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Our unit is doing charting audits for JCAHO standards. One of the things we are expected to do (and have fallen short in doing) is chart education on a pt each shift. The sheets for doing this are kept in the chart, so needless to say, not alot of ed charting is done. I originally made the suggestion to allow the nurses carry the sheet so it's not an out of sight, out of mind kind of situation. This was not acceptable because the manager is afraid we will lose them. Also, she states that all disciplines are supposed to be charting on them as well, so if the nurses keep them, noone else will have access. Keep in mind the other floors let the nurses keep the ed record with the flowsheet, I&O record, etc.
Ok, so I performed my own little audit and found that of the 12 pts we currently have, only 2 of them have been charted on by non nursing staff. Also, I believe each and every one of you day shift nurses can agree that you hardly ever get your hands on the pt's charts.
So my first thought is shot down; back to the drawing board. So I come up with plan B: make a second page of the education sheet and put it in the binder which holds the pt's MAR. This way, a copy stays in the chart for the non nursing staff (to not chart on) and a copy is easily accessible to my fellow nurses.
When I woke up this evening I had a message from my manager. She was upset with me for "removing the education sheets from the chart and putting them in the MAR". The end of her message was "I'm very upset about this. Goodbye."
I promptly called her office and left a message letting her know she was "misinformed" that I did not remove anything from the chart, I just made a second copy and put it with the MARS--won't get lost, and nurses will have easy access.
I have managed to stay under the radar up until this point, but I am very, very upset that it took a blatant lie to put me on the screen. Now, let's say that noone is able to find any fault with my "plan B", who wants to bet I will never hear any apology from anyone. Also, I go soooo above and beyond for these day nurses by staying late to start IVs on ECT days and priming IV bags, filling out parts of the discharge summaries (meds pt is being discharged on and a few non assessment items) and doing anything else I can. The day nurses are basically performing 2 jobs at once (caring for a full load of inpatients and being a PACU recovery nurse), so they are being abused to say the least. All I am trying to do is help. In fact, I am most helping the specific one who lied to rat me out. I'll bet ya next Wednesday morning, those bags won't be primed if she is the actual ECT nurse. I'll probably still do the IVs because that affects the poor inpatient/recovery nurses.
I am going to stew on this all weekend, and I'm already coming down with something, so the added stress is not welcome. I'm already thinking that if I get written up for disobeying a direct order, I will probably refuse to sign. I've said this soooooo many times, but why do nurses do this to fellow nurses?
Without a doubt, pt ed is one of our most important jobs. We can care until we turn blue in the face. If the pt goes home and has no clue what to do, we've virtually wasted ours and their time. I'm saying the charting is rediculous. The more we have to chart, the less time we have to care. Thank you for your kind words. That is one of the things I love about this job...I am appreciated by my fellow nurses. And as I said before, I probably most helped the nurse who lied about me. I feel I've been a bit blindsided, but life will go on.
hoolahan, ASN, RN
1 Article; 1,721 Posts
Three things.
One, pt ed is super important. As a home health nurse, I can tell when a pt has had any teaching or not and I always marvel when they have been well prepared, and wonder how on earth the busy hospital nurses find time to do it w all the other things going on. Jacho sucks, worthless papertrail. BUT, it is important for you to take credit for what you do, it truly truly DOES matter and makes a HUGE difference to the pt's, so charting it is important for maintaining the value of nurses to. Look at it from that perspective and hopefully it will be more bear-able.
Two, I APPRECIATE YOU taking that time to write the pt's meds like you cannot imagine!! When I get to the pt's home, many times the Rx's are at the pharmacy being filled, and the referral says under meds "see d/c instructions" and if that isn't filled out, I am doomed, and we have to make another visit the next day just to be sure we can cover the med teaching. Best I can do the first visit is say please carefully read the material the pharmacy sends w your meds, write down your questions, call us or the pharm if you have any questions before we come back.
Just wanted you to know, your hard work is greatly appreciated
by me!!
Third, lying is never acceptable. What goes around does always eventually come around, I've been in this field long enough to see it a few times, she'll get hers....and she'll hang herself, I promise.