A nurse friend of mine had the day from hell at work the other day. He was telling me all about it. Patients moving, discharging, admitting and too many patients from the get go. Just chaos all day. Then he gets a call a couple of days later asking about a personal belonging of a patient that was missing, he didn't get the inventory sheet done on admit. So they are looking for this one item. He said he didn't feel that doing the inventory had a very high priority when insulin was past due and patients were asking for water and to go to the bathroom and admissions had to be done. So I guess the jist of it, he is being told this must be done, MUST on admission. I don't like what is happening to nursing, can't the nurse set priorities anymore? Is everything an absolute MUST? How are nurses supposed to get anything done that is important if inventory sheets are listed as a high priority?( just an example). I think the world has gone crazy sometimes. He says there are signs all over the place that the hospital is not responsible for valuables and families are to take them home. He did not unpack for her, her family did. So he thinks he may get fired for this. Seems a bit much to me.
He also said that most of the nurses don't change dressings, do actual assessments, etc, but chart that they do it because it is a must, because the work load is more than a human can handle. It is really scary to be a patient in a hospital I think. I wonder if it is like this everywhere?
Everyone should think about that issue. There's no way in h I am going to falsify a legal document, commit fraud, or essentially perjure myself because of others' unholy demands. I prioritize as best I can, do as much as I safely can, and will answer for my decisions if necessary.
I won't do it either, yet I see and hear both nurses and CNAs getting their orifices ripped because all of their assignment check boxes were not checked off that shift, and that is not acceptable....what is not acceptable is the forced falsification of charting that exists in dozens on SNFs .
There is this silly axiom in nursing: "If it wasn't documented, it wasn't done."
The only thing less true than that is the assumption that "If it was documented it was done."
If you make somebody's livelihood dependent on documenting having done something that is impossible to do, they are going to document it.
8 hours ago, panurse9999 said:
I was constantly guided by "not documented, not done" mentality,
I know! As I struggle to find my footing in nursing, with about a year of experience, I realize that I am starting to think more in terms of "making my charting look good" than actually taking good, critically-thought-out care of the patient.
I can think of a specific example - there was a box I needed to check off - so I did, but it actually didn't make much sense at all in relation to patient care. I feel upset at myself. I'm going to try to do more mental checks and think through things more instead of going on autopilot and checking the boxes.
Sounds like an average day for me. Honestly, the only thing I document in terms of belongings are electronics, jewelry, and dentures. No complaints yet but I'm sure it'll happen.
On my floor, everything seems to conveniently fall back on the nurse. Not inadequate staffing, not insubordination by other staff. Just nurses. For example, our floor does daily weights of every single patient on the unit and it must be done before 6am, right around when we also have to do all the patient's lab draws. We have no house keeping, we have no phlebotomists, we have no unit secretary or free charge. We have CNAs that refuse to do brief changes, linen changes, answer call lights, blood draws, or do weights. Management is aware and none have been fired. Do you think every patient gets weighed, every linen gets changed, and every dressing is changed when we have up to 6 patients on drips (be it amio, heparin, argatroban, etc.) or continuous bipap/pulse ox monitoring? It isn't possible. But we had a physician complain that a patient wasn't weighed, so this became a top priority and the nurses are expected to pick up the CNA's slack on my floor.
On day shift, I recall one administrator going around to check if each IV tubing had been labeled with when to change it. She went around everyday with a clipboard documenting which nurse and which room didn't have labeled lines. In the time it took her to do this, she could've been the freaking designated line labeler. But no, just another mandatory task for nurses to complete.
That's the state of healthcare these days. If your floor doesn't seem similar, it will eventually, especially without a union.
Wow! and I thought I worked on the floor from hell. I do agree, more of the cna's duties/responsibilities are falling on the nurse. I've noticed in the past few nurses meetings there's something new added for the nurse to do or make sure something gets done. Where's management? why can't they pick up some of these extra duties? We have nursing students on our floor and the look some of them have on their faces tells it all. Of course, they are assured they would be welcomed when they graduate, but they're scared off because of the amount of work nurses has to do where I work.
Wow! and I thought I worked on the floor from hell. I do agree, more of the cna's duties/responsibilities are falling on the nurse. I've noticed in the past few nurses meetings there's something new added for the nurse to do or make sure something gets done. Where's management? why can't they pick up some of these extra duties? We have nursing students on our floor and the look some of them have on their faces tells it all. Of course, they are assured they would be welcomed when they graduate, but they're scared off because of the amount of work nurses has to do where I work.
CNAs??? What are those? Last hospital I worked in used the CNAs as transport aides, and we were lucky if there was even one on the floor, who was not also cleaning the rooms in lieu of housekeeping. In the rare case, we had 2, but were lucky to even get the vitals done.
My facility does make a big deal about the inventory sheet but we can delegate to the CNAs. It is co-signed by the patient.
although its common for people to check off treatments they haven't done, most of us don't do that in my facility. If i truly don't have time to do it, I don't do it and I say I didn't do it while asking the next shift to help me out.
Unfortunately things like inventory sheets and documenting to show not just what is going on with the patient but to ensure payment is maximized takes away from things like dressings and treatments. Its sad, truly.
Unfortunately, even in the short time I’ve been a nurse (13 years), things have changed immensely....it’s gone from providing outstanding patient care to being about corporations, JCAHO scores and cutting corners....it’s a travesty really....
Thats nice that you are still in touch with every single one of your ADN classmates to know for sure they are working in hospitals. Ask them if management did to them what is happening here, forcing them to be in school at their own cost, to get the BSN, or be terminated. (which basically means working full time and attending school part or full time). Thanks.
