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Discussion

Do I chart or do I take care of my patients?

So my hospital recently went to computer charting. I was sooooooooo excited to get computer charting because I had experienced a great program at another hospital and had hoped that most charting programs were similar. Now I'm sorry we ever went away from paper. The hospital did an amazingly poor job of prepairing us for how we were to chart (we are suppose to chart by exception). No one is sure how much of the assessment to fill out for new pt's (because it is a ton of boxes) and what excatly we should be charting on every shift (because while it is CBE there are a few things like Fall Risk Assessments that we are suppose to do every 12hrs regardless of change. The program was implemented all at once through the entire house...and usually such large systems are put in place one piece at a time. (ie., pharmacy and med charting first, then nursing charting, then doctors charting, the doctors putting in their own orders.) Well the system has had huge glitches since it starting running because of the large amouts of data, there is no set way for us to document when the computers are down. The managers made us get rid of all forms of paper charting without comming up with a plan. It is really, really nuts!

To top this off I recently decided to switch back to days because I found that I could not have a social life on nights. Just not a stay out late and party it up kind of girl, I'd rather go to a museum. While I LOVED night shift because I could at least get most of my stuff done, I find it impossible to attempt on days. For some weird reason my cardiac unit has also decided that the ratios should be the say day or night shift so we are all on 5 to 1 irreguardless of shift. And things like what happened to me today happen far more often on days (which is the original reason I switched from days to nights in the first place) than they did on nights. Today I come to my day shift and find that they are wanting two of us to streach to 6 while having only one PCA for 16 patients AND no charge nurse. This is craziness!!! The day before I came to work and we had two nurses at 5 patients, one PCA, no secretary, and they were giving our 'charge' 3 ICU patients at the same time!!! With things the way they are I barely have time...most of the time not, to chart a note every 4 hours on the pt like I'm suppose to. I don't chart an assessment (I do the assessment I just don't chart it because it takes to long). With the way things have been lately I mostly make a note at the beginning of my shift saying the pt is alive and well and one at the end of the shift saying the pt is alive and well. I chart big changes and when I call the doctors, but that is it. What am I suppose to do?! I've got to call doctors and then be ready when they call back. With the few PCAs I have to go change patients instead of delegating (I'll be damned if I'm going to let some poor PCA be responsible for every wet bed on the floor....and I won't let someone lay in their own filth for twenty minutes until I can 'get to them'.) And even spending most of my time with the patients there is usually one or two patients that I haven't been in their rooms more than the 3 times a day that I pass medications because my other patients need me more.

*Sigh* I just feel like the whole thing is hopeless and pointless. I don't feel like I'm giving any care even though I'm spending all my time giving care. I also feel like my license is on the line because I'm not doing any charting, but the patient is suppose to come first. Frankly there is no way I'm going to spend 2 or 3 hours after work catching up. That is just stupid. I should be able to have a life AND do a decent job at my chosen career. Heck most days I don't even really get to sit down to eat and maybe pee once if I'm lucky. I don't know how to get out of this! I got my BSN so I'm 48 grand in the hole, I can't just quit. I'm tired of people telling me that this is 'just the way nursing is'! If that's so then I don't know why we call it nursing, because it isn't. If I were rich I'd open my own hospital and do things right. I realize that we have to make a profit...we wouldn't get paid if hospitals didn't make a profit. But really do they need 3 and 4 times what it costs to run the place? UUUUUuuuuugggghhhhh! What do I do?

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    How long does your assessment have to be? If the patient is stable, breathing, pink, and the telemetry, IV etc is working/patent etc, I can write an assessment quite quickly and cover all the bases. You want to change shifts with a note saying all was well at hand off and so forth. it takes pratice but you can get faster with practice. I worked in a small rural hospital right after nursing school and I was thrown to the wolves. I was the only RN and would have to do every assessment on every patient in the building AND work the ER alone. Tough stuff.

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    How long has the computer charting been in effect for?

    It sounds like the hospital did a poor job of foreseeing any problems, but if it's been a short time things are bound to improve as they learn of these issues.

