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

[PedsRN25]

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.

[nynursey_]

If I think about it, it would be a safe bet to say I spend 99% of my day charting for some reason or another, whether it be an assessment, or several nurses notes supporting an incident with significant background data and my response as to not miss a beat and cover myself. It's pathetic.

[SecondCareerRnInKy]

It is sad to see that I am not the only experiencing the same workplace stressors. A comment was made to me from the night shift nurse supervisor about me staying until 8pm to finish charting, my reply was "It is a testament to the fact that I was in my patients' rooms today spending time with them". I had a nurse tell me "I make my patients wait, by god I will finish my charting first before anything else". As a new nurse (6 months to date) I am very discouraged.

[nynursey_]

It is sad to see that I am not the only experiencing the same workplace stressors. A comment was made to me from the night shift nurse supervisor about me staying until 8pm to finish charting, my reply was "It is a testament to the fact that I was in my patients' rooms today spending time with them". I had a nurse tell me "I make my patients wait, by god I will finish my charting first before anything else". As a new nurse (6 months to date) I am very discouraged.

I hear/see this all the time. Since my WPM limit is on the high end, I can chart in my care plan pretty quickly throughout the day. It helps that the care plan has specific patient-centered goals as outlined by the nursing dx, and so my supporting documentation is typically r/t patient progress (or non-progress as the case may be) throughout the day. I have, however, seen/heard new RN's (

[redhead_NURSE98!, ADN, BSN]

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).

Agreed. Each surveyor probably has more experience than everyone who commented on this put together.

[redhead_NURSE98!, ADN, BSN]

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.

For someone who is so torqued about the Joint Commission and management you seem to be fixated on a bottle of water. The Joint Commission doesn't give a rip about your water except to the extent that it violates OSHA's bloodborne pathogens standard, which prohibits the consumption of food and drink in "areas in which work involving exposure or potential exposure to blood or other potentially infectious material takes place, or where the potential for contamination of work surfaces exists." So if you're going to fixate on water, at least blame it on the proper governing body and understand why the ban exists. OSHA and your state's version of OSHA will come and fine the facility for your beverages as well. Maybe they should make a policy allowing your beverages if you agree to pay the fine when the regulating authorities come around.

It is what it is. Get a Camelbak and a scrub top one size larger. Problem solved. Management will just wonder when you got the hunchback.

[mtngrl, ASN, RN]

My life is charting. I am so burned out. I regret even becoming a nurse. We are constantly scolded like little children, I feel like we don't get the respect we deserve at all.

[Guttercat, ASN, RN]

are expected to spend half our shift in front of the computer

This. ^^^This chaps my hide for bedside/floor nurses more than anything. This being said, I'm not so sure the problem is staff being expected to spend half their shift at the computer (including all the gadgets...charting, phone, meds, etc.,) but rather an entire medical system that is constantly operating behind the curve of technological demand.I've been at this gig (nursing) for a long time, and I truly like technology, but never have I seen nurses so buried in gadgetry that the patient has become an afterthought. Even the patient him or herself now has to navigate a complex system of buttons and gadgets to ring a call bell: Press #1 for ice request; press #3 for bathroom; Press #4 for pain medication; press #2 for channel 13.Help. I've fallen, and I can't get up.

[Ginger's Mom, MSN, RN]

CMS aka Medicare is demanding the charting, we are all to blame for not protesting when CMS comes out with new documentation requirements, How many of you have posted on their website when new measures are being proposed? Fact is no documentation in the correct format the government will not pay for the patient's care. Also the government is reducing reimbursement, Have you written to your Senator and Congressmen?

[amygarside]

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

Me too. I hope this is temporary.

[SummitRN, BSN, RN]

Having just acheived return of spontaneous circulation on a code, the Nursing Sup pokes her head in and asks: "Why aren't the restraint flowsheets filled out?"

[redhead_NURSE98!, ADN, BSN]

This. ^^^This chaps my hide for bedside/floor nurses more than anything. This being said, I'm not so sure the problem is staff being expected to spend half their shift at the computer (including all the gadgets...charting, phone, meds, etc.,) but rather an entire medical system that is constantly operating behind the curve of technological demand.

It IS quite obnoxious. I think currently our nurses are charting about SCD's in three different places in the computer charting. And I have to sit there and defend it by saying "I'm sure one of them is connected to corporate's monitoring system, one is tied to billing, etc. They are have to be completed." WE JUST WANT TO BE ABLE TO DO OUR JOB AND DOCUMENT WHAT WE DID!!! Why does it have to be so redundant? And in my opinion it's an AWESOME way to get a med mal lawyer to eat you up, since the documentation is bound to be inconsistent on one of the three screens.

[VersatileRN]

Been doing it 15 years and I'm very young. I'M GETTING OUT. NURSING SUCKS!