Crushing Burden of Regulatory Compliance on Healthcare

Nurses General Nursing

Updated:   Published

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Over and over I have seen hospitals spend vast amounts of resources and time on achieving Regulatory Compliance. Often the rules seem to have been cooked up in an office by officials who are very far from the bedside. The formulas that these people are using to develop policies seem highly flawed.

Some of the charting requirements are extremely cumbersome. Inconvenient workplace modifications and barriers turn the workplace into an obstacle course. Workers have many other requirements such as online education that often is meaningless, much of it being driven by regulatory and legal forces.

These burdens make the delivery of care much more difficult, without much tangible benefit,  except in what seems to be merely a theoretical way. Making systems more and more complicated each year doesn't lead to better outcomes. I'm not seeing that anything will be changing in the near future. Instead I think the burden will become too much to bear for the system at large.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
2 minutes ago, Tweety said:

I tape a half sheet of paper to my computer on wheels every day that has when meds are do and other "to do's" and it really keeps me organized and reminds to do things.  

We are in the process of having a Joint Commission visit any day now and I was told that I couldn't use tape anymore. 

Meanwhile I'm being crushed by poor staffing and you're worried about me being busted by tape.  You'd best be worried about my mouth because I've lost my filter.......

It's nitnoid picky stuff like this that is making us crazy. You are doing your best to stay organized, doing no harm to the damned COW. They nitpick us to death anymore.

I am sorry you're going through this.

My own mouth is getting harder and harder to regulate myself.

Specializes in Retired.
3 hours ago, SmilingBluEyes said:

I am slowly cutting back my shifts/hours. I am winding down to retirement. I try to work less, spend less and live more. I am sick of this crap. It's time for a new generation to take on this fight. I am done to a crisp.

I have fantasies of being a barista or working at Lowe's. Except I can't lift that much weight. I think working in the greenhouse would be a dream if I could lift heavy plants and soil around. I love being around plants. People, well not as much these days. So many just suck.

I would rather babysit my grandbabies than anything. Nursing is not at all what it was in the 90s when I entered. Nor is medicine. It's all BS anymore.

Hah, the 90's.  I started in the 70's when the patient paid a flat fee for the day.  We didn't charge for each and every item used.  Charting consisted of short paragraphs that challenged the charter to be concise and useful.  All hospitals had a Director of Nursing who was a nurse.  Good times.

2 hours ago, SmilingBluEyes said:

It's nitnoid picky stuff like this that is making us crazy. You are doing your best to stay organized, doing no harm to the damned COW. They nitpick us to death anymore.

I am sorry you're going through this.

My own mouth is getting harder and harder to regulate myself.

This is why I maintain that JCAHO is a complete fraud. Of all of the many issues in hospital-based, health care delivery today that directly impact patient safety, what hot button items do you suppose the commission auditors have historically chosen to focus on?  Nurse/patient ratios? Physician staff relations?  Redundant/unsafe practices and workarounds? Nursing retention you say?  Nope, tape residue, refrigerator temperature logs, restraint documentation, food/drinks in the nursing stations.  Talk about the Emperor's new clothes

 

2 hours ago, morelostthanfound said:

This is why I maintain that JCAHO is a complete fraud.

In regard to any quality/safety stuff: If the first question/thing audited and investigated isn't the n:p ratio (and it never is) then it's just a façade. I mean that about almost everything; every organization, committee or group that purports to be working on safety improvements.  I will feel this way until every entity who claims to have anything to do with safety or quality demands actual staffing standards as a starting point to their work. All of these fools have made things so much worse by refusing to address the real issue and focusing on a multitude of other minutiae instead.

Too bad JCAHO, TJC, JC, jOiNt, whatever they call themselves, didn't have  "check stockpile of N95s" on their list of things to check all of these years along with "check blanket warmer temperature log." ?

 

Specializes in Retired.

There are other options besides JHACO but they might make a point of short staffing so go with the accrediting agency that's happy to shut up in exchange for getting thir bill paid.  This is pure politics at it's worst.  I don't know if anyone in Congress wants to start this battle since it's member collect contributions from hospital associations. 

Specializes in Geriatrics, Dialysis.
On 6/16/2021 at 9:34 PM, morelostthanfound said:

JCAHO is a complete sham!  Through my tenure in nursing, I've been through many audits at the various hospitals I've worked at.  This dog and pony show is all in the 'guise' of improving patient safety....  One year, it's almost a complete preoccupation in refrigerator temperatures, the next time, it's restraint documentation!  Give me a break, really? Really?  None of these commission pencil pushers ever ask the hard questions-those that directly and consistently impact patient outcomes, I.e. nurse/patient ratios, retention of experienced nursing staff ....  Like Emergent, I can't wait to bow out also and

It's the same for LTC/SNF. State surveys are a joke. The only thing they accomplish is having the place fully staffed for a change.  One year it was the aforementioned fridge temps, the last year I was there it was food temps. Then it was eye drop administration that was the thing of the year.  A few years ago some genius came up with a new method for doing accuchecks that expanded that  process to 13, yep 13 steps!  The one or two nurses that got watched doing that by a surveyor weren't happy but the place didn't get cited so they must have done OK.  Even two years later when I left the ridiculous accucheck instructions were still  posted even though not a single nurse actually followed them. 

