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.
