There is always a COMPUTER between me and my patient. We are required to scan meds to patient bracelets, enter admission and assessment date into the COMPUTER , text doctors and other departments from the COMPUTER.
I am looking @ the almighty COMPUTER much more than my patient. A major facility I worked for mandated that during the lengthy admission documentation, nurses ASK the patient if it was all right if they looked at the COMPUTER during the process!
They were, of course , aware that we must look at the COMPUTER more than the patient. The solution was to ask the patient for permission??? I feel typing is more valued than any people/ assessment skills I may have developed over the years. Data entry is the name of the game now.
I would so much prefer touching my patients than that damn COMPUTER!
Somebody wanted to know a patient's perspective....here's mine (also a nurse since 1985, but disabled since 2004- but keep license). I've been in ICU, a cardiac care unit, oncology, a cardiac hospital several times, ortho, intense rehab hospital, and regular med-surg over the past 7 years... The patient care techs by FAR do the most actual care. The nurses gave pills/meds, and most did the obligatory shift assessment (but not all). Then, they were gone ( a few would show back up; on oncology, I saw them much more often- which was great). Telemetry was a babysitter- if I still showed up on the screen, no need to check...
When I was a new grad, my first hospital job was on an acute neuro floor- 28 beds, 2 nurses, no aide on 11-7.... dipstick blood sugars (urine), no hoyers or lift systems, many trachs, crani's, closed head injuries, fresh laminectomies, strokes, head injury observations, and the progressive degenerative diseases AND whatever pediatric cases came in that were neuro- no pedi floor back then in that large city in Texas.... that means I had 14 patients, and I did ALL of the care and meds. When it was a 'good' night, my co-worker and I helped each other turn pts (a 'bad' night meant that it was too busy to catch up with each other)...otherwise I just had to sink or swim (and ended up with a back injury and 4 months or so off work on comp, ending up ON the floor I worked on as a patient). BUT, I saw my patients and gave them the care. And hand wrote all notes. No check lists.
I think progress is great until it takes us away from patients. Then it just makes us trained apes who 'phone in' the care...... JMHO. (and I miss it !) I can't imagine having done anything besides nursing- especially back when it was about the patient.
Oh, and I forgot, you have to type in your password for just about every single entry you make. That takes a lot of time.
Does it? How long is your password?
We use medhost in my ED and I cannot imagine functioning in an emergency department without computer charting. I can chart a comprehensive assessment quickly, see active orders instantly from any screen in the department, and check medication doses quickly with lexicomp online.
Computer skills are so important to have nowadays- digging your heels in and resisting rather than learning the new systems is a waste of effort IMO.
I don't think it's resisting computers- just having the time for personal interaction.... I hated it when nurses charted while they were talking to me. (and the ED is a different planet than the floor- lol :)). And when I had to assess 27 acute med surg patients as the only RN on the floor, I had my clipboard, and then charted on computer at the desk. But I was doing the assessment without a truck attached to me. :) I had my own system, writing down deviations from normal once I stepped outside of the room- the patients very rarely saw me write anything down while I was in the room.
Computers are a huge help in not having to have MD handwriting to deal with for orders, and much easier to look up specific info like labs and vs trends. But to me, it's another step away from patients to have handheld, or 'truck' computers/medcarts to deal with at the bedside. JMHO...
I don't think it's resisting computers- just having the time for personal interaction.... I hated it when nurses charted while they were talking to me. (and the ED is a different planet than the floor- lol :)). And when I had to assess 27 acute med surg patients as the only RN on the floor, I had my clipboard, and then charted on computer at the desk. But I was doing the assessment without a truck attached to me. :) I had my own system, writing down deviations from normal once I stepped outside of the room- the patients very rarely saw me write anything down while I was in the room.
Computers are a huge help in not having to have MD handwriting to deal with for orders, and much easier to look up specific info like labs and vs trends. But to me, it's another step away from patients to have handheld, or 'truck' computers/medcarts to deal with at the bedside. JMHO...
Saying that you were more able to give personal attention to 27 patients with paper charting rather than a (presumably) fewer number of patients with computer charting....is a little hard to believe. You can't step away from the computer to do your assessment and then go to your computer to chart? I find it hard to believe that there's no way to adapt your assess then chart method to computer charting.
