My Lament Over the Decline of Nursing

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]...it's not the decline of nursing only. It's healthcare in general. Maybe it's that we only view the past through rose-colored lenses, but it seems to me that it hasn't always been this way. In only the four or so years I've worked in healthcare, I've witnessed a slow yet steady sinking of the discipline of nursing into an endless sea of paperwork, checks and double-checks that help shelter from litigation, a useless array of CYA tests and medications, etc. How much easier would our jobs be as nurses if the fear of malpractice litigation wasn't forever hanging over our heads? Seems like it used to be that we felt pressure to provide the best care because someone's life, health, and happiness hung in the balance. Now, however, so many of us are propelled by the fear that our missed assessment or forgotten medication will result in our professional or financial ruin.

]"I'll be right in there with your pain medicine, right after I get all these boxes checked so that you can't sue me later on!"

]Don't misunderstand me: I don't lament the decline of nurses themselves. I work and have worked with wonderful nurses that I still strive to emulate.. nurses with keen eyes that pick up on key assessments, impeccable prioritization and time management, and great technical skills... But what kills me is to see these nurses practically chained to a chart or computer checking an endless amount of boxes that serve only minimize their risk of legal repercussions should the worst happen when they could be at the bedside (where they truly want to be, anyway) curing and comforting their patients.

]I love recovering fresh CABG patients. Usually there are two other nurses in the room helping me to get the patient settled in, drawing stat labs, arranging chest tubes, documenting, etc. But I get to take a step back and, if only for a moment, devote all my attention to that patient. What's the cardiac output? How does that PA waveform look? Are the chest tubes draining ok? What does the patient need? Colloids? Pressors? Inotropes? After all these questions are answered and the patient has stabilized the high tends to wear off quickly. I snap back to reality when I return to the chart and see the mountain of safety checks, restraint documentations, and falls precautions assessments that have accumulated while I worked to keep my patient alive.

]So, what's a young RN to do? Deal with it, I guess. Continue to improve my time management so as to accommodate both patient care and all this documentation.

]Anyone else feel this way? I just needed to decompress, I think. Thanks for reading.

]JP

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Specializes in School Nursing.

Yep, one of the many reasons I left the bedside. I felt like I was just doing tasks, not really nursing. My hope is that the pendulum will swing the other way soon.

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Specializes in Critical Care, Education.

jpRN,

I completely agree with you. Everytime there is another 'thing' piled on it means an increase in nursing workload. This is a reality, but it's time for some creative approaches . . .

Why in the world can't IT systems be developed to automate all this 'busy work'? They should be able just to extract the information from other parts of the patient care record. We need nurse-centered electronic charting... maybe just attach a web-cam to our heads and use voice recognition? :D

Maybe some of that 'stimulus' $ for HealthCare IT should be directed our way.

Or - just get a transcriptionist/clerk assigned to each nurse. Their job would be just to keep up with the charting while we do the work. Whaddya think?

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Specializes in surgical, ortho, critical care.

When I left nursing over 12 years ago, I was worked critical care and even then, thought we nurses should all have ways to dictate the care we were giving or info gathered in order to lessen documentation time! A nice dream. .

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Specializes in L & D; Postpartum.

You've watched carefully and have hit the nail on the head. Our main priority these days is charting! I'm serious. Patient care has taken a backseat to charting. I am so happy to think that I don't have too many more years of this. But honestly, it frightens me. What will future health care become? Throwing more money at it, Mr. Obama, isn't going to fix a thing?

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

the charting is bloated, overblown and heavily slanted toward making it easy for other disciplines. some surgeon wants to do a study on relationship of blood glucose levels to post operative wound infections? add another page of charting for the nurse to document it yet another place the hourly glucose checks, meter number used, and the treatment if any. we're already charting the glucose result in the computer charting for point of care testing. then we must exit that program and chart it again on the provider order entry-generated emar where we chart what change we made to the insulin drip in response. now we must also chart it on the vital signs flowsheet (so the research assistants can find it easily) and on an orange piece of paper that comes from the or. now it seems to me that the research assistants could just pull it out of the two places we already chart it and not take my time from the patient to chart hourly glucoses in two more spots. and that's just one of the many studies that increase our charting.

one day we'll marry our two charting systems so we only have to chart hourly glucose checks in one computer program, but by then some genius will have devised yet another study that will require us to chart it in two more spots for the convenience of the research staff. what about making it more convenient for the beside nurses to actually, i don't know, take care of patients?!!

