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.
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.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
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.
You think logically.
For whatever reason, Administration and the PTB..do not.
You are fighting something that is a GIANT DINOSAURIC THOUGHT PATTERN.
You will lose..only for now, hopefully....even the T-REX didn't survive. There may be hope yet.
Specializes in Hospice, corrections, psychiatry, rehab, LTC.
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.
One thing I learned a long time ago: Arguments about time, care and efficiency go nowhere with management without specifics. These people deal in numbers, and they're a lot more worried about their money than your time. Tie a dollar figure to it and you get their attention. For instance, my employer implemented a medication policy change that greatly increased the workload of the nurses. Complaints about it went nowhere. Then I decided to take a fiscal approach to the issue. I estimated how much time it took to document and pour each additional dose, then through extrapolation I showed that it would require hiring two additional full-time nurses just to keep the workload where it was before the policy change. I submitted a report in writing to my superiors, fully explaining how I arrived at my figures. The policy was rescinded within two weeks. Before my report, all they got was vague complaints that the workload was too much. I demonstrated for them in terms they could understand exactly how much extra work it created.
I'm not saying that you will get the same kind of result, but simply telling management that something is redundant and wastes time isn't enough. Estimate the time you spend on each task and the number of times you perform it in a specified time period (I suggest one year), multiply it by the number of nurses performing the task and then by your hourly salaries and you will have a dollar figure showing them how much money they are wasting through inefficiency. It will get a lot more attention, plus you will gain a reputation as someone who analyzes and quantifies a problem and suggests a solution rather than just complaining about it.
One thing I learned a long time ago: Arguments about time, care and efficiency go nowhere with management without specifics. These people deal in numbers, and they're a lot more worried about their money than your time. Tie a dollar figure to it and you get their attention. For instance, my employer implemented a medication policy change that greatly increased the workload of the nurses. Complaints about it went nowhere. Then I decided to take a fiscal approach to the issue. I estimated how much time it took to document and pour each additional dose, then through extrapolation I showed that it would require hiring two additional full-time nurses just to keep the workload where it was before the policy change. I submitted a report in writing to my superiors, fully explaining how I arrived at my figures. The policy was rescinded within two weeks. Before my report, all they got was vague complaints that the workload was too much. I demonstrated for them in terms they could understand exactly how much extra work it created.
I'm not saying that you will get the same kind of result, but simply telling management that something is redundant and wastes time isn't enough. Estimate the time you spend on each task and the number of times you perform it in a specified time period (I suggest one year), multiply it by the number of nurses performing the task and then by your hourly salaries and you will have a dollar figure showing them how much money they are wasting through inefficiency. It will get a lot more attention, plus you will gain a reputation as someone who analyzes and quantifies a problem and suggests a solution rather than just complaining about it.
have you considered the fact that documentation is PART of your patient care?
Sure. But what the OP describes is excessive. To safely care for patients there needs to be a paper/electronic trail that shows the doc's order, the patient's condition, the time the order was carried out and how it was done, and what the effect on the patient was.
Faking taking saline out of the Pyxis for billing purposes is many steps away from patient care. I'm not saying it's not important, but nurses should not bear this responsibility while also trying to protect human life.
I was just talking about this same thing. In the past week there have been 5 new tasks added to our shifts. Also we were assigned to be on a team where we have to contribute. I was not asked nor do I know what the agenda is. (silly) But I have come up with a few ideas of efficiency and evidence to support it.(at least some evidence)
I am in the process of getting info together and presenting it.
It is mainly simple things that are very doable but could make a difference in nurse morale.
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.
i have to disagree with that. i would rather have a person that creates software for a living do it right than have a nurse that doesn't fully know how to use proper coding/technology to try to create software that is "nurse friendly" but lacks proper usage. which is what i am experiencing now coming from a professional electronic charting system to an "in-house" created crapbox
i have to disagree with that. i would rather have a person that creates software for a living do it right than have a nurse that doesn't fully know how to use proper coding/technology to try to create software that is "nurse friendly" but lacks proper usage. which is what i am experiencing now coming from a professional electronic charting system to an "in-house" created crapbox
But perhaps there is some "middle ground" possible -- maybe a nurse and IT pro working together ...
i have to disagree with that. i would rather have a person that creates software for a living do it right than have a nurse that doesn't fully know how to use proper coding/technology to try to create software that is "nurse friendly" but lacks proper usage. which is what i am experiencing now coming from a professional electronic charting system to an "in-house" created crapbox
It should be a joint effort between nursing and IT to ensure the needs are met for the nurse and proper technology is in place. It's not an either or situation.
we have to "pretend" to sign out bags of fluids in the accudose too... and not only are we documenting start times, we are required to document stop times and restart times for ALL IV meds. apparently, if we don't put the time that our bag of saline was finished, they don't get fully reimbursed for it. even emergency overrides.
they wonder why we have overtime.
and our pain reassessment screens take forever. if i give two tylenol i have a whole pain screen i have to fill out, and then another reassessment screen within an hour that is twice as long as the first.
if our meds are later than 1 hour, we have to put a "file variance" code for each and every med... so say you have 8 meds to give, you have to click each other and put "late: reason". if not, you have to sign a discrepancy form for each one.
i have 8 patients!
our emar coordinator is a nurse. she is wonderful and helpful and she does try and make our system more nurse friendly, but she says when she brings our suggestions to the "higher ups" they get shot down.
actually, no I'm not. don't care to be. but i do think that the op's "solution" is juvenile and unrealistic. No manager is going to spend their day following around nurses and timing them on how long it takes for them to complete a new task. If the op wants to be taken seriously, the management is going to want to see data, research...you know...evidenced based practice. so, do the research, prepare the data in an easy to follow format and present it to the admin. but seriously, whining and complaining about it isn't going to change anything, except maybe your blood pressure.
Guest219794
2,453 Posts
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.
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.