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

  1. 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.
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    About martymoose

    Joined: Jan '03; Posts: 1,847; Likes: 4,209


  3. by   tewdles
    This is a difficult conundrum for nurses. The documentation is, of course, part of your care...if you don't document it wasn't done...but it cannot take priority over direct interaction with our patients.

    Look closely at your day and find those small things that you do which can be set aside so that you can instead spend a few moments with the documentation.

    Ask you manager or experienced co-workers for some time management tips.
    Perhaps you are charting too much and could be more concise and quick?

    Good luck!
  4. by   martymoose
    well, it's the epic charting , so it takes most of us about 20 mins or so per pt( thats even the experienced nurses) it's very tedious. Before we went to this, charting could be done in maybe 5-10 mins.
    But we also didn't used to have so many help- less patients either.
    I'm pretty sure nursing homes don't toilet their pts a few times an hour with 2-3 assist , do they? Fairly sure they aren't staffed like that..
  5. by   RNperdiem
    There are no easy answers and I think you know it.
    I try to find times when I would otherwise be waiting impatiently, and work in a bit of charting while on hold for the lab, or when hanging out waiting for the doctor to call you back or while waiting in the patient room for them to finish using the bathroom.
    As much as a still hate computer charting, my hospital does have computers in all the rooms and laptops on wheels that can be put where you need them, so I can do charting when I can find the time.
  6. by   curiousauntie
    "Do it on your own time" Hummm...very illegal for a company to tell a worker to work for free in the state I live in. And charting is "working for free". Just a thought.
  7. by   martymoose
    I know it is illegal- but it is also legal for them to fire me for overtime- which is what I think they are hinting towards. We just lost a 25 yr employee- I do believe there were other issues, but new manager had to set an example, i guess.
    Maybe it's just a no win situation, and that's that.
  8. by   lmccrn62
    Most states its illegal to not pay when you are working. A nice anonymous call to your states labor board will be nice and if they are caught they have to go back and do retro pay including OT Olof that is required.
  9. by   nursefrances
    Quote from jrwest
    I know it is illegal- but it is also legal for them to fire me for overtime- which is what I think they are hinting towards. We just lost a 25 yr employee- I do believe there were other issues, but new manager had to set an example, i guess.
    Maybe it's just a no win situation, and that's that.
    When I first started working at the hospital I was clocking out at the end of the day and going back to finish my charting. Then one of my coworkers mentioned that I was doing this "off the clock"...on my own time...MY time, I am not covered by my work if something happened while on my own time. That documentation is done off the clock, it shows what time you documented. What if something happened to a patient and that documentation was taken to court? Ugh....I thought of that and stopped charting off the clock.

    I would try to real time chart as much as possible. If I needed to call a doc or get an order I would try to put it in then. If possible I would put some of my assessments in while at the bedside with the patient. I had to stay organized. Some days it's just too crazy and you feel like you are chasing your tail. (I hated those days. )

    Now I am at an ambulatory surgery center and have one patient for 15-25 minutes. Charting is done before the patient walks out the door. Yep....made the change last August. Life is much less stressful now.
  10. by   tewdles
    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.
  11. by   martymoose
    I am not the only one staying after. At all. The other nurses who don't stay after, just don't do the full charting that is required. They don't update the care plans,, they don't doc any teaching. Some of those nurses have recently moved to nights so" they don't have to deal with this <insert word of choice>", and never get seen by management. One of the gals who has been there on nites 25 years says she doesn't care, why should I worry about it?

    Nevermind. I guess it IS the floor, and the clientele we have now ( we didn't used to).
  12. by   tewdles
    Well, it sounds then like something needs to be done about the documentation.
    Have you discussed the issues in a staff meeting?
    Can you look at the documentation on a common/large screen to discover if there are shortcuts? Perhaps invite IT or a superuser?
    Does the software company have support?
    This is an expensive issue for the agency/facility and they run the risk of violating labor laws if there are legitimate issues with the software.
    Good luck!
  13. by   chrisrn24

    - If this happens a lot with many different nurses maybe more techs/aides need to be hired so your valuable and more expensive time is not wasted toileting and providing ADL care to patients. I'm not sure why a facility wouldn't notice this.
    - Nobody needs to use the bedpan or BSC 3x/hour unless they have diarrhea. Is it a behavior issue? UTI? Help to figure it out so you can spend your time doing more productive duties for you.
  14. by   martymoose
    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.