Buried in paperwork...This is NOT why I became a nurse.

missdiorcherie · Mar 11, 2013

Yes! I'm just finished my first month of being an LPN in a LTC facility and I feel like 1/2 of what I do is charting and paperwork...but like they say if you didn't chart it then it didn't happen...

HouTx, BSN, MSN, EdD · Mar 11, 2013

Unfortunately, this is just part of the job. At this point, Nursing documentation is crucial for reimbursement, risk management, quality improvement/assurance, regulatory compliance, etc...... as well as communication with everyone else caring for the patient.

Maybe someday there will be voice recognition systems in place so we can just dictate as we go through our day - wouldn't that be great?

lucyloo1 · Mar 12, 2013

Ive been a nurse 15 yrs and charting/paperwork will always be vital. Although annoying and time consuming, its what makes the medical field 'go round'. Now depending on where you work it can be more or less but guarantee it will always be a thorn in your side! (But always remember it will be there to protect you in the event you need it) There will be days where you experience more direct patient care, and others where you feel you and your pen have become one! Take the good days as they come and keep truckin along:)

libran1984, ASN, RN · Mar 13, 2013

I'm an LPN in both a LTC and hospital setting.

To compare, the paperwork in the hospital is incredibly minimal. They use EPIC, most everything is point and click. The pharmacy and patient files are connected. The doctors are connected to Epic. Everything is connected! Not to mention, at most you're only charting on an average of 3-7 patients any given day!! There is so much patient contact that the nurse can do so much and still find time to chart novels when they get hyped up.

My first and last bit of PRN work at a LTC rehab facility last just 3 weeks. They said they were using computer charting- that accounts for

Now let's talk about the amount of redundancy that is done... A verbal order confuses me to no end. I know that it must be placed in three different boxes (a white, pink, and green copy). It must be faxed to pharmacy. It must copied again and put in the hard chart, and should be documented in the computer (which it never is).

The morning vitals are charted on the nurse's cheat sheet (bc bedside charting does not exist at the facility), charted in the MAR, and charted in the computer (which it never is). The accuchecks are charted in the MAR, the accucheck book, in the computer(which it never is), and in the nurse's cheat sheet. There are 16 patients everyday, and everyday of the week is designated a specific kind of assessment day such as cardio-pulmonary monday or skin check Wednesday, etc. of course if your pt is there for cardiopulmonary issues, every day is a cardiopulmonary assessment in addition to whatever other assessment is designated to the given day of the week. This assessment is charted as a bunch of check boxes in the MAR. In addition, it is to be free-typed as a progress note in the computer (which it never is).

The computer is not linked to any other discipline so the doctor and the pharmacy has little to no access. There are no known rehabilitation goals. The med pass is in excess of 2 hours. Treatments, new orders, and new dr appointments are frequently missed due to the lack of time to review all 5 books and the insane patient load for such high acuity patient load. Every day 4-6 patients are receiving IV vancomycin!! This too needs to be charted in the MAR and in the computer.

I can't do it. I thought being an ER nurse I could handle anything. But this paperwork is too much. My final day was Monday. There were two ladies by the same name and similar last names with similar problems. The nurse who admitted them mixed up the pt mars like a deck of shuffled cards and then cut the deck putting the top half as Jane Doe A and then Jane Doe B. there were no patient identifiers like birthday. Only allergies were listed. The names were very faded as that they were carbon copies done with very light pressure.

Omg. The MARs... Everytime a new pt is admitted - everyday, the admission paperwork is insane!

Presuming you can get just the daily paperwork done and charted in your 8 hour there is no more time to chart the unexpected!!

Example: 8 hours in a given work day

med pass takes at least 4 hours

Treatments take 2 hours.

Mandatory lunch is 30 minutes.

You now have left 1.5 hours left.

30 minutes are spent scribbling illegible scratches on the daily assessment log which were all half assed. Did you really strip your full 16 residents down to his/her birthday suit to search for skin breakdown? No you did not. You presume your aids will tell you if so. You know that those that are immobile will be at a higher risk so you may check their bottoms in a rush but forget to check heels! What about the 4-5 cardiopulmonary people? Did you put your stethoscope to their chest and listen? Did you touch all extremities looking for edema? Have you been getting proper daily weights? No no no. You asked the 16 patients during med pass how they feel, if they have a new cough, and eyeball their extremities. You have 16 patients and every single one of them has an unanswered call light going off at all times during the day!

1 hour left in your day... Did you get any new admissions? How long did it take to receive or give report? Did the doctor give any new orders? Did you have a day where pain levels were abnormally high. Did your daily supply of medications come in and did you actually count and verify all meds that came in? Btw that is a fair amount of paper work! Did your faxes to pharmacy go through? Did a lot of family members come through that day to occupy your time?

This facility is in the top 200 in the nation for its kind. What do the more squandered or lower ranking facilities look like?