When I had the 27 patients, I was in charge. I had 3 LVNs doing meds. The facility's system worked. Orders were entered into the computer, we had Pyxis for chargable items and meds, and it all worked. And I said I entered the data into a computer at the desk- not lugging something with me... we had handhelds, but it was like talking on a cellphone while with a dinner party- rude (maybe other systems are God's gift to nursing- in my experience, they were a royal PIA). But before that facility got computer programs for charting, they did have paper charting that was great- checklists for the assessments and pages for longhand charting . I didn't say I did paper charting on 27 patients :) (but I did on 24, with the chart forms JUST outside the rooms in a cabinet...didn't leave the doorway without doing the charting)....
Have you done purely paper charting? Have you had more than 5-7 patients at a time? (I can't see your years of experience on the reply page)..... if so, then obviously your experience was different- this is mine. Not about right or wrong- :)
This is not my current "work" situation.... No system needs to be changed...I'm disabled- still keep my license...worked for 19 years, an RN for a total of 26. When I started, we didn't have accucheck machines (dipped glucostix into urine), no lifts, some meds that needed glass syringes, etc. Back then, nursing was about the patient, not about avoiding lawsuits, or dealing with as MANY nutty families (visiting hours were usually enforced, unless someone really sick or dying and family was wanted BY THE PATIENT). A lot has changed- most for the better, but a lot of us older nurses did things that newer nurses now would quit a job over...back then it was simply how the job got done... :)
If I'm "hard to believe" then I guess there's not much I can do about that...with due respect- you weren't there when I experienced things the way I did, nor do I know what it's like for you.... just opinions :) (and yes, I know what they say about those).
Also just noticed (if it matters in the flow of the replies) that tntrn posted just before I did- if your reply was just to mine, that doesn't matter, but didn't know if you thought it was still tntrn.... just curious. Our user names are so similar.
I don't get how computerized charting takes away the "human touch" any more than paper charting. If we paper charted I could say that I am always looking at the chart, not my patient, there's always a chart between me and my patient, etc. Computerized charting for us has made a lot easier. I can look up what a drug is for right from the MAR; many of our forms have been consolidated online, making overall less paper work; I can easily find lab results and notes without hunting down a chart or going through mounds of paperwork.
After doing so many admissions, I've memorized what's on our admission paper work. I ask the patient those questions as I do the admission and go back and chart it. Our admission form isn't too lengthy, and a lot of it is common sense questions I would ask anyway. Once in awhile I forget something and go and ask it next time I'm in the room.
Maybe a solution would be having the nurses who use the progamming on a documentation committee to help make changes to the charting programs. There should be a committee for it somewhere in the hospital, trust me they are the ones who usually write what is and is not acceptable to use as abbreviations, etc. Find out who they are, and petition to make your programming easier to use, and make it seen as a "liability" issue. If the computerized flow sheets are difficult and time consuming and confusing, then nurses are not going to chart correctly.
My facility has very simple and easy computerized charting. It's also extremely thorough.
We have suggestion sheets, so that if you think someone needs added/changed, you can submit that to the documentation committee to vote on.
I prefer doing the majority of the admission paperwork on the computer in front of the patient, because the whole medical record is right there on the computer...and if the pt can't remember if they pneumovax (part of the admit), I can look in the chart and say, nope, but you can get one in the morning if you want, just sign this form!
Most, if not all, facilities buy their programs. Inhouse would be great, but to make everyone happy it would almost have to be by specialty (like who cares in neuro where someone's fundal height is?!! :)). That's not practical....
All I hear when people complain about the "shortage" of nurses is the horrible burden they have with the technology....well, stuff still got done in the past, and it was done by hand.... not saying it was all perfect. But, it seems that one camp is burdened by the charting, and another is so into the technology that they don't mind being in front of machines more than actually dealing with the patients (and I'm not saying that people ignore the patients- but I hear nurses constantly talking about the horrible load of computer work, having to wait for meds to be uploaded into the Pyxis (or whatever med dispensing system), etc....
Whatever. I'm glad I went to school when I did, and have had the experiences I have. All I hear now is how lousy things are.
