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.
On 6/19/2021 at 7:40 PM, Undercat said:
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.
Yeah, I lost it the other day with my manager. We were working about 2 or 3 nurses short, and I had to take a heavy assignment as a charge RN (when I am not supposed to take any per our own staffing grid). And every other nurse was floated to my floor for a decent sized unit. It was absolute chaos and management did not want to come in and help (even after I called and told them that we would go 1:7 soon). I did everything right but she wrote me up for not printing out the assignment sheets. Assignment sheets. Really? That is what you are worried about? And not the fact that this floor is hemorrhaging nurses left and right and our staffing ratios are unsafe?
I can't wait to leave hospital nursing. Management is out of control.
Best wishes in your new endeavor, art furniture sounds really cool!
One thing I found particularly ridiculous related to precaution changes after COVID at our hospital. Before COVID all patients with MRSA were on contact precautions. And if you had ever walked out of room with a N95 and then went into another room, you would be severely reprimanded. Then COVID came and suddenly, MRSA patients no longer need any kind of precautions. Was there some new research with this best practice change? Who knows. And your single use N95. Yeah, you can wear that for a month. The paper bag you put it in clearly has magical antibacterial properties that are keeping you safe.
The CDC lost a lot of credibility in my book. Every day it was a new rule or regulation that completely negated yesterday's standards. And then it would switch right back.
It became obvious that the rules changed to suit the whims of administration, not based on actual science.
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
On 6/20/2021 at 11:47 PM, 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.
I’m with you on that, just being three weeks post op myself. My nursing care in a specialty hospital, I am very glad to be able to say, was first-rate from start to finish, but the discharge paperwork was obviously not nurse-driven.
As to the rest of it, I haven’t worked inside a hospital for a long, long time. As a legal nurse consultant I do, alas, see a lot of dreadful EHR documentation that does not reflect well on nursing. It’s sometimes hard to tell whether the care was better than the documentation, but given that I see mostly cases where outcomes were bad and often because nursing didn’t do their jobs, I don’t think so. If EHR is distracting nurses from true nursing assessment, analysis, and planning, as it appears to be, then it’s a very bad thing indeed.
The nursing profession has fallen so far because of the staffing crisis..just calling it what it is. Someone in D.C. needs to put together a commission who would define the problem and change the conditions that make health care undesirable. My personal favorite New Rule would be that redundancy in charting needs to stop. No vital sign should appear twice on any chart. Nurses have the numbers to make a difference but we have far too little voice. The ANA is a lackluster organization that doesn't seem to do much for working nurses. What would it take? Strikes for sanity in the paperwork that is bringing providers to their knees.
The nursing profession has fallen so far because of the staffing crisis..just calling it what it is. Someone in D.C. needs to put together a commission who would define the problem and change the conditions that make health care undesirable. My personal favorite New Rule would be that redundancy in charting needs to stop. No vital sign should appear twice on any chart. Nurses have the numbers to make a difference but we have far too little voice. The ANA is a lackluster organization that doesn't seem to do much for working nurses. What would it take? Strikes for sanity in the paperwork that is bringing providers to their knees.
The ANA is in bed with the AHA and in no way advocates for the average rank and file nurse. Why is this and why is it also that almost every healthcare regulatory agency refuses to address the elephant in the room; nurse/patient ratios? Could it be the fact that hospitals and nursing homes spent over $100 million last year lobbying to curry favor with policy makers? That's the kind of money that can easily snuff out any safe staffing legislation or convince the JCAHO administrators to direct their auditors to focus on tape residue, restraint documentation, and refrigerator temperatures as opposed to those other hard questions. First, do no harm.....right?
The ANA is in bed with the AHA and in no way advocates for the average rank and file nurse.
I have lost any respect for the ANA...now all they want to do is make money from certification exams. Where were they during Covid when PPE was scarce....Oh yes, those at upper levels said they wrote 'letters'. Where are they now? crickets...
My facility was preparing for a big survey and accreditation. The things that became urgent were ridiculous. Laminating any paper notices, as if covid was just waiting to get on to a paper bulletin to bring humanity to its knees?
OMG! You got the paper thing too?! We got dinged so hard on that by our compliance officer you would have thought we were drowning puppies.
On 6/19/2021 at 8:32 AM, Emergent said:
Those mandatory questions have gotten totally out of control. Yes, people just check them off. More garbage from regulatory that is notable only for its lack of accurate data and practical relevancy.
Our newest is a financial screening. Seriously, I now have to talk to patients about affording the IV I’m about to stick in their arm.
On 6/19/2021 at 8:01 PM, Tweety said:
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.......
We are, at minimum, doing the assignments of 2 nurses on the daily. I’ve been forced to run 2 clinics and answer the triage phones (3000 calls per month) at the same time. I did none of the roles well. Paddling like crazy and barely keeping our heads above water but everything is laminated so the world is safe.
Someone in D.C. needs to put together a commission who would define the problem and change the conditions that make health care undesirable.
LOL, the folks in DC are a huge part of the problem. They have no idea how to dismantle a useless program or mandate. This problem is not going to get solved, it is going to get worse. The people in DC are so far removed from reality, it's a pathetic joke to expect them to have any thing to do with solving it. They are worried about one thing, the big businesses that pay their campaign costs and give them other goodies on the side.
I went back to the ICU to help out during COVID and HATED it. I spent so much time doing data-entry that I didn't have time to take a break. Our facility is not unionized so breaks are only "as patient care allows." Which means that you usually don't get one. I too damn old to work 12 hours straight with nothing more than a 30 minute lunch break. The only reason that I get the lunch break is that they have to pay me if I don't get one. I didn't enter nursing because I wanted to become a data-entry specialist. I enjoyed the patient care, but only helped for a few weeks because of the data entry and lack of time to take a break. I hear complaints about nursing shortage and nurses leaving the career. IT IS ALL ABOUT THE WORKING CONDITIONS, stupid! And regulatory compliance has done nothing to improve working conditions.
SmilingBluEyes
20,964 Posts
I wish I knew what that all was like......*sigh*