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Discussion

Administration lacks the reasoning ability of a 5 year old

After returning to a facility I had not worked at for a year, I found numerous additional documentation requirements. None had been removed or simplified. For example, hanging a bag of saline now involves 5 separate instances of documentation:

  • Sign it on the paper chart.
  • Pretend to remove it from the Pyxis. It isn't in the Pyxis but signing into the. Pyxis and pretending to remove it creates a record for billing.
  • Document a start time in the computer. This involves logging in, and clicking several levels into the system.
  • Repeat above to edit the above document to reflect a stop time.
  • Electronically sign MAR.

What makes this process even worse, is that high school senior could create a program that consolidates these tasks, freeing me up to actually take care of patients.

This is just one example of many.

Last year, my twelve hour shift had 720 minutes in it, and I had frequently used each of those minutes. Since I generally get good evaluations, presumably I use my 720 minutes on tasks important to the well being of my patients. A year has passed, and twelve hours still contain only 720 minutes. Now that some of those minutes are designated for new documentation, I have to cut out some of the tasks I have previously done.

In my mind, this concept, beyond the reach of administration, is so simple a small child could understand it

For this experiment, I borrowed a five year old. This particular kid has smart parents, so he could be a little advanced.

I lined up three glasses. I left one empty, filled the other half way, and, filled the third to the brim. I took a pitcher of water, and asked him if I could pour some into the first glass, then the second. He said that I could. A close approximation of our conversation when I got to the third glass:

Can I pour more water in here?

No!

How come?

It's too full.

What if I pour some water in it anyway?

It will spill.

Well, I am going to pour some in anyway.

You're silly.

So- a five year old understands the concept that if something is full, and one adds more, something comes out. How is it that hospital administration cannot grasp this simple concept? Some of these people seem reasonably intelligent. They can tie their own shoes, obtain drivers licenses, etc.

There might be some good reasons for a new requirement. It could be required for reimbursement, it could come from JCAHO, or an in house committee. That doesn't change the fact that my time as a nurse is a limited resource, which, if expended on one task, cannot be expended on another. And....Time spent on documentation is not spent on patient care.

While the above may seem like a rant, (it is), I actually have a suggestion to administrators: Treat my time like a budget. Not like a government budget, but like a real budget. If you add a new piece of documentation, figure out how much time that task will take. Do this by following a couple of nurses through the task in real life. If the new task takes three minutes, figure out a way to gain those three minutes back so it is not at the expense of patient care.

This may be easier than it sounds. The system you have me working in is terribly inefficient. I have worked hard for my education and clinical skills. Please allow me to use them more wisely.

Featured Replies

perhaps instead of being a part of the problem you should be part of the solution. Management is often willing to consider a more time/cost efficient way of doing something but they want to see the data to support it. So, come up with your solution, prepare a paper and then present it to your manager. You'd be surprised at how receptive they will be.

  • Expert

I hear ya! I work in a facility that looooves redundant documentation -- everything we do has to be documented in three or four different places. It drives me crazy. The administration doesn't seem to care that it eats up a lot of time that could be spent doing something actually useful and productive.

My personal favorite little weird thing is that, on every new admission, we enter the physician's diet order into the computer along with all the other orders -- presumably, that diet order information goes somewhere, and perhaps the kitchen is able to access that information -- but, every single morning, the kitchen telephones every unit and asks us how many clients we have and are any of them on special diets. (Gotta love that 19th Century technology!)

perhaps instead of being a part of the problem you should be part of the solution. Management is often willing to consider a more time/cost efficient way of doing something but they want to see the data to support it. So, come up with your solution, prepare a paper and then present it to your manager. You'd be surprised at how receptive they will be.

perhaps you should real the whole post, because this nurse DID offer a solution. a good one, too.

perhaps instead of being a part of the problem you should be part of the solution. Management is often willing to consider a more time/cost efficient way of doing something but they want to see the data to support it. So, come up with your solution, prepare a paper and then present it to your manager. You'd be surprised at how receptive they will be.

you are in management, aren't you?

  • Expert
you are in management, aren't you?

:D That was my first thought on reading that post, too!

"So, come up with your solution, prepare a paper and then present it to your manager. You'd be surprised at how receptive they will be."

