The powers that be have always behaved as though staff nurses can assume infinately more duties without impacting patient care. Nothing new there. But this latest delegation irks me particularly.
As staff nurses we are responsible for patient care, of course, appropriate charting, noting orders, checking medical adminstration records nightly, doing 12 and 24 hour chart checks to insure orders have been noted etc. ---the usual stuff.
But now the expectation is that we complete chart audit tools which take 15-30 minutes for each patient. Previously the audits were performed at the manager/clinical coordinator level; later they were delegated to the charge nurses. Now with the blessing of administration they have been "dumped" on the staff.
Now I realize that an extra half hour a day for 2 critical care patients doesn't seem like much. However, these audits are just the latest in addtional duties/documentaion which are taking time away from patient care. And our productivity has consistantly exceeded 100% due to chronic understaffing.
When things are slow/census low I don't think anyone would have a problem doing some audits. But I have never heard of making chart audits a staff nurse responsibility. And for good reason; nurses who are unable or unwilling to document properly will "fudge" on the audit tools as well. In fact that is what is happening; nurses are checking boxes without actually performing the audits. So when management audits the audits for blanks......well you get the picture. Those of us who refuse to document an audit was done properly when it wasn't because we had other priorities are regarded as the noncompliant, bad nurses deserving of "nastygrams".
So my question to my fellow staff nurses: Do any of you perform chart audits in addition to a regular or even greater than budgeted patient load? I know we're the only ones in this city)
Oct 10, '05
When I worked Resp/telemetry in hospital staff did audits too.
One of the best reasons for staff RN's to periodically do chart audits is to realize just how important correct documentation is, exactly what's involved and areas for improvement.
Now in homecare, quarterly each RN has 10 charts to audit within a month time frame: 5 of their own and 5 peers. "I never realized I kept missing the same areas on assessment"; "ZXY RN missing hard of hearing box, yet it's documented on intake referral."
Peer to Peer nudging has really paid off in my homecare agency. All the supervisors comments went over like a lead balloon: staff did not want to have peers see their poor work and often improved in their week area after peer audit completed.
Our agency does 100% admission audits; 10% discharge audits on 1,200+ patients/month along with focus reviews on certain diagnosis Medicare is targeting.
Last edit by NRSKarenRN on Oct 12, '05