The crazy amounts of required documentation, don't even get me started! That played a major role in my eventual  LTC burnout. When I spent more time sitting at the computer that with the residents it just got to be too, too much. Plus no matter how much charting was done it seemed there was always more, always something else that just had to be charted on.  Case in point, I switched to dialysis nursing. Would you believe there's actually more required follow up documentation in the SNF for dialysis patients than I have to do in the actual dialysis clinic? It's insane. 

9 hours ago, JKL33 said:

In regard to any quality/safety stuff: If the first question/thing audited and investigated isn't the n:p ratio (and it never is) then it's just a façade. I mean that about almost everything; every organization, committee or group that purports to be working on safety improvements.  I will feel this way until every entity who claims to have anything to do with safety or quality demands actual staffing standards as a starting point to their work. All of these fools have made things so much worse by refusing to address the real issue and focusing on a multitude of other minutiae instead.

Too bad JCAHO, TJC, JC, jOiNt, whatever they call themselves, didn't have  "check stockpile of N95s" on their list of things to check all of these years along with "check blanket warmer temperature log." ?

 

^^^PERFECT, 110%.  My sentiments exactly!!  The real truth is that eight hours after the auditors exit the building, the stretchers, wheelchairs, and clutter return to the already congested hallways and it’s back to business as usual. It’s like a mandatory automobile safety inspection that focuses almost exclusively on the car’s  hubcaps.

Specializes in Cardiac, telemetry..

I am constantly either reminded/ "coached" and even disciplined for not conforming to the corporate click-bait that my employer requires in the patient's EHR. I personally have just focused my charting on the clinical/pertinent data rather than contributing to the vapid inundation of their health record with DV screenings, alcohol use (when clinically insignificant) etc. #resistthedumb. 

I’m trying to find more and more ways to get away from bedside.  I’m so tired of every, little thing being my responsibility at the bedside.  Because, we will get dinged by JCHAO.  I’m tired of the redundant education we do every single year coming with a threat of no raise if I don’t get it done.  All of it is driving me mad.

I don’t even want to take care of patients anymore because I’m afraid I’ll get written up for a minuscule detail that I miss.  Forget the fact they were crashing half the day, or I spent time with the family deciding how to proceed with care.  Even if I remember my care plan, god forbid I forget to check one box, it’s a write up.

Its truly sad because I like taking care of people.  I enjoy educating them and their families.  I enjoy trying to see what I can do to progress my patients that day.  But that web training on hand hygiene was due today and I didn’t get to it.  I didn’t check a box that I educated my comatose patient on scds.  
 

I have said on numerous occasions I dare jchao to try me with the tape thing.  Because it was perfectly acceptable for me to reuse PPE in other rooms this past year.  I wasn’t even given an n95 until a positive test came back so I had so many exposures this past year.  So many.  So yeah, tell me tape is an infection risk.  I’m ready to battle.

Specializes in ER.

On the other end of it, I  remember getting discharged from the hospital a few years ago. My DC instructions were cluttered with non-pertinent info, like smoking cessation (I don't smoke) and other regulatory driven nonsense. The instructions on my particular surgery was click of the button stuff with lots of generalities, much of which didn't cover my specific problems,  but referred to many general types of surgeries on that particular part of the body.

It was totally unhelpful. There was really no personalization to my situation. I was very confused by it. The whole things seemed like it was just computer-generated. It probably even had a suicide hotline number, and where to call if I was a victim of forced prostitution. 

What I really needed was the specifics of my case. It was a scary and confusing time.

Specializes in OB.
9 hours ago, Emergent said:

On the other end of it, I  remember getting discharged from the hospital a few years ago. My DC instructions were cluttered with non-pertinent info, like smoking cessation (I don't smoke) and other regulatory driven nonsense. The instructions on my particular surgery was click of the button stuff with lots of generalities, much of which didn't cover my specific problems,  but referred to many general types of surgeries on that particular part of the body.

It was totally unhelpful. There was really no personalization to my situation. I was very confused by it. The whole things seemed like it was just computer-generated. It probably even had a suicide hotline number, and where to call if I was a victim of forced prostitution. 

What I really needed was the specifics of my case. It was a scary and confusing time.

That's such a good point!  When I worked bedside I was always frustrated about our 'patient education' handouts because they were all auto-generated by our EMR based on diagnosis codes.  I wished so much we could have written the education as a unit group, we could have done a much more clear and concise job.  I was on a surgical unit and we took a lot of patients with super complex, rare surgeries that needed really detailed education.  It was all made more complicated than it needed to be.

Specializes in ER.

Nothing will change,  it will only get worse. I'm very thankful that my children have not gone into Healthcare. I advise everyone to get their finances in order. Be extremely frugal. Try to have very stable relationships with people that have good jobs. Have an exit strategy from nursing.

It would be nice if there were pensions like there are for cops, teachers, firefighters, the military. Some jobs just take too big of a toll on the workers.

 

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