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Specializes in surgical, ortho, critical care.

how rediculous to make nurses enter the same data multiple times!!! in my humble opinion (as a nurse who's been out of the field 12 years, but is looking to return), you need to join your voices and let president obama know this--how it impacts patient care and discourages those of us looking to return to the bedside! the powers that be just need to imagine themselves in the patient's position. i'm sure they would rather have a nurse who is attentive to them than the computer documentation (as would i)!!

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Specializes in telemetry.

Amen. I mentioned passing off the RN coming on at the bedside and was laughed out of the room. The report itself is overbearing. Just see your patient and youll know the answers.

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Specializes in OR; Telemetry; PACU.
jpRN,

Why in the world can't IT systems be developed to automate all this 'busy work'? They should be able just to extract the information from other parts of the patient care record. We need nurse-centered electronic charting...

I completely agree and at my last position I stated this same thing. I have only recently learned computer charting and I hate it (and I'm a computer junkie). It does not free up time or make things go quickly. You're sitting there asking assessment questions AT A COMPUTER! Anyway at my last position I was told as an Pre-op nurse I would need to chart the floor nurses' beginning assessment since I had just completed it and charted it for the OR. I balked at this and I got completely riled up over it! I said that I was not the person laying eyes on that person when they hit the floor post-op and I sure as heck don't think it's right for me to chart some of this stuff...and it's MY name on that charting not Nurse X, Y, Z on the floor. I was told it was a "courtesy" and my reply was there is a difference between being courteious and being responsible. :angryfire I said there needed to be a way to pull the data from my assessment to the floor's charting yes, but I was not assessing their ability to do things, etc. It's a fine line here, but basically I would open the floor's med/surg chart and start the charting and then they would get the patient after surgery and finish it. UGH! Then I was told it wasn't the floor's JOB to fill out a pre-op assessment sheet for a floor patient going to surgery, but they did it out of courtesy to the OR nurse - WHAT?!...I said I've worked in over five different hospitals and it sure as he*l was the floor's job! Just like I don't ask a floor nurse to run her hiney back to PACU and assess my patient before I hand him/her off to them...that stopped the ruckus right there because that made a good point to the director.

DO YOUR JOB and what's BEST for the patient! I want to asses my own patient and gather a baseline for the care I'll being giving during my shift and then the next nurse coming on does the same, and on and on! But at this place it was "let's be nice"...ummmm, and let's be dumb too. As I said, those standard questions like, how did they eat and communicate prior to surgery questions should just pull through to med/surg's charting. In the old paper days those questions were answered upon admit to the hospital...and then the floor nurse could look that info up on the paper, but she still did her head to toe assessment and established a baseline. I didn't go out and do her paperwork for her or her assessment.

I'm just ranting now...not sure if I'm making my point or not, but I'd never been faced with this issue and computer charting has created more crappola than making things easier (well besides the higher ups can watch ya more closely and they now have a better way of helping with malpractice suits as was mentioned....ON PAPER. But bedside is lacking)....and charting in the OR??? UGH! You CANNOT watch the field and computer chart at the same time.

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Specializes in Cath Lab, EP.
]...it's not the decline of nursing only. It's healthcare in general. Maybe it's that we only view the past through rose-colored lenses, but it seems to me that it hasn't always been this way. In only the four or so years I've worked in healthcare, I've witnessed a slow yet steady sinking of the discipline ...

]JP

Has anyone seen the movie idiocracy? I think the decline of nursing is directly proportionate to the decline of intelligence in our nation (think of the bell curve with regard to IQ....). Americans are getting dumber, add to that the fact that Americans are also getting more letiginous, and your end product is redundant charting and healthcare that is practiced via the CYA method. GOD HELP US ALL!:down:

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I agree- only america now a days is not only dumber but HOH. NOONE ever listens to the nurses not even when it's too late- we still get passed over

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oh my gosh i am having the EXACT same issues/feelings/frustration now. i just transferred (3 weeks ago) to a bigger icu in a different hospital system and the computer charting is really challenging. and everyone agrees that works there. my preceptor gets on me for being behind on my charting and talking to my patients too much. she also makes me refuse help from anyone with anything (orders, health assessments, admissions) because "some days you aren't going to have help and a seasoned nurse should be able to do this all on her own without help." i don't know why each day has to be made harder than it already is because some day, down the road, i won't have help.

i am so frustrated that everyone focuses on my charting and that i do it on time, that nobody cares if i skimp on mouth care or comforting a family before withdrawing on their loved one (actually told i didn't need to be in there and should have cleaned up my other patient's urine filled bed instead.)

i want to scream and bang my head into a wall that we shouldn't allow this as nurses. it blows my mind that so many people are only worried about charting and getting out on time. AAAHHHHHHHHHHH!!!

has anyone out there been able to stand up to the fancy suits that make these rules and make a change in their own hospital?

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