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?
The hardest thing to learn is delegation. You HAVE to delegate some stuff. It sounds like you're trying to take on too much. Charting doesn't have to be a novel, keep it to the facts. You really have to take time to chart because the golden rule is...if you didn't chart it, it wasn't done and it's your license on the line. Nobody is going to pat you on the back and say "Well, her patients were at least clean and dry." I do jump in and help out the patient care aides when I can, but getting my own work done comes first. You have to prioritize and delegate. You can't do it all...
You have to do both. You always take care of your patients first and then you chart the essentials. Both are very, very important. It's a new system so you'll take a few weeks to get used to it, but you'll learn. If you're still having problems with it beyound that, then there might be a time management problem on your end. You need to learn to delegate certain tasks. For example, if a patient calls you and asks for a cup of ice, but the CNA is busy and can't get to it for 15 minutes, then the patient needs to wait. It won't be the end of the world for the patient. I agree there are some things that shouldn't wait 20 minutes, like a soiled patient. That part is OK. But I hardly think that what is setting you back is helping your CNA with soiled patients. I think that you may be doing things that can be delegated and doing things that are not necessary. Maybe buying a book on priortization might help with this problem, too. Just remember... you worked hard for your license and it's your license that's on the line every time you go to work. Prioritize, prioritize, prioritize.
Patients can't sue you over not getting a blanket or ice chips in a timely fashion. Remember that.
Specializes in Certified Med/Surg tele, and other stuff.
I would take charting over pt care at this point. You have to cover your own butt. I certainly don't spend a lot of time on the floor like I used to. I have way to much paperwork. The first thing I do, when I get out of report is go do my assessments. Granted, I'm waking them up at 4am, but I can generally sit and chart in a few minutes, my initial assessment and get it out of the way.
Specializes in Infusion, Med/Surg/Tele, Outpatient.
What I do to keep my own head above water: I go see my pts 1st thing, make a narrative note with any abnormalities, then also throughout the day every time something is not normal (gave a prn for nausea etc) I make a quick narrative note. Like for example, pain treatment - darvocet n100-650 2 tabs po. Later I will go back and fill in that the pt reported 8/10 shoulder pain. On a morning assessment my note might read: trace edema bil LE, pt c/o constipation, abdomen distended, last bm 3 days, foley cl/y, 20g lt FA D51/2NS @50, pain 0/10. When the day gets calmer, usually 1000-1100 I'll go back and fill in the "assessment" and any blanks in my charting. On the worst days, when nothing gets filled in until after report, it'll only take me about 30 minutes.
Specializes in L&D,surgery,med/surg,ER,alzheimers.
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.
I wanted to add to my above post: At the little rural hospital I worked at for about 5 years, I would be the only RN on staff for much of the time, if I worked nights especially. I would have to write the assessments on 20 plus patients. We used paper charts and it was common for only one RN to work the shift. You learn by doing. And of course you need telemetry strips in the chart q shift or you will be written up, some things never change.
Thanks for all the replies and advice. This program has been implemented since October 2009 in my hospital. I have gone to manager and asked for a more specific example of CBE, but she wasn't really able to help me out. I think the truly horrid thing about my hospital is the lack of the KISS principal (however I have heard from traveling nurses that this is a common problem among most hospitals). I want a very structured procedure to follow, thus when I deviate from it I will probably be able to understand the reasons I took the steps I did if I ever had to look back on it. For example, I have worked for two different hospitals...
Hospital #1 in a code scenerio:
-People yell out their position (r/t their responsibility). Like I would say "Documentation RN!" Out loud so everyone would hear and know what I was doing. There were several mapped out positions to take in a code situation from techs to doctors. Each position had assigned responsibilities and a base of 10 things that needed to be done at the beginning of every code no matter what....For example, Bedside nurse's responsiblites would be the following:
1) establish a 20 or 18 gage IV access if one was not already established
3) Draw a rainbow for labs
2) Draw up and administer meds ordered by MD and yell out what is being administered
3) assess ABC's and yell out assessment results
4) etc...etc...
Now some of these may seem like common sense to most people who have been in the field for many years, but I think it is time to realize that some pretty darned inexperienced people are the ones involved with codes. It would be alot more efficent to have a plan. The cool thing about all of this was that except for being the "doctor" in a code nurses learned all the "steps" of everyone below them. This created an enviornment where if my brain was freezing up because I was starting to panic I could just recite the ten things I had to get done and go through the motions. Most of the time by the time I got the 10 things done I could think more critically and jump in where need be. It made us very smooth, calm, and coordinated in a time where panic could quickly take over.
Hospital #2 (my current hospital that I'm contracted to stay at until the end of June) in a code:
The current plan is whoever notices a patient in danger or possibly coding needs to go find the nurse or get the charge nurse or call the code team.
As you can see, one has an actual plan and the other has well I don't know what to call it. EVERYTHING they do at my current hospital is like this!!! "You need to chart by exception!" Well alright I will...to what extent I know CBE. Then they'll go, "You need to chart by exception, but you're forgetting to chart your skin assessment every shift." Well see to me if I am charting by exception, if nothing has changed from the previous assessment that I see noted, then why do I need to chart anything anywhere unless something has changed? (Now I know why it is a gosh darned good idea to chart something everyshift and I make notes on my own on all of my patients, but why it is a good idea and what the baseline course of action is are always two different things.)
I left hospital one because it was a very, very large teaching hospital that did not get to be very personel to their patients. I've moved to a smaller hospital but the lack of organization and structure kills me! I've tried to explain what it is that bothers me so to my manager and director, but I got in HUGE trouble for opening my mouth. If other small hospitals are truly like mine as some of the traveling nurses I've met have indicated, then I think I have entered the wrong career. There is just no way with that sort of lack of structure that any company can offer decent care to a large number of people.
shiccy
379 Posts
Or Keep It Simple, Stupid