Med-Surg Topic of the Week ..... CHANGE

RN-PA, RN · Jan 22, 2005

I accept that change is a natural part of working in healthcare, but we're starting to get hit with some changes that are beginning to feel overwhelming.

Over a year ago, we switched to computerized documentation. I went kicking and screaming into that-- even thought I'd have to find a new job since it seemed so overwhelming-- but I lived and am used to it, but it DOES take more time than handwriting. I can't sit down to document some nights until my patient care is done, so am often getting out late. I also was afraid when we were given Pyxis(es) to dispense narcs and other meds around 6 months ago, but now generally like it and appreciate not having to count narcs each shift.

Last night when I worked, I saw our meds individually packaged with barcodes printed on them for the first time. That is the next change coming where all our meds will be computerized, both with documentation and administration. Supposedly, we will be given a scanner to scan our namebadge, the patient's bracelet, and then the med before administration. I'm definitely beginning to hyperventilate over this.

And the next really big change is that our hospital is going to implement a "Universal Bed" system. We will all be monitor trained, take ACLS, and on our unit, we will also have to be chemo-certified. (We are a Med-Surg unit with oncology emphasis and there are a few RN's that are chemo-certified and administer it the few times we have those patients.) Administration wants the universal beds to cut down on transfers from telemmetry to med-surg and vice-versa.

I know the universal bed system makes sense for continuity of care, and it's going to be implemented over the next two years. I don't mind learning, but administration is going to have to consider lowering our nurse to patient ratios if we're to have this possibility of even higher acuity than we're already dealing with on med-surg.

I gotta go lie down now..... Getting overwhelmed.... Very tired..... :stone

RNPATL, DNP, RN · Jan 22, 2005

Thank you for such a heart-felt and "real" reply ..... these types of changes are certainly stress provoking and can lead to nurses feeling very overwhelmed. We are also in the midst of some very big chnages with my hospital. We are going to be implementing computerized charting and bar code medication administration together. Talk about being stressed out over change! Of course, I love technology and think that getting away from the paper charts will improve patient safety and help the nurses. But, having all this change together removes our focus from the patient and places it on the change, which I think is wrong.

I also would have to agree that moving to a universal bed monitoring system makes a lot of sense and will hopefully improve patient comfort. However, you are right, nurse to patient ratios need to be considered when making changes of this nature.

Thank you for sharing your story and like the rest of us .... hopefully time will reveal that the changes were good and did help the nurse and provide the patient with a safer environment.

RN-PA, RN · Jan 22, 2005

Of course, I love technology and think that getting away from the paper charts will improve patient safety and help the nurses. But, having all this change together removes our focus from the patient and places it on the change, which I think is wrong.
.... hopefully time will reveal that the changes were good and did help the nurse and provide the patient with a safer environment.

I've highlighted these two parts of your response to say that I think those who are making these changes happen think that all this technology will help nurses, but honestly, it's adding more and more to our loads. The big theory with having our documentation computerized was supposed to be, "More time for the nurse at the bedside". But it ain't happenin'.

Originally, administration wanted us to take our computers (on wheels) into the patient rooms and document while we're there. I tried it, but the computers are difficult to maneuver in the tight spaces of a semi-private room, and I also have to have my hand-written (assessments, vital signs, blood sugars, labs, etc.) notes to refer to as problems arise and for when I give report at the end of the shift. So computer documentation occurs when I finally get the chance to sit and type away, referring to the notes I've written (double work).

I have no idea how they'll be working medication administration with the bar codes, but how can it NOT take longer than what we're currently doing? As you said, time will tell whether these changes make for a safer environment when we're having to rush all the more to keep up with all the new demands.

I have friends who work 12 hour shifts rather than the 8 hours like me because they say there's no way to get all the work done in 8 hours. Sorry to sound negative, but sometimes I wish administration would quit having meetings about "improving" things and just leave us alone for a while.

Thanks for letting me whine!

RNPATL, DNP, RN · Jan 22, 2005

I certainly feel your pain, but currently work in a paper chart environment. I can't even begin to tell you how many errors there are because orders are missed or handwriting can not be read. I agree that computerized charting does NOT safe time for the nurse, but it is safer than paper charting in my opinion.

Now, bar code medication administration ... that is another story ... while I can see putting into place, there are many ways around the fail safe systems that will save the nurse time, but that places him/her at risk. I don't know if there is a perfect answer for nurses, but it would be nice to have a happy medium.

