In my opinion many of the requirements set up by organizations such as the Joint Commission are written by out of touch people who spend years acquiring advanced degrees, yet lack the down to earth experience of working in the trenches of healthcare. Much of what they require seems to be based on nursing theory, and strikes me as being straight out of academia.
They create a workplace that seems more like an obstacle course. There are codes required to get into supply rooms, fall precaution sheets to fill out by the end of the shift, pain assessments to be done with mandatory numbers to plug in based on a pain scale that is not universally applicable to all situations.
Regulating bodies are staffed by people who often don't understand the day to day reality and flow of work that healthcare providers face. They create systems that totally frustrate doctors, nurses, and other providers.
I hear a lot of complaining from doctors as well. They are on our side. They share our pain. Their stress levels are up because of the increased demands on their time be systems put into place that are highly inconvenient to those of us providing direct care to patients.
What I see in my interactions with physicians is a similar mindset that I hear from nurses. They are sick of people in offices making their professional lives more difficult with inconvenient regulatory overkill that tries to solve problems by creating more documentation.
Doctors and Nurses need to unite with other healthcare disciplines to bring common sense back into healthcare! We are on the same team!
Specializes in Community Health, Med-Surg, Home Health.
One of the things that saddens me is that while trying to comply with these outrageous demands from regulatory agencies is that I believe we spend more time performing document care to cover our butts than we do patient care. I can think of too many times where I would say to myself that I have to get to my notes, find that policy (that mysteriously disappeared) or think too hard before I write while a patient needs my assistance.
Just last week, a friend of mine that works permanently on med-surg told me that now each patient has to be offered a pneumococcal vaccine; and the doctor has to be called to come down if they refuse and additional paperwork and computer work has to be done. She has to stay by the telephone after paging the doctor (who clearly doesn't want to be bothered with a refusal-hey patients do have rights), only after all of that is done, that many patients change their minds hours later. Now, it may sound like a small issue, but it's not. Time has already be wasted by the nurse and the physician, yet, if it was left simply for the nurse to document the refusal, give teaching and move on to more emergent things, that more patients would get well needed attention for more acute issues. A pneumococcal vaccine is just one issue. Imagine the other insanity that can waste a day, stress a nurse out and possibly cause a mistake that can do serious damage. These fools need to stop...really.
I also have grown to hate JCAHO. Working at the bedside IS an obstacle course, great analogy!! But don't blame nursing theory or academia for this insanity. It is corporate and governmental bureaucracy, not university professors, that have created this mess. Increasingly, nurses cannot give the care patients need because of all the rules and protocols. For every patient JCAHO and state regulations have helped, they have hurt a dozen more. It's just no fun to be a doctor or a nurse anymore, and no matter how hard you try or, increasingly, even how few patients you manage to have, you just absolutely can not get the nursing done. How in the world do new nurses manage all this nonsense when they still don't have a grasp of the basics of patient care? Or is it harder to be an older nurse or doctor and remember that it used to be so much easier and satisfying for both the patients and ourselves. And then we have to add customer service into the mix...
It seems that each year a new "focus" is decided upon which simply adds more and more and more work for us each year; and at the same time they are not hiring as many people to do all this extra work. Honestly, how many more mountains of "focuses" can they pile on us before we crush under the pressure!?! Heaven forbid we actually spend time taking care of patients!!
And each new focus comes with more documentation.
"For the new goal, we've come up with new (read: complicated. time consuming) ways to document that it's being done. Check off this for 'xyz', write this note on 'blah.' Go to this class on your day off to learn about the 3 new areas to computer chart this in."
Good grief.
And this year it's about early detection or rescue or something to that effect. Might have to rescue us from your BS first, so we can do our jobs.
We need our own comission.
Agenda #1: Downing documentation overkill.
Agenda #2: Burning P-G at the stake.
And with less people leaving in droves from 1&2, it will hopefully help with -Agenda #3: Staffing
I think between liability issues in a society that encourages litigation as a solution of first resort and the technological ability to store and process data, organizations have gone overboard in documentation requirements.
