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

Chaya, ASN, RN · Oct 10, 2008

hey guys, had 4 patients today, not only did I do patient care, but my sheets were up AND signed (imagine that), and charting was done by 1400!!
It did make me feel good that I was actually able to provide care and please management. But it's the days that everything goes south by 7:30, you have doctors and families in constant battle, and you have either A: I want my pain meds every hour, or B: a really sick person that needs help....what about those days....when it's all you can do to make sure no one dies.....
am I really inadequate, or do other nurses struggle with this???

The words I live by are "Life is about Plan B". I pretty much expect **** to happen at this point in my career, and am happily surprised when it doesn't! Usually I can work around it when I get 2-3 well-placed curve balls in the course of a shift. But it's those days when you get 2-3 unexpected things happening at once that have me running to catch up all day, and especially if it's as soon as you walk on the floor and take report. All you can do is:

1) prioritize (A,B,C/Airway,Breathing, Cardiac-which one isn't breathing or has no pulse...that's the one you start with and hopefully resolve before other patients go critical!) and

2) Delegate; hopefully another nurse can get that pain med for a less critical patient, or a NA can get someone out of or back into bed for you. Luckily our charge RN's usually step in to direct traffic flow when stuff is happening to 2-3 pts at one time and they will assign whoever is free to do whatever they can.

#) And then there are those days I never do catch up and you find me doing paperwork and notes long after my shift ends...:)

lee1 · Feb 15, 2009

Do you have to sign a special "contract" that you are doing the 1 hour rounding???? Does anyone, or even for 2 hour rounding?????

rngolfer53 · Feb 15, 2009

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 wouldn't be at all surprised if many patients would opt for the bigger screen TV rather than more nursing attention.

Managements don't want to spend more money than needed on facilities any more than on nursing or other expenses. If they're spending those extra millions, it's likely because "clients" tell them that's what they want.

babydoll99_99 · Feb 15, 2009

I didn't read all of the replies, so this may have been said before, but I use Meditech too and at our hospital we got IT involved. Don't ask me how, but there is a way that IT can program Meditech that instead of using the F9 lookup function you can have the choices out to the side and just hit numbers for your answers. It doesn't seem like it would save a lot of time, but it really does. Especially if you have a pt that is out of your ordinary range of charting.

Also you have to keep on top of your CNAs about pt rounding. I just let them know that it is their hour to round, and if I see them not doing it I will gently tell them that I would appreciate it if they would stick their head in on pts this hour. Usually that does it. I am aslo really careful to make my hour the hours that VS are done and the most accuchecks are done. That takes away the added pressure for the CNAs and it gets done more often. If I have an emergency and can't round, then I can't round. I don't worry about it. If asked I simply state why the round was not done that hour.

I hope this helps. Get on your IT team, it really has helped.

CO2emission · Feb 16, 2009

I know there is no turning back but I've been around long enough to remember the Nightingale wards. The desk was in the middle and you could see all your patients. When patients were put into private rooms or bays, they could no longer be seen or heard from a central point. This opened up many cans of worms. Patients were deteriorating and no one noticed. Patients who needed help could no longer get it in a timely way and...now we have to do houly rounding to observe and document our patients conditions. Some aspects of the old days had their merits!

eyeball · Mar 12, 2011

Let's hear from some management types -- I KNOW you're out there. What advice can you offer and HOW can you defend these unrealistic expectations?

This is part of the problem....On this thread (and truthfully this entire website) we are preaching to the choir. In my hospital there doesn't seem to be any honest dialogue between management and the foot soldiers (us) about the realities of nursing care/health care. There's lots of phony sucking up and a grim cheerlessness to the entire operation. And BTW Meditech still stinks....it is the clumsiest computer program and at times when I'm especially stressed and frustrated I think it's just another ploy of the powers that be to put us in our place.

I reiterate the quoted post: Are there any management people here and what do you have to say in response to the posts on this thread?

Katie5 · Mar 12, 2011

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 complain too much. You are supposed to be there 12hours for the patient/work. Be there fully and give that time.

If we spent as much time working/finding solutions as we do complaining, the world would be a better place,in this case, nursing would be a better respected profession!!!!

OCNRN63, RN · Mar 12, 2011

You complain too much. You are supposed to be there 12hours for the patient/work. Be there fully and give that time.
If we spent as much time working/finding solutions as we do complaining, the world would be a better place,in this case, nursing would be a better respected profession!!!!

In case you haven't kept up to speed with this thread, it's three years old, and the OP got another job.