How do you get the nursing care done with hourly rounding & computer documentation?

[medsurgrnco, BSN, RN]

I work on a high-acuity med/surg unit and typically have 6 patients. We are now expected to do walking rounds, hourly rounding on patients documented on a form at the patient room (alternating with CNA's who often don't do it), document extensively in Meditech, do 24-hour chart checks, and respond promptly to patient phone calls and bed alarms. Anyone have any advice on how to get everything done timely? Also, does anyone have suggestions on how to document quickly in Meditech? I've used the system long enough to know the basic key functions and we can use the F5 key, but those F9 lookup tables are long and cumbersome. And doing patient orders is difficult as I often have to make many guesses to find an item.

[oldiebutgoodie, RN]

Hmmmm...

Sound like my hospital. You will not be able to get all those things done. The only thing you can do is prioritize, and make patient care your priority. Your manager will probably yell at you, but what can you do? Or you can be a good "documentation nurse" but give patient care the boot.

We are between a rock and a hard place. I also think Meditech is a lousy system, but you can't change that.

Wish I had words of advice. I think that hospitals are expecting the impossible.

Oldiebutgoodie

[Roseyposey]

I work on a high-acuity med/surg unit and typically have 6 patients. We are now expected to do walking rounds, hourly rounding on patients documented on a form at the patient room (alternating with CNA's who often don't do it), document extensively in Meditech, do 24-hour chart checks, and respond promptly to patient phone calls and bed alarms. Anyone have any advice on how to get everything done timely? Also, does anyone have suggestions on how to document quickly in Meditech? I've used the system long enough to know the basic key functions and we can use the F5 key, but those F9 lookup tables are long and cumbersome. And doing patient orders is difficult as I often have to make many guesses to find an item.

We don't use Meditech, but my hospital just started doing the same things - mandatory hourly rounding and document on top of the SBAR type form for each patient in addition to the normal report sheet and we already did 24-hour chart checks. All this is well and good if we only had 3 patients, but as you said, with six it's nearly impossible. I try my best to round often and spend as much time as I can with my patients, but one new admit or fresh post-op and that chews up a solid hour right there. It' almost like they're looking for one more way to hang us! In addition, because they evidently don't have enough to do at the administrative level, they've decided that nurses aren't allowed to wear print scrub tops of any kind any more - all solids.

[CVICURN2003]

I work on a high-acuity med/surg unit and typically have 6 patients. We are now expected to do walking rounds, hourly rounding on patients documented on a form at the patient room (alternating with CNA's who often don't do it), document extensively in Meditech, do 24-hour chart checks, and respond promptly to patient phone calls and bed alarms. Anyone have any advice on how to get everything done timely? Also, does anyone have suggestions on how to document quickly in Meditech? I've used the system long enough to know the basic key functions and we can use the F5 key, but those F9 lookup tables are long and cumbersome. And doing patient orders is difficult as I often have to make many guesses to find an item.

you must work in an HCA facility...welcome to our world...we can't care for the pts because the paperwork MUST get done....

[medsurgrnco, BSN, RN]

I appreciate the agreement from others that management expects too much of RNs at my job. But this is the expectation for us, so any ideas on how to deal with the situation?

[medsurgrnco, BSN, RN]

So nobody in this forum has a clue how to satisfy all the current expectations of RNs in units like mine, even tho management thinks it can all be done? Obviously no RN can do all assessments & meds due in the first 3 hours of the shift on 5-6 high-acuity med/surg patients when part of that time is taken up getting report, giving report to the CNAs, answering pt/family questions, leftover stuff from day RNs, with repeated interruptions from phone calls and bed alarms and pts needing assist to BSC, and having to inefficiently do your tasks because you must go do your hourly rounds. How in the world could anyone also computer document during that time? And if you get an admit in that time period... I've read elsewhere that RNs typically spend 1-2 hours after their shift ends completing documentation, but management really hates paying for overtime, and it's hard to document accurately so much later and when I'm so wiped from running top speed all night and not having time to take breaks I'm entitled to in order to care of myself. So how do other RNs prioritize all the tasks? If I don't make patient care my priority and cut corners, then I compromise patient care/safety.... Yet if any adverse event occurs, not fulfilling the documentation expectations timely will be treated as proof that I'm not providing good patient care. And if CNAs are found lacking in their work, then it's my fault I didn't fix that problem. With Pyxis machines, tracer tags, and rounding sheets, management can easily check the timing of your tasks and get on your case if you don't meet time expectations. Anyway, I'll switch my account so anyone can send private messages, in case that'll increase responses as maybe others don't feel safe discussing this stuff in this forum. Again, I'd really appreciate any advice or comments from others!

[pagandeva2000, LPN]

Most people prioritize. There will always be something left out, unfortunately, but be sure that the patients are safe. I know some nurses take shortcuts by shorter notes, but, it is basically impossible to do ALL that they say.

[medsurgrnco, BSN, RN]

Reducing documentation seems to be one of the safer ways to save time during a shift. How much time do others spend documenting? How much time is saved by not complying with some of the overkill documentation expectations? Other RNs I work with don't allow patient calls to interrupt current tasks so that they can work more efficiently, which works as long as the call isn't about a confused patient with a bed alarm going off.

[NRSKarenRN, BSN, RN]

OP looking for more replies

[BUTTERFLY63]

This sounds an awful lot like my hospital! It is impossible to accomplish all the things upper management wants us to do. It is all about patient satisfaction scores. We aren't a hotel and I didn't go to college to be a hostess.

The only answer I can come up with is to change nurse patient ratio. Of course upper management won't go for it because it would be more money out of their pockets and they wouldn't get their bonuses.

A question I think they should ask patients on their stupid surveys is would they rather have a nurse with 4 or 5 patients or a nurse with 6 or 7 patients!

I know I am a good nurse and I love being a nurse. So when upper management comes up with all this patient satisfaction and hourly rounding ******** I smile and nod my head in agreement and just keep doing what I always have been doing!

[rnmi2004]

I work on a high-acuity med/surg unit and typically have 6 patients. We are now expected to do walking rounds, hourly rounding on patients documented on a form at the patient room (alternating with CNA's who often don't do it), document extensively in Meditech, do 24-hour chart checks, and respond promptly to patient phone calls and bed alarms. Anyone have any advice on how to get everything done timely? Also, does anyone have suggestions on how to document quickly in Meditech? I've used the system long enough to know the basic key functions and we can use the F5 key, but those F9 lookup tables are long and cumbersome. And doing patient orders is difficult as I often have to make many guesses to find an item.

Magic beans and rainbows are the answer.

[RNBelle]

good ol meditech. i didnt know anyone else was subjected that pain in the butt. do you have the magic workstation version of medictech? i find that easier. once you get more experienced with it, it will get easier. at our hospital nurses make rounds on odd hours and cnas on even hours. but depending on how my night is going that is a pipe dream. i usually have 6-8 pts a night. its all a balancing act. if i have a high acuity pt that is worrying me she is at the top of my list and i may spend most of the night working with that pt depending on the problem. we have awesome cna's on our floor and the other RNs really help out.