Ive been a nurse for 7 years, almost 8.. Before that I was a CNA for 3 years. IVe worked med/surg, tele, been a float nurse, done agency, and now I work in an icu. Ive worked at a multitude of facilites and dealt with all kinds of charting.
Before nursing I obtained an associates in computer information systems, was an A+ certified computer tech, and was well on my way to obtaining my microsoft network engineering certificate.
I know my way around a charting system, and I know my way around computers.... But I see a trend. And I dont like it.
More and more it seems like people who have absolutly no concept or background in bedside nursing are creating programs and dictating charting on us who live, breath and sweat bedside nursing. either that or they worked bedside in the days of 20 patients and blanket warmers for blood.
Im also seeing a "customer" approach to patient care, which is complete pc bullcrap. No customer in the world is allowed to spit, ****, assault, or cause chaos in any business in the world. No customer has the potential of dying at any moment in any business (except planes of course, but people dont fly planes because they are sick as hell)
Add this together and you have more and more charting taking away more and more from patient care.
We had a new system come online today in our hospital and I had an admission. Fairly stable, came to the icu for initial bipap support until lasix and antibiotics get her better.
It took me 2 and a half hours to do her admission assessment, and her regular assesment. If she was busy, it would of been a nightmare. Mind you... I know how to chart. This was a system problem. It should of taken me no more than a half hour.
I am finding more and more as time goes on, we have more and more charting added on to us... expectations that far exceed reality when it comes to charting.. especially in the presence where no overtime is allowed.
I am finding that I have to rush true nursing care like a bed bath, or repositioning a patient because of the amount of charting.
I love my job, but I can not see myself continueing as a bedside nurse much longer if this continues. I dont know how ethicaly I will beable to when my job is turning into 75% charting, 25% patient contact.
Im rambling now, Im tired, and I worked a 12 hour shift then went to the gym before venting this... but I am getting very frustrated with the way nursing is going.
I disagree Grace Thats the perfect person because as a bedside nurse t hat person would know what we need and as a "computer geek" would know how to cut out all the extra copies of the same forms, in a different order, for a different department, or whatever cockamamie system these so called professionals are coming up with!:throcomp:
Well, again though, you're missing the point which is that this nurse wants to do MORE bedside nursing. Going into nursing informatics is a bad idea for someone that prefers actual bedside nursing. Just because someone is good with computers, does not imply that they like working with computers, or want to have a job using them. My guess is that if OP wanted to work on computers and designing software, he would have pursued that as a profession, and not nursing. The OP may very well be good at nursing informatics, but may be miserable at it, so it would be a bad road to take imo. Since bedside nursing is what this nurse wants to do more of, finding a field of nursing that is more patient-based and less documentation-heavy seems like the most logical avenue.
We need people like him to go into NI so that the madness stops. (OK, so it slows down a little at least.) How many times have you been charting and had the thought "A floor nurse would never have this set up this way"? It's perfectly clear that the input on the software end comes overwhelmingly from people who have not spent any time at the bedside. Which is an incredibly poor business model anyway, from a purely objective point of view. It means that a significant amount of R&D hours go into a product that the end users are frustrated with to the point that they are thinking about leaving their careers. Honestly, I don't know of any other industry that's this bass-ackwards.
I grew up the daughter of a computer geek. We got our first computer before I was in kindergarten, so long ago that there wasn't even a hard drive. I married a computer geek...when we moved in together, our first shoppping trips weren't for furniture, they were for computer parts so that we could build out first computer. When we were preparing at work for EPIC to go live, I was a super-user....I asked my boss if I could be one b/c I knew that there would be issues and wanted to be able to be involved in helping to fix them. I put through so many tickets on how to make things better that the support guys recognized my voice and knew how to spell my name without asking after the first day. The vast majority of my requests wouldn't even have come up if a handful of actual bedside nurses were involved in a product-testing phase.
It's so frustrating to know what the systems should be capable of, and instead have it waste our time. We have the technology, I know that it wouldn't be that difficult to fix the flaws within it and add customizeable parameters to certain areas within the program, and it would make everyone's life easier.
If only the software develpoers had to deal with Press-Ganey surveys from us. Maybe then we'd see some changes.
The current EHR systems are a huge obstacle for nurses... none of them actually reflect the way that care is delivered. "Meaningful Use" is adding even more work... making sure patient education documents are integrated into the EHR, manually emailing discharge instructions to patients, flipping through a bazillion screens to document any other new requirement that comes along, etc.
My vision??? We just wire the whole dad-gummed place -- motion sensitive a/v technology in every patient room to capture work as it occurs. The nurse would just 'dictate' any actions or observations that weren't obvious - "checking IV drip rate" "noting increased respiratory effort". No need to make any extra entries at all. OK, so maybe we're not there yet. What about simply hiring a 'transcriber' (like court reporters) to accompany each clinical person & record all the 'stuff'. It would undoubtedly be cheaper than paying nurses to wade through all the layers of EHR required to document care provided.
Of course, I also think that all bedside nurses need to have access to the type of wearable robotics that Sigorney Weaver wore in the original Alien.... no problems turning patients, right??
I think down the road Ill look into teaching. I know I will be doing tons of papers, but I think Ill actually enjoy that.
I did just that (Masters nursing ed, online), and found that I actually enjoyed a fair number of the papers just because I was finding out so many new, or at least a different way of looking at things.
