o.k. guys, i need some advice. we recently went to laptops and for some reason i can't understand, i take forever to do evals.
for routine visits it seems i can manage, but evals seem to take me hours upon hours at the house and then anywhere from 4 to 6 hours to get it all on the laptop.
i know i probably spend too much time in the home. i just love to talk with my patients and get to know them. and i think i am putting way too much info into the notes.
i've asked for help with it, and been told to concentrate on the diagnosis for which they are being admitted onto hospice. but i don't seem to be able to not add everything about them on there.
i remember first getting out of nursing school and trying to learn time management, but this is even worse. while just about everyone else is out of work on time, i'm routinely putting in 12 hour days. nice for the paycheck, but i hate it!!
anyone had similar issues or just is good at 'cutting to the chase'? i don't use the laptop in the home cause it seems to create a barrier between the patient and i. i'm so busy trying to get it right in the laptop, i can't even look at my patient.
i seem to feel the main issue is getting the info into the computer. how can it possibly take me so dang long!??! :typing :crash_com
whiiine, whiiiine, whiiine - i know, but i need help. thanks, y'all.....
I just resigned from a hospice that informed me I was not "organized" because I never got finished on time. On a daily basis, I would have 5 or 6 patients with at least 30 mintues drive time in between each one. The boss never took windshield time into consideration when making assignments and advised me that I could do it in 8 hours because my colleague could do it in 8 hours (all her patients lived in the same town which was also conveniently her home town.) Being salaried, I got tired of donating my time to the company.
I suspect things will start to tighten up here pretty soon. Think the OT is being O.K'd since we just changed to laptops. Not something I imagine they'll be willing to part with long term.
Have talked with nurses from other agencies who all say they feel the computer has slowed them down considerably, but its not like we have the choice to return to paperwork. So, I am hanging in there and trying to improve.
Think it drives me crazy because I've always been an organized, OCD type and not one to lag behind. True, as I get older I have mellowed out a lot and no longer seek perfection. Something in the vicinity will be more than good enough. But still want to be in the vicinity, if you know what I mean.
I do feel too much is expected of us if they stick with their present plans, but will just hang in there and see how it goes. Do my best - can't ask for more. Think I'm just gonna have to forgo the nice, relaxing 'getting to know you' chats with my patients - seems to be heading in the same direction as everything else. Only so much time to fit everything in, and its usually the patient time that suffers.
What program are you using? I'm a slow typist also, but I know it will get better as you continue-the firsat time our agency went up on computers they expected it to take us 1 month to get "up to speed". This is not a rational expectation. It takes far longer, say at least 3 months for us to internalize the stuff.
Don't make the mistake of not using your computer in the home. Why write something twice? Show your patients how the computer helps you know more of what is going on and they will be all for it! You won't let it get between you and your patient, I know from your posts, but don't, please, cut your own throat.
Somedays we still wish for paper, but I lover to be able to flip thru all the notes when I'm trouble shooting a problem without getting up or going somewhere else to see them. Good luck!
Wouldn't be so bad if we could just freely type in information, but using the forms where you have to check the 'almost-correct' answer and then type in the 'real' answer, and having to 'fill-in-the-blanks' takes sooo long. If you make a mistake with a med you can't just delete it, you have to cancel, then the screen goes back and you do it again. Just a second there, five seconds here, and before you know it an hour has passed.
I really take very few notes in the home. Just jotting down vitals. The rest I can remember till I get back to the office. I've tried using the computer in the home and it takes even longer, cause you are stopping to answer questions. Was told we're going to have another meeting as there are apparently quite a few unhappy laptop users.
Only one hour of OT today. Woot!!! Ain't I great? :stone
I don't work in hospice, but have done home health for 15 years. We went computerized 8 years ago. THe first 6 months it cut my productivity and my satisfaction in half. However, after lots of practice and increased typing speed it actually was better and easier than paper. Have talked with other home health nurses who have gone computerized and the consensus is the same. At first it is horrible, then bearable, then wonderful.......but it does take time. You might have your management team talk to the vendor for your program. We were able to get several very time consuming things changed in the program. Took some doing, but it really helped. Meds were one of the things that we had changed. Hope it helps. Hang in there.
...THe first 6 months it cut my productivity and my satisfaction in half. However, after lots of practice and increased typing speed it actually was better and easier than paper. Have talked with other home health nurses who have gone computerized and the consensus is the same. At first it is horrible, then bearable, then wonderful.......but it does take time. You might have your management team talk to the vendor for your program. We were able to get several very time consuming things changed in the program. Took some doing, but it really helped. Meds were one of the things that we had changed. Hope it helps. Hang in there.
Thanks for the encouragement. We've been at it about six weeks now and just about everyone is pretty discouraged, and the meds are the worst part. We're having ongoing conversations and some things have changed - unfortunately not enough.....yet anyway.
I know I'm a slow typist, but really don't think that is the problem. There is just so many 'picky' little things that have to be clicked on, and no typing speed, I believe, could make some of the stuff go any faster.
