Documentation, Scapegoating and Fear for Jobs.. The Current Status of Being an RN.

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  1. Do you agree?

    • 299
      Completely
    • 252
      Somewhat
    • 241
      Not at all

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My nursing career has spread over several hospitals and units, and in all my years I have never been more ashamed and frustrated to be a nurse as I am nowadays.

Between hospitals lack of money and the constant fear of being sued I have noticed a shift from caring about the patient to caring about proper documentation and "saving your own butt".

I am seeing a lack of comraderie between staffmembers, as they no longer have eachothers backs, but now overlook one another and write eachother up numerous times.

We are expected to document in both the paper and computer flowsheets, and are immediatly written up if something is charted in only once.

Animosity now exists between the ER and the floor, rolling their eyes.. refusing report and patient.

Management once had our backs and supported us when accusations were made from families or other staffmembers, but now they merely make a note in our file of the incidence, not wanting to cause waves as their own positions of middle management are unsteady.

Management now does 'quality assurance' everyday double checking our charting and making daily notations on how to improve our written word.

We have checklists for everything.. checklists to monitor the chescklists.. it really has become quite ridiculous.

I personally once was in the middle of moving a trached patient on a vent from stretcher to bed, and the nurse manager came in mid movement to ask about the MedReconciliation.. never once looking or asking about the status of the critical patient.

In defense everyone is acting out in fear of their job, fear of the DOH, CME, or Joint Commission showing up... all suits who do not understand the medical profession nor have realisitc expectations. I would truly like to see anyone of the Commissions work a full 12 hour shift in a busy ER without being allowed to have their bottle of water at the nurses station.

Nursing is no longer the "art and science" we were taught in school.. it is now "charting and fending for oneself". I have seen many incredible nurses leave the bedside practice because they can no longer deal with the micro-management of insignificatnt daily tediousness. Make no mistake,

I am no bitter nurse that is tongue-lashing after getting in trouble, and I am making a realistic observation of how the nursing profession has quickly moved its focus off of caring for a patient. I really wish nursing could go back to what it was years ago when we had a a sense of pride and comraderie... I fear what the future holds.

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I absolutely, completely (sadly) agree with what has been said here. The number one thing I hear at work is "document it... ya gotta save your butt." Charting is now done for lawyers, not doctors. Every tiny minute detail that is being done to the patient has to be documented. Most of the time is spent in front of the computer than with the patient so we can "COVER OUR BUTTS." It is really depressing if you think about it. I don't like how it is nowadays (I can say that about a lot of things).

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Specializes in Registered Nurse.

I agree completely. Some of the checklist for documentation are very long. The checklist used at my place of employment will also prompt nurses to give action plans for resolution of problems checked. Example > PLAN: The patient will stop eating 3000kcal day, discontinue over indulging in alcoholic beverages, and start self administration of prescribed insulin dose. HOW: The nurse will move in with the patient and hit him/her over the head when patient adopts unhealthy lifestyle choices. :banghead:

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I think nursing in general has taken a sad turn. I hope it's only temporary.

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Specializes in Critical Care; Cardiac; Professional Development.

I agree on the documenting. I disagree on the scapegoating. Where I work the team is very effective and supportive. I think there are bad and good work environments everywhere.

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Specializes in Assisted Living nursing, LTC/SNF nursing.

Try working in an SNF/LTC, same thing there only twice to four times the amount of patients and what you don't document, didn't happen. Team work is absolutely necessary but the shear number of staffing to Resident ration is ridiculous in most cases.

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Healthcare has become big business. At it's center is no longer sick, dying PEOPLE, but money. Documentation is how the hospital provides the payor source of the acuity of the client, the procedures, the medications, the supplies everything used to care for the patient so that they can bill and make money. All the while, the patient, is in an unfortunate trap of just being a source of dollar signs. The more the nurse does, the less staff they have to hire to care for the sick. Pushing nurses to their max, squeezes every dollar back into the healthcare system. Documentation and double documentation is the ONLY way you have to protect yourself in such a crazy and busy world of health care. The rules, are becoming impossible. Patient satisfaction, documentation and double documentation, unrealistic expectations, and not a kind word of thanks, but a demand to produce more. Health care is not what it was more than 25 years ago when I was in nursing school. Health care is now about the all mighty dollar, and protecting yourself because there is nobody else out there that will help protect you. It even shows with the old eating their young, and the rest milling around trying to fight their way through the system. No answers to the problems, just an observation to the situation.

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Specializes in Critical Care, Education.

I blame this on a complete failure of nursing leadership. It's their job to create and maintain an environment that supports nursing practice. That is the sole purpose for requiring an RN for those jobs. :no: My advice - vote with your feet. Find a new job in a more supportive environment as soon as you can.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I blame this on a complete failure of nursing leadership. It's their job to create and maintain an environment that supports nursing practice. That is the sole purpose for requiring an RN for those jobs. :no: My advice - vote with your feet. Find a new job in a more supportive environment as soon as you can.
I agree 100% Unfortunately, administration do not want this type of manager any more....it's why I left management.
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Healthcare has become big business. At it's center is no longer sick, dying PEOPLE, but money. Documentation is how the hospital provides the payor source of the acuity of the client, the procedures, the medications, the supplies everything used to care for the patient so that they can bill and make money. All the while, the patient, is in an unfortunate trap of just being a source of dollar signs. The more the nurse does, the less staff they have to hire to care for the sick. Pushing nurses to their max, squeezes every dollar back into the healthcare system. Documentation and double documentation is the ONLY way you have to protect yourself in such a crazy and busy world of health care. The rules, are becoming impossible. Patient satisfaction, documentation and double documentation, unrealistic expectations, and not a kind word of thanks, but a demand to produce more. Health care is not what it was more than 25 years ago when I was in nursing school. Health care is now about the all mighty dollar, and protecting yourself because there is nobody else out there that will help protect you. It even shows with the old eating their young, and the rest milling around trying to fight their way through the system. No answers to the problems, just an observation to the situation.

I agree with you completely, and thanks for understanding my pov. While I understand that yes, hoapitals are businesses that need to make money, it shouldnt come at the price of good patient care and supporting nurses. We have been stretched thin by every department possible and are expected to spend half our shift in front of the computer, now with even less staff in order to 'meet the budget'. Its astonishing what has happened to the profession.

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The Joint Commission does understand the medical profession (in order to be a surveyor, you are required to have extensive nursing/medical background), and does have realistic expectations (go to the Joint Commission website, and read their patient safety goals, which are extremely realistic).

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The Joint Commission does understand the medical profession (in order to be a surveyor, you are required to have extensive nursing/medical background), and does have realistic expectations (go to the Joint Commission website, and read their patient safety goals, which are extremely realistic).

So defensive of the Commission without any supporting evidence. Im sorry, have you ever worked in a trauma center ER for 12 hours without being allowed water? Our lounge is off the unit and down the hall, and thats where we are expected yonhave out only sips of water.. Because god forbid we keep a bottle at the nurses station. I have also personally seen them randomly quiz nurses on who the environmental and safety directors are... Sorry I have my 5 patients fresh in my head instead. This is justs the of iceberg ive witnessed during surveys. Neither expectation there is realistic.

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