The hospital is the best place I have ever worked and I will never, ever work LTC ever again. I would quit nursing before I do that again.

KRSLPN, LPN · Mar 13, 2013

You pretty accurately described my typical day in LTC. What has always amused me is the fact that I hear a LOT of nurses state that LTC nurses are "lazy" or not knowledgeable, couldn't be further from the truth since LTC nurses must be well organized and hustling for their entire shift.

SuzieVN · Apr 1, 2013

I'm an LPN in both a LTC and hospital setting.
To compare, the paperwork in the hospital is incredibly minimal. They use EPIC, most everything is point and click. The pharmacy and patient files are connected. The doctors are connected to Epic. Everything is connected! Not to mention, at most you're only charting on an average of 3-7 patients any given day!! There is so much patient contact that the nurse can do so much and still find time to chart novels when they get hyped up.
My first and last bit of PRN work at a LTC rehab facility last just 3 weeks. They said they were using computer charting- that accounts for
Now let's talk about the amount of redundancy that is done... A verbal order confuses me to no end. I know that it must be placed in three different boxes (a white, pink, and green copy). It must be faxed to pharmacy. It must copied again and put in the hard chart, and should be documented in the computer (which it never is).
The morning vitals are charted on the nurse's cheat sheet (bc bedside charting does not exist at the facility), charted in the MAR, and charted in the computer (which it never is). The accuchecks are charted in the MAR, the accucheck book, in the computer(which it never is), and in the nurse's cheat sheet. There are 16 patients everyday, and everyday of the week is designated a specific kind of assessment day such as cardio-pulmonary monday or skin check Wednesday, etc. of course if your pt is there for cardiopulmonary issues, every day is a cardiopulmonary assessment in addition to whatever other assessment is designated to the given day of the week. This assessment is charted as a bunch of check boxes in the MAR. In addition, it is to be free-typed as a progress note in the computer (which it never is).
The computer is not linked to any other discipline so the doctor and the pharmacy has little to no access. There are no known rehabilitation goals. The med pass is in excess of 2 hours. Treatments, new orders, and new dr appointments are frequently missed due to the lack of time to review all 5 books and the insane patient load for such high acuity patient load. Every day 4-6 patients are receiving IV vancomycin!! This too needs to be charted in the MAR and in the computer.
I can't do it. I thought being an ER nurse I could handle anything. But this paperwork is too much. My final day was Monday. There were two ladies by the same name and similar last names with similar problems. The nurse who admitted them mixed up the pt mars like a deck of shuffled cards and then cut the deck putting the top half as Jane Doe A and then Jane Doe B. there were no patient identifiers like birthday. Only allergies were listed. The names were very faded as that they were carbon copies done with very light pressure.
Omg. The MARs... Everytime a new pt is admitted - everyday, the admission paperwork is insane!
Presuming you can get just the daily paperwork done and charted in your 8 hour there is no more time to chart the unexpected!!
Example: 8 hours in a given work day
med pass takes at least 4 hours
Treatments take 2 hours.
Mandatory lunch is 30 minutes.
You now have left 1.5 hours left.
30 minutes are spent scribbling illegible scratches on the daily assessment log which were all half assed. Did you really strip your full 16 residents down to his/her birthday suit to search for skin breakdown? No you did not. You presume your aids will tell you if so. You know that those that are immobile will be at a higher risk so you may check their bottoms in a rush but forget to check heels! What about the 4-5 cardiopulmonary people? Did you put your stethoscope to their chest and listen? Did you touch all extremities looking for edema? Have you been getting proper daily weights? No no no. You asked the 16 patients during med pass how they feel, if they have a new cough, and eyeball their extremities. You have 16 patients and every single one of them has an unanswered call light going off at all times during the day!
1 hour left in your day... Did you get any new admissions? How long did it take to receive or give report? Did the doctor give any new orders? Did you have a day where pain levels were abnormally high. Did your daily supply of medications come in and did you actually count and verify all meds that came in? Btw that is a fair amount of paper work! Did your faxes to pharmacy go through? Did a lot of family members come through that day to occupy your time?
This facility is in the top 200 in the nation for its kind. What do the more squandered or lower ranking facilities look like?
The hospital is the best place I have ever worked and I will never, ever work LTC ever again. I would quit nursing before I do that again.

I already liked this, but I think you're fun! I like your style. But, also- the sick fact is that 90% of the forms, etc. used in LTC could be eliminated, by creating a single 2 page, all-inclusive, comprehensive assessment that meets all regulatory requirements, both state and federal. It was based on the typical 'monthly summary' format used on LTC patients that may otherwise lack any monthly, routine documentation. Did it fly? Nope. "We've always had a vital sign clipboard". "It's too many changes for the staff". Etc. and misc. inane arguments.

