Do you think we are over regulated?

Specialties Geriatric

Published

To the point that it's impeding how we do our jobs and actually compromising care?

Every time state comes in to do a survey and we get a deficiency, we are given a new piece of paperwork, or computer charting or "tool" to do in addition to everything else. The longer we spend on paperwork the less time we can spend with patients. Our CNA's are now spending so much time doing ADL computer charting torwards the end of the shift that they can't get out on time.

Or take the example of falls. Every time someone falls we have to think of a new intervention. You know some residents that if you googled fall risk, their photo would pop up they do it so often.

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Specializes in M/S, Travel Nursing, Pulmonary.

Yes. A lot of what we do has taken the wrong turn and ended up being a shadow of its prior intention:

Documentation was meant to be a way for nurses to communicate with nurses and other care team staff. Its pushed in school that we "document defensively". We are so busy writing article sized nurse notes "Just in case that pt accuses us of not fluffing the pillows" that we...............end up being more concerned about the note than the pt's well being.

Pt. education. Its every facilities new white whale. Used to be we "talked to" pt's instead of talking at them. We are so consumed by having to get this form printed and handed to them or get this or that education done so we can check the box for it..............we don't have time to say "How are you".

It takes too much busy work to get simple daily things done. Had a nurse tell me she wouldn't get a fan for a pt who claimed they could not sleep unless one was on them.................because she couldn't get the doctor's order for it. Yep, it takes an order from the physician to have "individualized equipment" in the room. What do you think that pt. will give us on the PG survey?

Other professions don't have to write an article about everything they've just completed as they do it. Can you imagine an accountant having to write an essay each time he fills out someone's taxes? Production would come to a screeching halt. But, somehow, people don't put two and two together and realize........................if we are bogged down by paperwork...........care is sacrificed. Period. No amt. of threats to our jobs or pep rallys will change that.

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Specializes in OR, OB, EM, Flight, ICU, PACU.......
To the point that it's impeding how we do our jobs and actually compromising care?

I recall a study in the 70's by one of those big, New England think tanks, that showed Nurses and Doctors spent 43% of their time with paperwork. In the good, old , modern 21st Century, it's now 50%.

You tell me.....

:down:

:twocents:

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Specializes in LTC, assisted living, med-surg, psych.

I have to agree with you all on this one. I know that out of a typical eight hour shift in my facility, at least three hours are spent on documenting everything in triplicate. Which is three hours NOT spent with my patients, assessing them and looking for signs that all is not well.

I understand that "not documented=not done". But why must everything be written in three or four places when one should suffice? TPTB have got to know that the higher number of places you have to write down, say, a blood-sugar reading, the higher the chance of missing one, and the higher the likelihood of making an error. Now how does that improve the care you're giving to the patient? Does it make your sliding scale insulin dose more accurate? Or, does it increase the possibility that you'll get so bound up in the paperwork that you give the wrong dose, the wrong insulin........or forget to give it at all?

I've been doing this a long time, and I have rarely, if ever, seen an instance where extra paperwork improved the care that was given on the floor. :banghead:

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Specializes in Cardiology and ER Nursing.

Pretty much everything the government get's involved in gets F'ed up. The intentions are generally good, however, a large bureaucracy just can't function effectively.

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Specializes in LTC/Rehab,Med/Surg, OB/GYN, Ortho, Neuro.

I wouldn't mind the paperwork if I had the staffing that went along with properly taking care of my patients.

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I am certainly not defending excessive paperwork, but, just in terms of regulation (the OP's original question), I worked for several years as a hospital surveyor for my state and the Feds (acute care hospitals, not LTC) and I can tell you that all those regulations are reactive, not proactive. States and CMS are not sitting around thinking up new regulations and requirements for healthcare organizations/facilities because they're trying to think of ways to make life better (or even improve care) for residents of nursing homes or hospital clients -- new rules and regulations get put in place because someone, somewhere (or, more likely, multiple "someone"s in multiple "somewhere"s -- a problem usually has to be a pattern to end up justifying a new rule/reg), did something awful that had a really bad outcome, and all the relevant agencies sat up after the fact and said, "Golly -- we've got to make sure that never happens again!"

And it's typically not the regulating agency that specifically requires that more paperwork be done -- surveyors find that facilities are out of compliance with a rule or reg, but don't dictate to the facility what they need to do to comply with the reg; the facilities are free to determine for themselves the best way (for them) to comply with the rule. However, adding more documentation (paperwork) seems to be the answer most facilities come up with.

I can assure you that, if you'd seen some of the gawdawful ugly messes my team encountered in my experience surveying hospitals, when they knew we'd be coming to look at them (all our surveys were unannounced, but they knew we'd be coming at some point during the year), you'd agree with me that we need more regulation, not less, and more oversight, not less, in healthcare. I can tell you for a fact that we cannot just assume that (all) healthcare organizations and facilities are going to do the right thing just because it's the right thing to do ... :)

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Specializes in Critical Care.

I'm all for quality control and standards. However, a lot of it has become a debilitating monster. How can we teach new RNs not to be task-oriented automatons, when it has become all about dotting the "i"s and crossing the "t"s?

And I soooo disagree with "if it's not charted, it wasn't done." That is a total logic fail. As we all know, many things get done that were not specifically charted, and sadly we've seen things get charted that we know were not done.

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I wouldn't mind the paperwork if I had the staffing that went along with properly taking care of my patients.

AGREED !!!!!

SOMEONE NEEDS TO SAY SOMETHING HOW "OVER STAFFED" we are and hows all of the sudden the directors are so involved in patient care and on floor procedures. these state people should pass a law, to keep coming back and placing fines on hospitals everytime whenever they are under staffed, and policies get cut because of insufficient resources.

THEN is when NURSE would be HAPPY!!!!

BUT im SURE the REPUBLICANS get paid enough money by big HEALTH CARE CORPS for this to NEVER PASS!!!!

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Yes I agree, I am so worried about doing paperwork since theres so much and I'm very new to to all of it....and sometimes I will think well the patient is more important only to get some emails or complaints that I forgot to do a specific piece of paper....

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Specializes in Gerontology, Med surg, Home Health.
AGREED !!!!!

SOMEONE NEEDS TO SAY SOMETHING HOW "OVER STAFFED" we are and hows all of the sudden the directors are so involved in patient care and on floor procedures. these state people should pass a law, to keep coming back and placing fines on hospitals everytime whenever they are under staffed, and policies get cut because of insufficient resources.

THEN is when NURSE would be HAPPY!!!!

BUT im SURE the REPUBLICANS get paid enough money by big HEALTH CARE CORPS for this to NEVER PASS!!!!

And you think the DEMOCRATS who passed the faulty health care reform are going to give us MORE money? They have cut both Medicare and Medicaid funding.

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And you think the DEMOCRATS who passed the faulty health care reform are going to give us MORE money? They have cut both Medicare and Medicaid funding.

And now our less stable residents are losing their beds. Thank you, man I voted for. What a sop to the insurance companies.

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