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    You have to do it all! Unfortunaltey that is the truth. I was recently written up because during one of our audits my manager discovered that I failed to do a fall assessment on a patient, not that the patient fell, but I didn't chart it in our HUGE PITA new computer. One of my co-workers was also written up for not having tele. strips in the chart every 8 hours. As nurses we are asked to do so much I wonder how long this pace & level of expectation can be maintained by nurses.

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    We have had computer CBE only for a few years now. It will get easier for you! Now we don't have to chart a note every 4 hrs unless I have a patient circling the drain, just chart an EOSS and KISS. Fall, pain, and skin assessment I chart when I first see my patient. Starting out with 4 patients at 1900 I can be done by 2000 with assessments and chart at the bedside IF I don't talk too much. Oh and we just chart one assessment per shift, in my case just once in12 hours unless there is a change. You will get used to it. It's much more quicker than paper charting.

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    Our computer charting sounds exactly the same as yours.. I used to really struggle and stay over 1.5 hrs most days just to chart the "necessities". Now what I do is try to chart the assessment right after I step out of the patient's room. It takes like 3 minutes to chart by exception and if you do it as you go it doesn't feel like you're drowning. Everything is also fresh in your mind as you go. Although some days when half my patients are calling out for PRN meds, then I feel guilty charting before I can get to them..and that throws a wrench in everything! I have to chart 2 assessments in a 12 hour shift but on the computer I can "copy" my own assessment to my reassesment and just change what's different. Good luck! Your floor sounds busssyyy!

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    We have had computer CBE only for a few years now. It will get easier for you! Now we don't have to chart a note every 4 hrs unless I have a patient circling the drain, just chart an EOSS and KISS. Fall, pain, and skin assessment I chart when I first see my patient. Starting out with 4 patients at 1900 I can be done by 2000 with assessments and chart at the bedside IF I don't talk too much. Oh and we just chart one assessment per shift, in my case just once in12 hours unless there is a change. You will get used to it. It's much more quicker than paper charting.

    What is EOSS and KISS? Thanks! :confused:

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    What is EOSS and KISS? Thanks! :confused:

    End of shift summary and keep it simple and systematic.

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    hmmm i have always heard KISS as keep it simple, stupid......

    the other responses all seem to be saying "it is possible".....is it? yes, the "assessment" gets quicker with experience....but what if you miss something? and 5 on days is too many, 6 is idiotic......good luck

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    Ahh, you must be dealing with the lovely Compass/Cerner system. And yes, it sucks. Meditech is better (assuming it's an updated version and not a circa 1986 patchwork like HCA in Austin has.) You will get faster on it. In my annual review I wrote that Compass was unituitive, difficult to use, and slowed me down. The boss sympathized but said that it was developed only to satisfy requirements for computerized charting. Ease in use had nothing to do with it.

    As for me, charting on an unexceptional patient is the last of my worries. I get my patient care done first and click on those million little boxes when/if I have time. And if they call me on it, so what. Their expecations are unrealistic and no one could meet them. Just take good care of your patients because that's why we're here.

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    hmmm i have always heard KISS as keep it simple, stupid......

    the other responses all seem to be saying "it is possible".....is it? yes, the "assessment" gets quicker with experience....but what if you miss something? and 5 on days is too many, 6 is idiotic......good luck

    There's high probability somthing would get missed or fall to the wayside with 5 or 6 pts on day shift. I never have more than 5 at night and day shift never has more than 4 at any given period. I would claim PTSD with the pt load plus new computer charting on top of that.

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    I've had a similar experience as you. One thing that you have to accept is that computer charting will slow you down. I can't tell you how many times I felt my BP rise while standing in front of a monitor waiting for the program to respond. I now use those extra minutes to focus and prioritize. Unfortunately, your employer has spent millions of dollars to convert to this system, so it is not going to change. Our unit had a log to record problems/concerns with the program. You should right down all of your issues and present them to your NM. Be patient, and good luck.

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    End of shift summary and keep it simple and systematic.

    Or Keep It Simple, Stupid

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