Ours is a bought program, but it's still able to be made "personalized" to the hospitals needs. That's what the big bucks where shelled out for. Someone in IT isn't just wanting to do their job if they aren't changing some of the parameters. IMO.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
does it? how long is your password?
we use medhost in my ed and i cannot imagine functioning in an emergency department without computer charting. i can chart a comprehensive assessment quickly, see active orders instantly from any screen in the department, and check medication doses quickly with lexicomp online.
computer skills are so important to have nowadays- digging your heels in and resisting rather than learning the new systems is a waste of effort imo.
i've been using computers since 1987 and was introduced to what passed for the internet in 1988. i learned to "keyboard" (touch type) in 1972. i'm neither digging my heels in nor resisting. some of us, though, are forced to use crappy software, redundant charting and unrealistic time frames.
the other thing about computer charting (and i've been doing that since 1994) is that most of the computer workstations are set up and a lower height, anticipating that nurses will have a chair when they chart. each patient bedside has one chair -- and if someone offers it to the family, you have no place to sit. if i were charting on paper, i could go find somewhere i could chart comfortably. here, i have to chart where the computers are.
i've been using computers since 1987 and was introduced to what passed for the internet in 1988. i learned to "keyboard" (touch type) in 1972. i'm neither digging my heels in nor resisting. some of us, though, are forced to use crappy software, redundant charting and unrealistic time frames.
the other thing about computer charting (and i've been doing that since 1994) is that most of the computer workstations are set up and a lower height, anticipating that nurses will have a chair when they chart. each patient bedside has one chair -- and if someone offers it to the family, you have no place to sit. if i were charting on paper, i could go find somewhere i could chart comfortably. here, i have to chart where the computers are.
our computer stations are at standing height and the lower ones are at the nurses station and we do not let family members use our chairs. software doesn't have to be redundant and non-intuitive. unrealistic timeframes and unrealistic expectations seem more like management issues than issues with computerized charting. or am i meant to believe that if we went back to all paper charting, all management woes would magically disappear?
hiddencatRN- It's a great thing that your facility has their act together and has efficient programs and adequate numbers of computers and workstations and that your system as a whole works. But as the replies to this post show, not everyone has had the same experience. I'm in Ruby Vee's shoes- I have extensive experience with both paper charting and computerized systems and can tell you the strengths and weaknesses of both. No one is advocating a return to the stone age-as I heard one new grad say last month when we had unscheduled downtime and gasp! had to paper chart. We are just giving our personal experiences as it relates to the original post. Your comment that lack of user friendly programs and inadequate numbers of computers is a management problem is spot on- managers get an earful of product and service improvement suggestions from bedside RNs every time anything about charting is brought up- and yet hospitals still have multiple computer systems that don't interface and require redundant charting. Every additional keystroke takes away from bedside care- there is no disputing that fact. All any nurse wants is to use technology that enhances patient care, otherwise there is no reason to use that technology. My 2 cents worth.
xtxrn, ASN, RN
4,267 Posts
Somebody wanted to know a patient's perspective....here's mine (also a nurse since 1985, but disabled since 2004- but keep license). I've been in ICU, a cardiac care unit, oncology, a cardiac hospital several times, ortho, intense rehab hospital, and regular med-surg over the past 7 years... The patient care techs by FAR do the most actual care. The nurses gave pills/meds, and most did the obligatory shift assessment (but not all). Then, they were gone ( a few would show back up; on oncology, I saw them much more often- which was great). Telemetry was a babysitter- if I still showed up on the screen, no need to check...
When I was a new grad, my first hospital job was on an acute neuro floor- 28 beds, 2 nurses, no aide on 11-7.... dipstick blood sugars (urine), no hoyers or lift systems, many trachs, crani's, closed head injuries, fresh laminectomies, strokes, head injury observations, and the progressive degenerative diseases AND whatever pediatric cases came in that were neuro- no pedi floor back then in that large city in Texas.... that means I had 14 patients, and I did ALL of the care and meds. When it was a 'good' night, my co-worker and I helped each other turn pts (a 'bad' night meant that it was too busy to catch up with each other)...otherwise I just had to sink or swim (and ended up with a back injury and 4 months or so off work on comp, ending up ON the floor I worked on as a patient). BUT, I saw my patients and gave them the care. And hand wrote all notes. No check lists.
I think progress is great until it takes us away from patients. Then it just makes us trained apes who 'phone in' the care...... JMHO. (and I miss it !) I can't imagine having done anything besides nursing- especially back when it was about the patient.
Just my experience :)