They just switched our T sheets, specific to a presenting complaint in the ER, to one generic, tightly printed and very incomplete 2 sided page, with very little room to say anything. It is supposed to be leading into what will be on our computer screens next year. I find I am writing out all my real assessments anyway, so it will be in the chart SOMEWHERE.
If I could pay my mortgage and bills on just my teaching salary, I would seriously consider leaving the bedside, but the sad truth is my BSN bedside pay is about a third higher than my MSN teaching pay. And like you OP, I enjoy bedside care in the ER.
Well Mikeperkins RN you have listened to all of us give our opinions on what you could do to make our lives easier, but I just wanted you toknow that you have my support whatever you decide!!! :mnnnrsngrk:
...Add this together and you have more and more charting taking away more and more from patient care.
I am finding more and more as time goes on, we have more and more charting added on to us... expectations that far exceed reality when it comes to charting.. especially in the presence where no overtime is allowed.
I am finding that I have to rush true nursing care like a bed bath, or repositioning a patient because of the amount of charting.
I don't have anything to add, but this really resonated with me. I feel like my actual job is paperwork, and then patient care comes when I can fit it in...
I work tele and have multiple admissions, discharges and transfers on any given shift. I am always in a mild state of panic not just because of the acuity of my patients but because of the amount of paperwork that accompanies each one (and we still use paper charting):
Admission? New stack of paper.
Give pain meds? Note it on the paper MAR, chart about it, fill out the Pain Assessment form.
Start a new IV? Chart about it, fill out IV sheet.
Pt has a medi-port or a central line? Chart about it, fill out Implanted Access Device Sheet.
Heparin drip? Chart about it, fill out Heparin Flow Sheet with each PTT. Oh, don't forget the MAR.
Post-cath, post-pacer, cardiac gtt? Chart about it (!), document on post-vascular flow sheet q15, q30, etc.
CHF patient? Chart about teaching, then complete CHF Teaching flow sheet.
Anti-Coagulant on the MAR? Oh, sucks to be you. Chart about it, teach it, chart about teaching it, fill out Anti-Coag teaching flow sheet.
Discharge or transfer? Oh, Lord.
Hourly Rounding Sheets? Check.
I&O Sheets? Check. Don't forget to chart it on the graphics sheet in the chart along with V/S (which you have already charted about in your, well, charting...)
Shall I go on? I could.
I find myself wanting my patients to stop talking to me so I can get to my paperwork! With all all the admits and discharges in one shift, I might have to do all this on ten or more patients. Complaints fall on deaf ears. It has to stop.
Unfortunately, this is the main reason why so many of the nurses (incuding myself) in my ER are leaving....
We went from T System to Meditech, and it is a disaster. We are a cardiac hospital, and see a seriously high acuity to not be a trauma center. At one point on Friday, I looked up at our Tracker (huge plasma TV in the nurses station) and EVERY PATIENT in the ER was an acuity 1, 2, or 3. All of the patients in all 25 of our rooms, and all 10 or so patients in the waiting room.
The problem is, Meditech has you repeat SO much information, doesn't ask important assessment questions, and it takes forever to nagivate through. We are all charting assessments on patients we have barely seen before they get admitted. It's just honestly dangerous, esp since I dont have the experience to fake ANYTHING.
Because we are so slow, we get backed up, but we have sick people in the waiting room, too! So, Friday, as I'm triage, when I have ONE room open, do I put this 17 year old possible appy who is crying in pain, this chest pain with a BP of 195/98, or this belly pain that's vomiting all in the waiting room, back? I really feel like they all need to be back. But who knows when another room will come open.
Those days are so frustrating. Ugh. All because of the SYSTEM!
Im also seeing a "customer" approach to patient care, which is complete pc bullcrap. No customer in the world is allowed to spit, ****, assault, or cause chaos in any business in the world. .
I have been a critical care nurse for 35 years and have seen charting increase exponentially over time. I hate all the useless documentation we do. I do, however, feel that a good computer documentation program really decreases my work load. We use EPIC and I think it has actually made documentation easier! The vital signs automatically come over into charting, the I&O's are automatically added including running totals for the entire hospitalization. Most of the useless info we document is mandated by the joint commission or the federal government. Documentation in the computer has changed my work flow but I don't think it has necessarily made it more burdensome.
I have been a critical care nurse for 35 years and have seen charting increase exponentially over time. I hate all the useless documentation we do. I do, however, feel that a good computer documentation program really decreases my work load. We use EPIC and I think it has actually made documentation easier! The vital signs automatically come over into charting, the I&O's are automatically added including running totals for the entire hospitalization. Most of the useless info we document is mandated by the joint commission or the federal government. Documentation in the computer has changed my work flow but I don't think it has necessarily made it more burdensome.
I'm excited to here that. I'm switching jobs to somewhere that uses EPIC and I've been curious to see if I was going to run into ANOTHER terrible charting system. Glad to know its helpful because Meditech for SURE doesn't do any of those things.
CaregiverGrace
97 Posts
Well, again though, you're missing the point which is that this nurse wants to do MORE bedside nursing. Going into nursing informatics is a bad idea for someone that prefers actual bedside nursing. Just because someone is good with computers, does not imply that they like working with computers, or want to have a job using them. My guess is that if OP wanted to work on computers and designing software, he would have pursued that as a profession, and not nursing. The OP may very well be good at nursing informatics, but may be miserable at it, so it would be a bad road to take imo. Since bedside nursing is what this nurse wants to do more of, finding a field of nursing that is more patient-based and less documentation-heavy seems like the most logical avenue.