Quit with the passive aggressive BS. Ironically, we actually DO stay in touch and just had a reunion a couple weeks ago where people announced where they worked. They also announced where they were being hired at prior to graduation when our professors surveyed us. And no, unless they're working downtown, they aren't forced to get their BSN. Do feel free to share your own experience, but don't imply it's universal, just as I haven't.
I don't envy anyone. The pressures have greatly increased and the temptation for fraud goes with it. Documenting things you didn't do. Horrible quality documentation, which I see all the time at the SNF.
One week a patient weighs 97 lbs, a week later 296.
There are fines for poor care, but nowhere near enough.
A couple of years ago, a SNF LPN had the nerve to document that treatments weren't done, because there was no one here to do them.
My theory is that nursing tasks should be like a balanced budget. Like my budget, not like the federal budget. If I decide to do one thing with my money, I understand that there is something else I won't be doing, as I will run out of money. Time is no different, as no matter what you want, there are only going to be 60 minutes in every hour.
So- feel free to add a task. But either remove one of equal time value, or make a couple more efficient. But, if you think about your last two years, consider what tasks have been added, and what tasks have been removed. It is literally impossible, so stuff is either being faked or done to a substandard level.
While working in the ICU, I was asked what I thought of the new flowsheet. (somehow there is always a new flowsheet.) I asked my boss if she had decided what I should stop doing. I got the same quizzical look I often get from my dog- "I know those words somehow relate to me, but I can't really put it together." I explained in simple terms that at that point, my shift was already full of tasks. The only way to add a task would be to remove a task, or to do some of my existing tasks less diligently, and I would like her input on what to stop doing. She changed the subject.
I like analogies. I would like one day to go into an administrator's office with a pitcher of water and a glass, and explain the the glass is my 12 hour shift, and the water represents tasks. I would put the glass on the desk, ideally on top of some critical paperwork, then fill it to the brim with water. "As you can see, my my shift is full to the top with tasks. Take this pitcher, and lets see what happens when you add something to a container that is full."
Many administrators possess at least basic intelligence. They can perform basic tasks like getting dressed, starting a car. Some can even do higher level stuff like using a check book and baking cookies. I have seen some do complex stuff like planning a vacation, coordinating lodging, food, transportation and entertainment. How they can miss some of the most basic concepts is beyond me.
This post is a work of art and deserves recognition. I hope administrators and nurse managers are reading this.
Quit with the passive aggressive BS. Ironically, we actually DO stay in touch and just had a reunion a couple weeks ago where people announced where they worked. They also announced where they were being hired at prior to graduation when our professors surveyed us. And no, unless they're working downtown, they aren't forced to get their BSN. Do feel free to share your own experience, but don't imply it's universal, just as I haven't.
A lot of hospitals have shifted in the direction panurse describes- if you don't have your BSN within 2 years in my system you're out; but they don't hire ADNs in the hospitals at all- only private practices and SNFs. The only way into a hospital as an ADN in my area is if you know someone who has a real hookup, otherwise you're starting in home care, dialysis, or subacute until you get your fancy BSN.
And the shift from hell in the OP is exactly what we see here. Worse in subacute settings.
There is this silly axiom in nursing: "If it wasn't documented, it wasn't done."
The only thing less true than that is the assumption that "If it was documented it was done."
If you make somebody's livelihood dependent on documenting having done something that is impossible to do, they are going to document it.
So very true! Also, just to be sure, documentation is the very least important thing I do as a nurse. Sure I'll start compression, but first I need to be sure to document the time and depth.
My theory is that nursing tasks should be like a balanced budget. Like my budget, not like the federal budget. If I decide to do one thing with my money, I understand that there is something else I won't be doing, as I will run out of money. Time is no different, as no matter what you want, there are only going to be 60 minutes in every hour.
So- feel free to add a task. But either remove one of equal time value, or make a couple more efficient. But, if you think about your last two years, consider what tasks have been added, and what tasks have been removed. It is literally impossible, so stuff is either being faked or done to a substandard level.
While working in the ICU, I was asked what I thought of the new flowsheet. (somehow there is always a new flowsheet.) I asked my boss if she had decided what I should stop doing. I got the same quizzical look I often get from my dog- "I know those words somehow relate to me, but I can't really put it together." I explained in simple terms that at that point, my shift was already full of tasks. The only way to add a task would be to remove a task, or to do some of my existing tasks less diligently, and I would like her input on what to stop doing. She changed the subject.
I like analogies. I would like one day to go into an administrator's office with a pitcher of water and a glass, and explain the the glass is my 12 hour shift, and the water represents tasks. I would put the glass on the desk, ideally on top of some critical paperwork, then fill it to the brim with water. "As you can see, my my shift is full to the top with tasks. Take this pitcher, and lets see what happens when you add something to a container that is full."
Many administrators possess at least basic intelligence. They can perform basic tasks like getting dressed, starting a car. Some can even do higher level stuff like using a check book and baking cookies. I have seen some do complex stuff like planning a vacation, coordinating lodging, food, transportation and entertainment. How they can miss some of the most basic concepts is beyond me.
The real kicker about this is that there's never a solution on their end. The answer ultimately always boils down to "you need to do better" without any specifics as to how.
If you're in management/administration and the only direction you can give is "start doing better," maybe it's time to start looking in the mirror.
panurse9999
1 Article; 199 Posts
I won't do it either, yet I see and hear both nurses and CNAs getting their orifices ripped because all of their assignment check boxes were not checked off that shift, and that is not acceptable....what is not acceptable is the forced falsification of charting that exists in dozens on SNFs .