RN-PA, RN · Jan 22, 2005

We're also still working with paper charts, so still dealing with doctors' illegible handwriting and unrecognizable signatures on orders. Only nursing documentation-- assessments, care plans, and all admission documentation-- are computerized. (IV team and Respiratory and Physical therapists also document on line.) The doctors were supposed to go online 6 months after we did in 2004, but that's still in the works. I wholeheartedly agree with you about the safety aspects. That's one of the things I appreciate about Pyxis. I still check my narcs since machines aren't infallible, but rather than rattling through similar-looking narc boxes in a drawer of our med carts, the Pyxis dispensing is much safer. So this was a positive change.

live4today, RN · Jan 22, 2005

RN-PA........I agree with everything you've shared thus far. Many of the "new changes" are making our work harder and causing unnecessary overtime to get it done (ie...computer documentation for one).

Maybe it's time to bring back Medication Techs to help nurses with patient care. In addition to training them to pass meds, they should be trained to take and understand vital signs since many meds require taking the BP, the apical pulse, etc. prior to giving the med(s).

Can anyone blame nurses for going on strike for improved nursing conditions when you read all the new changes in "paperwork and politics" nurses are being required to keep up with at the same time they take care of doctor's patients? I sure don't. :rolleyes:

Marie_LPN, RN, LPN, RN · Jan 23, 2005

"The only thing that likes changes is a wet baby"---Grandma

RNPATL, DNP, RN · Jan 23, 2005

"The only thing that likes changes is a wet baby"---Grandma

Excellent point!

RNPATL, DNP, RN · Jan 23, 2005

Maybe it's time to bring back Medication Techs to help nurses with patient care. In addition to training them to pass meds, they should be trained to take and understand vital signs since many meds require taking the BP, the apical pulse, etc. prior to giving the med(s).

Cheerful .... I am totally going to disagree with you here. I do not want another layer of unlicensed assistive personnel doing the job of the nurse. Rather, I would like to see a nurse doing the job of a nurse. Hospitals and other health care organizations have to understand that proper staffing levels and reasonable patient loads are the only way to provide safe care.

It's funny .... we talk about how computerized clinical documentation and bar code med administration is for patient safety and has improved the standard of care for the patient .... but they forget that if the nurse does not have adequate time to assess the patient, then is it worth having all these things? If patient safety is really the issue, then perhaps Joint Commission and individual States should legislate staffing ratios.

If it comes down to using illegal abbreviations or having more nurses ... I think your safest bet is going to be having more nurses to properly care for the patient ... agree?

nursbee04 · Jan 25, 2005

Our unit is moving away from total care.

I hate, ABSOLUTELY HATE passing meds for 14 patients at a time (had 16 the other night. I have developed a whole new respect for nurses who do the med nurse thing and pass meds on the whole floor.) The charge nurse does the assessments/signs off charts, the aid takes V/S and does pt care, and all I feel like I'm getting done is popping pills into people. I hate medicating people I didn't assess! Then after shift change usually I am charge with a full pt load.

I am used to knowing my pt's labs/radiology/h&p, reading their doc's progress notes, knowing their v/s, knowing their meds, knowing how many times they've been to the bathroom, what it looked/smelled like, and I don't have to worry about whether they're being turned or not because I'm the one turning and changing them. I just don't feel like I know my patients well enough. And now I have to chase down the aide to get a list of my V/S to look at, instead of just taking them myself.

This is one of several reasons I have decided to transfer to an intensive care unit.

Nurses are constantly asked to do more with less resources. And even with all the extra work they pile on us, we still get it done. And we do a darn good job with what we're handed, too, but there is a breaking point.

nursbee04 · Jan 25, 2005

Our unit is moving away from total care.

I hate, ABSOLUTELY HATE passing meds for 14 patients at a time (had 16 the other night. I have developed a whole new respect for nurses who do the med nurse thing and pass meds on the whole floor.) The charge nurse does the assessments/signs off charts, the aid takes V/S and does pt care, and all I feel like I'm getting done is popping pills into people. I hate medicating people I didn't assess! Then after shift change usually I am charge with a full pt load.

I am used to knowing my pt's labs/radiology/h&p, reading their doc's progress notes, knowing their v/s, knowing their meds, knowing how many times they've been to the bathroom, what it looked/smelled like, and I don't have to worry about whether they're being turned or not because I'm the one turning and changing them. I just don't feel like I know my patients well enough. And now I have to chase down the aide to get a list of my V/S to look at, instead of just taking them myself.

This is one of several reasons I have decided to transfer to an intensive care unit.

Nurses are constantly asked to do more with less resources. And even with all the extra work they pile on us, we still get it done. And we do a darn good job with what we're handed, too, but there is a breaking point.