Pt care- can't get my charting done!!!

[martymoose]

Is it me , or my floor?? It seems that lately we have more pts than ever that are very heavy cares . They have to go to the BSC/bedpan 2-3 x an hour sometimes, and if they happen to be able to get up- they require 2-3 assist( even if using an apex lift). Each "toileting " is a 15 20 minute fiasco. now times this by 15 other pts on the floor(out of 26) . We have 2 techs, but they also draw labs and do ekgs, etc. They cant do it all.I swear all we do the whole shift is put people on the toilet!!! I am not averse to pt care- it's just that I am not able to do my required charting work and doc communications when half the floor staff is in pt rooms all the time.

I hear of others saying they have to stay to finish charting, but we have have been told we are not allowed to do that anymore- do it on your own time.

Management just doesnt get it. :banghead:

[martymoose, BSN, RN]

Lately most of our pt are behavior issues. And some are legitimate- ie- got 80 of iv lasix, yet foleys are discouraged due to infection reasons. So, yes- they are going to BSC 2-3 x hr for at least a few hours. Or yes, they have been given bowel prep, or bowel regimen, etc. Some are bowel obsessed. Some refuse to use bedpan.

Oh, and add the dementia confused with this. We usually end up with a nurse sitting 1:1 with the pt because they refuse to stay in bed.

I should just stop right here. I have answered my own question. It is my floor.and the people I work with, and the non- supportive management.

Thank You.

[calivianya, BSN, RN]

Sounds like your floor is like the one where I work as a CNA. I firmly believe that there are some floors where no help could ever possibly be enough. I work on inpatient rehab, and the other day we had multiple full supervisions and total feeds, eight people total. Well. There's were 20 something patients, four nurses, and two techs. Even if you used EVERY SINGLE STAFF MEMBER to watch meals (and bad strokes with full paralysis on their dominant side can take almost forty-five minutes to eat sometimes) there would still not be enough staff members to take care of just meals, let alone medications, assessments, helping people to the bathroom... and management wonders why we always leave late. That's just one thing out of many. When you also take into account that we have a bunch of spinal cords at risk for autonomic dysreflexia if they don't get I&O cathed every few hours, and then there are the violent TBIs who hit/kick/bite and it takes four people to hold them down to safely administer medications... it's just impossible. The nurses don't always have 45 minutes to stop and watch patients eat, either, so there are times the patient gets their meals three or four hours late. It just is what it is. If meals arrive at 0700, it takes me 45 minutes to feed the first person, and then the people who can feed themselves all have to go to the bathroom at the same time, well... it can take me more than an hour to get to the next feed. I've had up to five feeds/supervision by myself before; some of those patients are lucky to finish breakfast before lunch arrives, that's for sure. And then it's charting every turn, every linen change, and exactly how much each person ate after that.

Sometimes the nurses stay three or four hours after their shifts to get charting done, and I know why! I will never work on rehab ever again; it is the worst part of the hospital. I float a lot and floating anywhere else is a better shift than working on rehab.

[salvadordolly]

Definitely sounds like you need more techs. I worked in a facility like this as well. All the nurses charted at the end of the shift. Of course, we were told to punch out and do it. I always stayed on the clock. My friend who was an attorney told me to always stay punched in while I was working and they couldn't touch me. They scowled at me a lot, but never did anything about it. I started going in the lounge about halfway through the shift so I could at least start charting. I couldn't chart in the rooms or by them or the patients would just keep talking to me and requesting things.

[martymoose, BSN, RN]

Ack ! to calivianya! Sounds familiar, but yours definitely sounds worse!!!! I wish management would have time studies to prove these situations.That we are not all sitting around twiddling our thumbs!

And ack! also to the staying punched in. If they really wanted to get picky, they can fire you for misappropriation of property- ie- your OT pay that is not approved.And then go hire a new person for cheaper.

[martymoose, BSN, RN]

Oh, and I forgot to say, we had a tech taken away. We used to have three on eves . now its staffed for only two. Sometimes it's even only one.Customer service anyone?

[nurseladybug12]

I work with EPIC too and I really like it, it is so much easier than Meditech which you have to tab through and it is not user friendly at all. I think Epic is quick and it takes me 5 minutes per pt to chart. At the end of the day I will go back and make notes for prns and pain medications given. Maybe you could do your assessment then chart it in the room with the patient, and that gives them time to talk with you and ask questions and it doesnt seem like you are rushing out of the room and not giving them enough attention. I started out on med/surg floor at one hospital and most of the pts were geriatric and palliative care/hospice total care pts and it seemed like I was working in a nursing home. Many of them were not even acutely ill anymore, the case manager would be working on where to send them for days and it seemed like I was just a babysitter, medicating them with their usual daily meds, enemas and laxatives, fun. I am at a much larger teaching hospital now and I have younger adult pts that are more acutely ill with rarer illnesses, yet are independent/minimal assists and I dont feel like a pill pusher anymore, where as before I would be pumping out 20 pills per patient every AM med pass, now I give 5-10 pills maybe per patient during AM med pass. So I think it depends on the hospital and the pt population it attracts as to what your workload will be.

[prmenrs, RN]

You are singing my song! Maybe I was just a disorganized mess, but I never could get it all done. I still have nightmares of blank flowsheets @ 6:30. No words of wisdom, just commiserating.

[Guest219794]

I have been a nurse for a long time.

Charting started on paper and evolved to electronic. I was actually part of that transition at more than one place of employment.

My observation is, in general, that most nurses who routinely have difficulty completing their documentation are having trouble with time management. That is especially true if most of the other staff are NOT having a problem...presumably the manager would know.

The alternative would be that the nurse is struggling with the skill sets either related to the EMR or to the patient care delivery itself.

It is very reasonable for a manager, if he/she believes there is room for improvement, to refuse to pay for the additional time.

We are, after all, professionals.

Whether or not there "is room for improvement" has no bearing on a managers obligation to pay. While we are, after all, professionals, we are paid by the hour. Working for free is wrong on so many levels it's hard to know where to start.

As far as time management goes: Many, if not most, nurses could improve. Regardless, there is a basic problem. It is simple math. The bulk of a nurse's day is divided between pt care and documenting. Documenting now takes longer than it used to. Patient care loads have not been reduced to account for the extra time needed. Something has to give.

Nursing seem to be the only field that does not recognize what happens to a work day when tasks are added, but none removed. I used to manage a window installation crew. Each worker could, on average, install 8 windows in an 8 hour day. That was re-using the old molding. If I told my crew I expected them to start cutting and installing new molding- and that I expected them to still do 8 a day, they would look at me like I was an idiot. (They would be right.) If I really pushed the issue, and told them their livelihood depended on it, they would install 8 windows a day. The windows wouldn't be square, or caulked properly, but they would have the new molding I insisted on.

Nursing is the same. There are 60 minutes in an hour. If more of those minutes are needed for documenting, fewer are available for patient care.

[wooh, BSN, RN]

Nursing seem to be the only field that does not recognize what happens to a work day when tasks are added, but none removed.

I swear, if I hear one more management person say, "It's only a few minutes!" about yet another task they add to our workday without taking anything away. Never mind that they add another "only a few minutes" task on a weekly basis without ever taking away anything that's only a few minutes.