At my large national for-profit company, all RNs and LPNs were supposed to do monthly progress notes on their primary patients (10-15 patients, depending on census and staffing). Mandated were 5 entries for each patient (I added some sample notes to give you an idea):
- anemia management
Hgb x. EPO increased to x U qtx. Venofer x q wk.
(was Kt/V reached; if not, reasons)
Kt/V inadequate at 1.10, however this is unusual for this pt. He missed tx 3 times this month due to personal problems; tx compliance encouraged.
CVC removed on 9/25; new AVG with strong thrill and bruit, easy to cannulate.
Most recent post-tx BPs [below x/x or list them]; current meds: ...
(dry weight changes, avg intradialytic gain)
EDW increased to x kg; avg wt gain 2.0 kg.
Those were the mandated ones - plus we could add anything we wanted to from a long list (yeah, right
In order to do these progress notes, you needed to print certain reports, which had to be up-to-date. Need I add that the daily workload of a clinic nurse simply did not allow for all of this to be done?! (Yes, management wanted us to do this in our spare time - and I don't mean OT, oh, no, within 40!
If they could, they would give you a "paper day" - about the only way this could be done; of course, due to staffing problems, these were usually cancelled. So you were constantly behind (you could never possibly be caught up - if you were, the next month would come around...) It was a constant source of stress for those of us (only one other nurse besides me) who tried to do it - the rest simply didn't, or only if given the extra day. But since we were all behind on the notes (more or less), management could us this as a tool to downrate us during review time
*This in addition to monthly med checks on these same patients (asking them to bring in their meds, address any problems with the neph, update the list in the computer) and monthly footchecks on all assigned patients (these used to be weekly! ), which had to be documented in the computer.
Sorry, I wasn't trying to scare you (I guess this was a belated vent on my part
). This was one clinic, one manager, some time ago.
To tell you the truth, I loved my paper days; they were a nice break from the floor, and let me sleep in. If your manager will let you have those, take you off the floor during slower periods, or let you work OT (if you care to), progress notes should not be a source of stress. They're the same thing that the SW and dietician have to do monthly (but of course they have the time
HTH. Best wishes to you!