Documentation has ruined nursing

EHR was not built for the end user. Data extraction, compilation and business metrics is the real goal.

A nurse's time is just not considered that valuable. Doctors and other providers too deal with the demands of EHR as well.

EHRs are not about improving patient care in any way. They are about proving aspects of care likely to cause problems for a hospital or facility. Documenting Q2 hour turns sometimes takes longer than the turns themselves, but if someone gets a pressure injury and family sues the hospital, the documentation is all the hospital really cares about. It's incredibly frustrating that almost every nurse on the planet would rather spend the time with their patients than chart the time they spent, but as was pointed out, every level of healthcare has become the same way. The charting my primary care physician had to do for my well visit was definitely longer than the visit itself, but they can't get paid if they don't click all the right boxes. 

Yes, having to stay an hour or two after the shift ends, just to complete all the documentation is not appreciated by the administration, because it means paying overtime. Maybe a ratio of fewer patients per nurse would help. You can only do so much in 12 hours, but God forbid you don't chart everything everywhere.

As a preceptor, orienting new hires, I get very frustrated that people think that if there is a line in a flowsheet, something has to go into it. 

Nurses complain about having to document too much, but then document stuff that they don't need. For example, if a pt resp status is WDL, there is no reason to chart "regular and unlabored" when that is the EXACT definition of what WDL is. Or, if a pt has an amputation, one should not be charting that the pedal pulse is "not accessible" when there ISN'T A FOOT. 

I have my MSN in nursing informatics and use this to try and help optimize the flowcharts as well as teach people how to chart more efficiently. 

I'm sure I am going to get flamed for my opinion, but that's how I see it. 

mmc51264 said:

As a preceptor, orienting new hires, I get very frustrated that people think that if there is a line in a flowsheet, something has to go into it. 

Nurses complain about having to document too much, but then document stuff that they don't need. For example, if a pt resp status is WDL, there is no reason to chart "regular and unlabored" when that is the EXACT definition of what WDL is. Or, if a pt has an amputation, one should not be charting that the pedal pulse is "not accessible" when there ISN'T A FOOT. 

I have my MSN in nursing informatics and use this to try and help optimize the flowcharts as well as teach people how to chart more efficiently. 

I'm sure I am going to get flamed for my opinion, but that's how I see it. 

I cannot agree with you more.  People document too many unnecessary items and double chart.  

So glad I'm retired ?

Emerald_Coast said:

So glad I'm retired ?

We actually had a few nurses retire so they didn't have to learn EPIC LOL I, on the other had, had a great affinity for it immediately and became a super-user. That's what got me interested in informatics. 

mmc51264 said:

Nurses complain about having to document too much, but then document stuff that they don't need. For example, if a pt resp status is WDL, there is no reason to chart "regular and unlabored" when that is the EXACT definition of what WDL is.

I think part of the problem there is that clicking a box doesn't feel as complete and true as making some comment about your findings using...words.

After all, lazy people who don't perform thorough assessments (or perhaps don't perform the full assessment needed to ascertain that the WDL definition is met) can click WDL just as easily as someone who performed a very thorough assessment. Your amputation example is a classic example of this very thing, where some box-clicker clicked that the distal pulses are present or WDL bilaterally when there is no foot.

I'm not arguing that we should go back to writing out all of our findings, just saying that rather than something like pure stupidity/work-making I think there is probably a desire to give some indication that yeah....I actually did this.

I found myself doing this just today; though it isn't my habit. But when a patient is complaining of constant wheezing, for example, and upon my exam I find that there is excellent bilateral air movement and no adventitious sounds of any kind, it doesn't feel complete to just click the WDL/normal box just as I did for all the other normal body systems. It reads as though the patient was wheezing (since they are having constant wheezing) and I went through as fast as possible and clicked every WDL box and called it a day.

$.02

I miss the old days of L&D when you would just jot a quick note on the fetal monitor strip, and the strip would just print out in a pile on the floor, and you went back AFTER the delivery was over, with your strip spread out in front of you, and you charted everything you did. You had exact times recorded for everything because it was right there, written on the strip. You actually got to spend the time with your patient, rather than charting.

Trouble is the mixed messages nurses get. 

On one hand we are told that if something isn't charted, it wasn't done. We are told stories of nurses who escaped unscathed from legal troubles due to their excellent and comprehensive charting. If your hospital has had trouble with Joint Commission, then the charting hysteria really begins. Nurses charting will really get audited then to make sure you documented the exact times you held and restarted that Propofol for your Q2 hour neuro checks, and have the flowsheet documentation to follow up.

Other times, nurses will get blamed for overcharting as a reason for poor time management. Before Joint Commission made a visit, there was actually a nursing committee formed to look into ways that charting could be streamlined and reduced. No changes were ever made.