPIC is not crashing constantly, not freezing up, etc. Makes my day much smoother.

When I lost my job 15 months ago, I thought that was the end. It actually was the beginning to a much better and brighter future!

[Debilpn23]

I thought I would just update this thread. Four weeks after my original post, I was terminated from my job that I had mentioned in the original post. When that happened, I thought my world was over! Bedside nursing was the only thing I knew in my career as a nurse. After 2 months of doing some agency work (in nursing homes...God bless those of you who work in LTC!), I landed in an office job. I loved it immediately! I leave at the end of the day not concerned about whether I may have missed something that would lead to a pt's decline. No more working holidays or weekends. Still have crazy patients and families, but contact time with them is very limited! I come home at night not feeling like i have been through a war zone. I actually have the energy to stop by the grocery store or a department store and shop! My husband says I am a whole different person when I come home from work now. Even though I took a huge paycut, my benefits are much better and so is my health insurance!

As our office is owned by a large hospital that uses EMR, we started using the EPIC system last year. It makes CPSI look like it was designed by kindergartners. Of course the charting in an office is nothing like the charting for acute or LTC, so I can't make a fair comparsion there. I do know that EPIC is not crashing constantly, not freezing up, etc. Makes my day much smoother.

When I lost my job 15 months ago, I thought that was the end. It actually was the beginning to a much better and brighter future!

JordanRose

I am so happy for you that you found a new job, and one you love

[jadelpn, LPN, EMT-B]

Not sure what kind of unit you work in, but I work in an ICU. Our policy requires that pt's be charted on q 2 hours; full assessments q4 hours. Our computerized flow sheet is long (CPSI...not sure if anyone here is familiar with that computer charting. If I have 2 patients, it can take an hour to chart both of them correctly for the full assessments. This doesn't include tracking down labs and other tests, accompanying patients to radiology and back. We have no CNAs in our unit; we do full care. That means we feed them if they are not able to feed themselves, no unit clerk, just be and one another RN. Can get quite hectic at times. Not to mention if we get one unstable patient, or one crazy family and that can add to the load and the charting.

I feel like I am taking care of the chart more than I am taking care of the patient.

Management's take seems to be "re-education" and "learning how to set limits". Let us not forget "meaningful use"......