Pretty soon, we'll just videorecord every room and hallway to ensure that people are doing their jobs right... and then have to employ another full set of people to review the videorecordings... and another set to follow-up on infractions...
The ideal of having every last thing fully documented and to be able to "catch" every last error and to 100% prevent avoidable problems is simply unrealistic and as we see isn't the most effective use of resources.
Specializes in ER, ICU, Infusion, peds, informatics.
not to mention that all of this "extra" charting causes our nursing documentation to seem worthless.
take fall precaution and restraint flowsheets: who really uses that information? people who audit charts -- not people taking care of patients.
charting has become so standard, that you don't learn much about the patient by reading nursing notes. we are so busy charting all of the crap that we don't have time to chart the important stuff.
i was looking into a code that happened several months ago, and know what was charted about the events leading up to the code? absolutely nothing. according to the nursing notes, the patient went from getting insulin at 10pm to going to the morgue at 6am. nothing was charted (in the notes) between those two events. but the fall precaution and restraint documentation were current (up until the time of death, which was about 2am). sigh.
we are so busy charting all of the crap that we don't have time to chart the important stuff.
what should only take hours takes us at least two days to document on every assessment and reassessment because of our state and federal government's
mindless regs. to make matters even worse, we no sooner get acccustomed
to documenting what they want....when we receive another directive telling us to document the same information a different way. if we don't comply, they
take monies away.
i've been in this business going on 39 years, and what used to be a fairly simple and straightforward task of documenting nursing observations, assessments and interventions has turned into an unqualified nightmare.
You all make such accurate and well stated comments!
I wasnt to add that this problem isn't unique to healthcare. Just ask any public school teacher what they think of the 'No Child Left Behind' federal education program.
You all make such accurate and well stated comments!
I wasnt to add that this problem isn't unique to healthcare. Just ask any public school teacher what they think of the 'No Child Left Behind' federal education program.
Don't even get me started about that!
My son was actually threatened with jail time a few years ago when my granddaughter was sick and he couldn't produce a written excuse from her Pediatrician for every
day she missed school...even though the doctor had made it clear to them in her original note that she was too sick to attend and did not need a daily office visit to document her absences. The school systems are going after everyone, in fear of being placed on the government's dreaded "Needs Improvement" list because of poor attendance records.
A parent (or guardian) who doesn't give a flying fig whether or not their kids go to school or not is one thing....but a parent keeping a sick child at home is another...and the government needs to stop interfering.
Specializes in med-surg, psych, ER, school nurse-CRNP.
I wasnt to add that this problem isn't unique to healthcare. Just ask any public school teacher what they think of the 'No Child Left Behind' federal education program.
I am not a teacher. I was a full-time school nurse for a couple of years, and I can tell you that THAT program is baloney! I know of one woman who would bring her wheelchair-bound, spina bifida-stricken little girl in every day, who could do nothing, not even grunt or track with her eyes, bless her, and leave her. The school had to provide for her, and the mom, as she put it "got a break for 8 hours a day, for free!"
The school put special-needs children in mainstream classrooms, with their own aide, which caused no end of disruptions. An autistic child has no place in a mainstream classroom. It's cruel. They don't process things the same way, and this child would run around the room, trying to get out. The aide would chase him, and it would create havoc all around. But, guess what? The mama insisted he be in there. "There's nothing wrong with Ian. He's fine. He never acts that way at home."
And the kicker? Federal program.....we're paying for this, guys. We pay these people to make this mess up and impose it. How's that for irony?
i was looking into a code that happened several months ago, and know what was charted about the events leading up to the code? absolutely nothing. according to the nursing notes, the patient went from getting insulin at 10pm to going to the morgue at 6am. nothing was charted (in the notes) between those two events. but the fall precaution and restraint documentation were current (up until the time of death, which was about 2am). sigh.
my nsg notes will always remain my first priority.
psalm, RN
1,263 Posts
We have been told no drinks in "patient care areas" but to me the nurses' station isn't where I give pt. care.