Ok, somebody owes me a new keyboard, because I just lost my mouthful of coffee!

have you considered the fact that documentation is PART of your patient care?

  • Expert
have you considered the fact that documentation is PART of your patient care?

Of course it is, but it's hard to see the point or benefit of documenting the same piece of info three or four times in three or four different places ...

Documentation is a part of care, we are all aware of the whole "if you didn't document it you didn't do it." But a lot of hospitals have become incredibly redundant. I feel like half the time I'm charting in three sections, if not more, the exact same information.

I have seen some EXCELLENT electronic medical records programs which have streamlined the process and actually freed me more to do the physical part of the job. I have also seen some horrible ones where the medical records actually takes you more time and makes more incomplete information requiring you to go to various different "parts" in order to chart.

I am really hoping the technology will make things easier. We used this awesome program at this clinic I worked at, it really made things so much easier. It was a definite learning curve and took us a couple months to get the ball rolling...but imagine a place where all doctor's writing is legible because it's typed!

It sounds like the program you are currently using is out of date and completely useless. As programs develop, I hope we will someday not have this problem, but because of cost-efficacy, they'll probably keep you doing that same amount of ridiculousness.

First let me say I agree with everything that the OP stated---redundancy in documentation is ridiculous--but it will never get better unless we can do Tort Reform and cut down on the ridiculous amounts of frivilous lawsuits in the healthcare industry. Until that happens--(sorry it won't happen--lawyers have too many lobbyists in DC)--managers will continue to follow the CMA rule.

While the above may seem like a rant, (it is), I actually have a suggestion to administrators: Treat my time like a budget. Not like a government budget, but like a real budget. If you add a new piece of documentation, figure out how much time that task will take. Do this by following a couple of nurses through the task in real life. If the new task takes three minutes, figure out a way to gain those three minutes back so it is not at the expense of patient care.

This is an interesting idea--when I read it I immediately thought about the auto industry--where I worked for many years before I became a nurse. I recommend from my experiences there never to allow management to do a time-study on you--which is what it would become. Management will always find ways to maximize your output--meaning if they are watching you and they perceive you are not productive enough--they will find ways to add even more work on you. I saw it myself and I also saw the quality of the product drop drastically. I know that once the auto industry initiated the "Continuous Process" on the assembly line I never saw anyone get less work-- only more--and believe it or not I have read articles where Hospital administrations have studied continous process to see if they can use it in their industry--watch out for Team Concept--alot of backstabbing.

Don't ever give up your autonomy. JMHO

That is because the people who create the software don't have nursing backgrounds and don't seem to understand the importance of making it nurse friendly.

I don't know what to say about management.

  • Author

In response to a couple of posts:

Accurate documentation is a part of patient care. But, nothing is gained by documenting the same fact in different ways.

Assuming it is correctly documented the first time, additional documentation only provides the possibility of a discrepency.

If it it is wrong the first time, it will remain wrong, no matter what you do down the line.

Think of your documentation like a pass/fail test that you need to get 100% to pass. would you rather have one question, or multiple questions?

But, back to my original point: If you give me an additional task, please recognize that it means I will have to stop doing something I am currently doing. Or, change the system to allow both. Giving me an additional load, then telling me to change the system you created seems a bit unfair.

I recently hired a guy to paint my house. Figured I'd do the trim myself. To do it right, would take 40 hours, which fit right into my budget. I later decided that I don't want to paint the trim, so I asked him to do it, but I didn't have any more money to pay him.

Here are my options.

  • He paints the house and the trim, but not at the same quality as originally agreed. Maybe the back just gets one coat.
  • I buy a paint spray machine for him to use. It's going to cost a lot now, but over the ownership of my house, it will pay off.
  • I come up with some extra money and get him a helper. He is a skilled painter, and gets $20 an hour. If I get one of the local kids to do some of the less skilled grunt work for 10$ an hour, He can get the job done the way I want it, at only a little extra expense.

What I can't do is say "I know this is a 40 hour job. Please do an additiona 5 hours of work in the same time frame, and don't cut corners" This won't work. He may finish in 40 hours, but something won't get done right.

Boy, I am kind of full of analogies. But, point made.

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