MedChica · Jun 11, 2013

I'm an LPN in both a LTC and hospital setting.
To compare, the paperwork in the hospital is incredibly minimal. They use EPIC, most everything is point and click. The pharmacy and patient files are connected. The doctors are connected to Epic. Everything is connected! Not to mention, at most you're only charting on an average of 3-7 patients any given day!! There is so much patient contact that the nurse can do so much and still find time to chart novels when they get hyped up.
My first and last bit of PRN work at a LTC rehab facility last just 3 weeks. They said they were using computer charting- that accounts for
Now let's talk about the amount of redundancy that is done... A verbal order confuses me to no end. I know that it must be placed in three different boxes (a white, pink, and green copy). It must be faxed to pharmacy. It must copied again and put in the hard chart, and should be documented in the computer (which it never is).
The morning vitals are charted on the nurse's cheat sheet (bc bedside charting does not exist at the facility), charted in the MAR, and charted in the computer (which it never is). The accuchecks are charted in the MAR, the accucheck book, in the computer(which it never is), and in the nurse's cheat sheet. There are 16 patients everyday, and everyday of the week is designated a specific kind of assessment day such as cardio-pulmonary monday or skin check Wednesday, etc. of course if your pt is there for cardiopulmonary issues, every day is a cardiopulmonary assessment in addition to whatever other assessment is designated to the given day of the week. This assessment is charted as a bunch of check boxes in the MAR. In addition, it is to be free-typed as a progress note in the computer (which it never is).
The computer is not linked to any other discipline so the doctor and the pharmacy has little to no access. There are no known rehabilitation goals. The med pass is in excess of 2 hours. Treatments, new orders, and new dr appointments are frequently missed due to the lack of time to review all 5 books and the insane patient load for such high acuity patient load. Every day 4-6 patients are receiving IV vancomycin!! This too needs to be charted in the MAR and in the computer.
I can't do it. I thought being an ER nurse I could handle anything. But this paperwork is too much. My final day was Monday. There were two ladies by the same name and similar last names with similar problems. The nurse who admitted them mixed up the pt mars like a deck of shuffled cards and then cut the deck putting the top half as Jane Doe A and then Jane Doe B. there were no patient identifiers like birthday. Only allergies were listed. The names were very faded as that they were carbon copies done with very light pressure.
Omg. The MARs... Everytime a new pt is admitted - everyday, the admission paperwork is insane!
Presuming you can get just the daily paperwork done and charted in your 8 hour there is no more time to chart the unexpected!!
Example: 8 hours in a given work day
med pass takes at least 4 hours
Treatments take 2 hours.
Mandatory lunch is 30 minutes.
You now have left 1.5 hours left.
30 minutes are spent scribbling illegible scratches on the daily assessment log which were all half assed. Did you really strip your full 16 residents down to his/her birthday suit to search for skin breakdown? No you did not. You presume your aids will tell you if so. You know that those that are immobile will be at a higher risk so you may check their bottoms in a rush but forget to check heels! What about the 4-5 cardiopulmonary people? Did you put your stethoscope to their chest and listen? Did you touch all extremities looking for edema? Have you been getting proper daily weights? No no no. You asked the 16 patients during med pass how they feel, if they have a new cough, and eyeball their extremities. You have 16 patients and every single one of them has an unanswered call light going off at all times during the day!
1 hour left in your day... Did you get any new admissions? How long did it take to receive or give report? Did the doctor give any new orders? Did you have a day where pain levels were abnormally high. Did your daily supply of medications come in and did you actually count and verify all meds that came in? Btw that is a fair amount of paper work! Did your faxes to pharmacy go through? Did a lot of family members come through that day to occupy your time?
This facility is in the top 200 in the nation for its kind. What do the more squandered or lower ranking facilities look like?
The hospital is the best place I have ever worked and I will never, ever work LTC ever again. I would quit nursing before I do that again.

I work LTC psych. Minus the computers and with the addition of a few psychiatric meltdowns, elopement, fights, wandering, etc...

THIS...in a nutshell, is my day.

In our defense, most of the nurses write in ways that can be read. Now, the providers? I've seen bad handwriting but we have a doctor who seems to compose her notes as if she's half-asleep or seizing. You can't even make the symbols out. They're not letters. It's alien language.

I thank God for our CNAs, man. (...when they aren't dragging us into their 'CNA shift rivalries'. anytime I can walk out of there without hearing a lot of b--ching and whining about 'mornings'/evenings/nights'...is a good morning. Every nurse in that dept is in agreement. way too much infighting and I'm not sure how I can fix it. the different shifts aren't very forgiving or easygoing on each other. they look for things to complain about. you can't even give report without being interrupted, these days). Seriously. We lean on them more than you know...and they're good. Anytime, something goes on with the residents: A change in bowel habits/urination, a bruise, skin breakdown, pain, lethargy, bleeding, breathing difficulty, seizing, a resident just not acting as they should, etc...?

...and they'll break their necks to let us know.

They're our eyes and ears, truly.