Published Mar 7, 2005
I'm not sure if I should discuss this with our nursing coordinator - would like some input from you guys...
Last semester we were assigned 2 patients per clinical day, and did not have to hand in our paperwork, care-plans etc., until the following week. This semester we are going to be assigned up to 4 patients per clinical day. We cannot 'Pick up our Patient' from the hospital until after 4pm the evening before clinicals, and we have to hand in ALL our paperwork the following day. For our 1st patient we have to fill out (by hand) 2 sheets of patient info, research all meds, research all unusual lab values, write 2 pathology papers, then write a careplan for EACH pathology (each careplan requires 1 nursing diagnosis, 2 outcomes, 4 interventions, 4 evaluations). For the rest of our patients we have to write short-form care-plans, research labs and research all meds. This is working out at around 20 to 27 pages of paperwork that has to be done in a single evening....as well as travelling to & from the hospital to copy info from patient charts, which means that most of us don't even get to start on the paperwork until we get home from the hospital at around 7 or 8pm.
Now last week, we were only assigned 1 patient because there was some sort of misunderstanding, and my clinical instructor was sick - but doing all the paperwork for just 1 patient took me around 6 hours. I finally got to bed at 1am - luckily clinicals were cancelled because the instructor was sick, but otherwise I would have had to get up at 4.30am. I just cannot see how we can get all this paperwork done in one evening, if it takes me until 1am to do just one patient, how am I going to manage with 4?
I am really, really concerned about this - I'm the type who really needs at least 7 hours sleep, or I get headaches, fall asleep while driving, cannot concentrate etc., I am very concerned that this will be a big risk to both my safety and the safety of my patients if I am having to work through the night. I had heard from 2nd year students that sometimes they don't even get to bed at all the night before clinicals - but I had assumed they were just exaggerating!
Do you think I should bring this up with my instructor? Are there any tips that would make the paperwork get done faster? I have already started to make drug cards on my computer, so I can just print those out - but I don't have many drugs on there yet, so at the moment it's not much help.
Altra, BSN, RN
This is working out at around 20 to 27 pages of paperwork that has to be done in a single evening....as well as travelling to & from the hospital to copy info from patient charts, which means that most of us don't even get to start on the paperwork until we get home from the hospital at around 7 or 8pm.
Hate to break it to ya ... but this sounds about typical. Last summer during my 14-credit Med-Surg class I was just getting down to paperwork around 9pm, getting 2-4 hours of sleep, then getting back up to be at the hospital by 0645.
Some of us from class just went out recently to celebrate The End of Paperwork - we're done with that now that we're 13 weeks from graduation. :balloons: Hang in there - it's not forever.
wonderbee, BSN, RN
I'm not quite sure what the objective is with all the writing. If the message is "there's lots of paperwork in nursing", I think there are more efficient ways to get that message across. The question is, are you benefiting by all this documenting. You'll have to think on this and the answer might not be obvious till after the rotation is over.
If this has been this instructor's MO since the days the dinosaurs walked the earth, your chances of seeing any changes are not good at all. Let's face it, they've got our asses for at least four semesters. My last clinical instructor gave us a caveat at the very beginning of the rotation. She said, and it's pretty close to a quote, I don't feel one bit sorry for any of you so don't come to me with your complaints about paperwork. That pretty much ended any discussion on that issue.
I would definitely keep an organized database in my computer of careplans that can be tweaked to personalize it to each patient. Same for meds and labs. The meds and labs for the patient two days post-hip are gonna be pretty similar. As for pathophys, can you find one online and print it and use that? I've been doing that and it flies with the instructors so far.
I personally think that is ridiculous. I am the type that refuses to attempt functioning on two to three hours of sleep because the school is having unreasonable expectations. It is dangerous to go in sleep deprived.
We spend several hours on our prep work for ONE person, I can't imagine doing it for four to the extent that you are describing.
I would be sure to attempt to get it done a few times, seeing if it is actually as much work as it seems like it will be. If it is just plain too much to get done in the given time frame I would definitely discuss (professionally, not whining) my concerns with the instructor.
Good luck with things :)
As for pathophys, can you find one online and print it and use that? I've been doing that and it flies with the instructors so far.
Careful, our school defines this as plagerism... Check first.
It can't be plagiarism if you don't try to claim the work as your own. The printed webpage comes with all the appropriate citations, including the web address. Our instructors want textbook pathophysiologies with cited references. I just annotate with a "see attached".
wow....i think it wouldn't hurt to bring it up to your clinical prof. is this how it is with other clinical groups in your class? i've found my clinical professors to be concerned if we bring up the fact that we're not sleeping the night before. after all, it is THEIR license on the line if you make a mistake. this semester i had two patients and i only had to do care plans for the patient that my prof deemed more difficult. of course we had to do prepwork for the other patient too like looking up meds and labs and their information but i know i would have been up so late if i had to another set of careplans for the other patient. at some point later in my program i know i'll get 4 patients, and students who have 4-5 patients in their last clinical rotation typically just come a little before clinical to look at their patient's charts rather than doing prep the night before. my prof's and many others' rationale is that when you're a nurse that's how it will be. nurses don't come in the night before to see who their patients are going to be the next day. i feel it's defintiely a point worth discussing with your prof especially because it's a safety issue since you're not getting any sleep. if she's not very flexible, RNKittyKat gave some awesome advice about tweaking care plans.
I think that's ridiculous, especially if you can't cut and paste and use references. Our care plans get longer and longer as we go through the program but the sections that we turn in the morning of clinicals is abbreviated and the longer part we turn in a couple of days after clinical.
"Safety" is a big buzz word... kind of hard for anyone to argue if you push it that way... but you also have to evaluate the whole situation to see if it is going to help or do more harm by bringing the whole thing up. The lack of sleep reminds me of that issue with physician residents. I feel for you because I also have to have a good bit of sleep to function well (don't ask why I want to be a midwife in light of this fact!!)... plus I have a two hour commute on boring country roads so it is already hard to stay awake in the morning.
If your program has been doing it that way and students have been successful or at least able to pull it off this way for some time, then the faculty is going to think it is just you having the problem, KWIM? In that case they probably aren't going to do a thing and you are just going to look like a whiner (true or not). If you are going to bring it up, you may want to get a majority of the students on board with you first. Good luck!
Thanks for all your replies and advice - sorry it took so long to reply, but the morning after clinicals we had an exam, which I bombed - and that's the first time I've ever got less than an A in an exam. I was so tired, my brain just wouldn't function - but it was a hard exam, and most of the other students did badly as well, it's not the end of the world. Anyway, it took me a couple of days to recover from the shock of that....
Anyway, another student brought the subject up with our instructor, and although she didn't give us any extra time, it turns out that we only needed to do one patho paper, not two, so that's a little better. We were only assigned 1 patient again as there seems to be a patient shortage at the moment - but I was still up until midnight getting paperwork done. I think it will get better as I get more practice - my meds database is building up, and one of the students came up with the idea of reading information off the charts out loud and taping it, so you could get home quicker to get on with the paperwork - it's confidential because you only have to refer to each patient as 'A' or 'B' etc. If I can manage to streamline things so that I can be in bed by 11pm at the very latest, I can settle for that. If it gets worse though - then I will bring it up with my instructor again.
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