But I do love my job, and management is really responsive to our request for changes, so I'm a hangin' in there..........just may need to vent sometimes........particularly when it takes me a ridiculous amount of time to finish what could have been done in a quarter of the time with paper.
Am anxiously awaiting the time when it becomes not only bearable, but wonderful. Good to know that is possible.
It's somehow so comforting to read about other hospice nurses' struggles with laptops. We trained on laptops about 3 yrs ago and for almost the first year I put in hours of overtime nearly everyday I worked. My world shrunk down to seeing patients and charting. The system I've pieced together that's worked for me includes that: for admissions I printed up a barebones outline of the data to be entered in the same sequence as the computer (verified Medicare number, physical assessment, contact info, goals, etc) and I fill that out in the home - I use it to keep me on track as well as to not forget anything; for routine visits for most patients (not those in crisis) I chart assessment info right into the computer and get down a couple lines in notes about any issues, new orders, etc. and then take 5 minutes in the car to flesh it out.
Of course, somedays I feel too fried and harried to lug the computer around and jot notes on paper and then have to spend the evening charting to remind myself why I shouldn't do this.
I know we can't go back but I do miss paper. We have one MSW who is very good about charting everything in the home and I have been in homes where she is visiting and seen the barrier the computer creates to uninhibited communication. Ah well, that's a whole other topic.
Good luck with your computer struggles, it sounds like you're doing a phenomenal job. I'm sure you'll find a system that works for you.
It's somehow so comforting to read about other hospice nurses' struggles with laptops. We trained on laptops about 3 yrs ago and for almost the first year I put in hours of overtime nearly everyday I worked. My world shrunk down to seeing patients and charting. The system I've pieced together that's worked for me includes that: for admissions I printed up a barebones outline of the data to be entered in the same sequence as the computer (verified Medicare number, physical assessment, contact info, goals, etc) and I fill that out in the home - I use it to keep me on track as well as to not forget anything; for routine visits for most patients (not those in crisis) I chart assessment info right into the computer and get down a couple lines in notes about any issues, new orders, etc. and then take 5 minutes in the car to flesh it out.
Of course, somedays I feel too fried and harried to lug the computer around and jot notes on paper and then have to spend the evening charting to remind myself why I shouldn't do this.
I know we can't go back but I do miss paper. We have one MSW who is very good about charting everything in the home and I have been in homes where she is visiting and seen the barrier the computer creates to uninhibited communication. Ah well, that's a whole other topic.
Good luck with your computer struggles, it sounds like you're doing a phenomenal job. I'm sure you'll find a system that works for you.
That's whats so great about this site - you get to see you are not alone with nursing issues and get good advice to boot.
Been doing some thinking about why I feel the need to put in so much info. Doing the eval. and being the first nurse involved makes me feel like I need to do a detailed H&P, to include all aspects of the patients illness and life. Kind of like trying to paint a picture for the nurses to follow. So I include waaaay too much info, when you consider they are on hospice because they are dying, and we are there for comfort care. Not necessary to write a novel including the kitchen sink.
Funny how some stuff just has to come to you in its own good time. Like realizing the above. Ten people can point it out, but you have to 'digest' and internalize it before it makes sense to you. Does that make sense?
Anyway, it is good to see I'm not alone. Thanks for your tips. I'm still chugging along. No overtime so far this week. Woo Hoo!!
Don't bring the laptop in the home. We're always being told to do that, but I think it's intrusive. Plus, the thing is heavy! (nursing bag, notebook, folder, bags of chux... laptop... ? no)
Take good notes in the house, though. Make a cheat sheet that mimics whatever your software program looks like, so your written info sort of matches up to what you'll be inputting.
I think I overdocument also, but I've been told my notes are great and whoever follows me appreciates getting a thorough picture. I used to agonize over what to include, but now I basically just go through the visit in my head, and input it. I've gotten faster with practice.
Also, sometimes I will chart in the car between visits when I have time. And on really good days, I stop at Starbucks and chart!
(ps. Public libraries are good too.... but no lattes...)
Still a struggle to get it all in by the end of the day though. Usually doesn't happen.
Yeah, I've been told my notes are very thorough.:rotfl:
What I'm finding helpful (when I have time) is to go back and look through other nurses notes and see just what they chart. Wow! can be a real eye opener. I've got to stop thinking there is a need to include so much info.
I'm actually leaving the laptop at work. Eventually we are supposed to be able to do all our charting from home, which will be nice. In other ways maybe I'll miss the companionship and just being able to turn in any direction to ask a question.
And, I agree - Starbucks is a fantastic place to chart!! Far better than trying to find a shady spot, though I sometimes will stop in a park after getting some fast food for lunch. Except I inevitably manage to spill sweet 'n sour sauce all over my blouse.
RN4ustat, BSN, RN
54 Posts
I just resigned from a hospice that informed me I was not "organized" because I never got finished on time. On a daily basis, I would have 5 or 6 patients with at least 30 mintues drive time in between each one. The boss never took windshield time into consideration when making assignments and advised me that I could do it in 8 hours because my colleague could do it in 8 hours (all her patients lived in the same town which was also conveniently her home town.) Being salaried, I got tired of donating my time to the company.