At my facility, we have two areas of charting--the MAR and the TAR. The MAR is obviously for medications. The TAR is for treatments and other orders such as vital signs and when to notify the provider. Lately, I've been finding that nurses are deleting orders from the TAR that they don't agree with or because they want to reduce the charting workload. Problem is, they're deleting orders such as to document daily wound notes that are needed to monitor a patient’s conditions. I've also noticed that the nurses deleting orders are those who generally dislike charting to begin with, so it's not really surprising they're getting rid of orders.
What would your approach be in resolving the issue? I don't want to stir up drama but the orders were entered for a reason
I've made some progress, I think. I haven't completed any disciplinary action, yet but I have done the following:
1. I've re-entered orders that absolutely needed to be there. I've then followed up with the nurse deleting them to explain why an order was entered and why it's important to keep it. So far, no issues with this.
2. I've asked staff for feedback as to which orders are helpful and which ones are distracting. Within reason, I've tried getting orders from the provider to discontinue or at least reduce the frequency of the order if at all possible. I feel that a good manager listens to the staff. I'm also hopeful that by listening to their feedback and incorporating suggestions, they'll be more willing to comply with orders that are more of a must
One example I can think of is a patient was admitted to us with an infected wound. I specifically put in orders for daily documentation and frequent vital signs for a reason. One nurse got rid of the daily wound note and reduced the vital sign checks because they don't enjoy charting and wanted to reduce the workload. This patient is now in the ICU for sepsis. I have every intention of addressing this with this nurse once I see them. Yes, I'm very heavy on documentation, but it's for good reason and this incident is an example of why I do things a certain way.
Some nurses who don't enjoy charting will state that patient care is the most important thing. While no one can argue with that, patient care doesn't mean crap if you can't prove you actually did it.
In my opinion, someone deleting an order they don't like would be comparable to me canceling a care conference because I don't enjoy that type of meeting. In fact, I detest most Care Conferences and would avoid all of them if I could. BUT, both documentation and Care Conferences are important to patient care, even if one would rather be doing something else. Unfortunately, we can't always do what we want or like.
A while back I mentioned an Infection Control doctor who would demands a nurses get sent home to change if she caught them coming out of a room with an iso gown. This very same Dr will be the one to literally check EVERY frivolous order she entered. She will call the CN to complain if not followed. God forbid you delete one of HER orders. It is a big deal, all hands on deck when this doctor calls the nurses station.
One example I can think of is a patient was admitted to us with an infected wound. I specifically put in orders for daily documentation and frequent vital signs for a reason. One nurse got rid of the daily wound note and reduced the vital sign checks because they don't enjoy charting and wanted to reduce the workload. This patient is now in the ICU for sepsis. I have every intention of addressing this with this nurse once I see them.
Good for you, SilverBells ??
But keep in mind that the Holidays are coming up ? Now, don’t you go ruining Christmas for this nurse with a bunch of drama. I mean, after all they don’t enjoy charting and I think you really need to be mindful of that.
On 12/8/2021 at 2:40 PM, macawake said:
I am sooo fed up with having to change the CO2 absorbent allthetime and having to chart about it (every single time!!) ? that I think I’m going to introduce a new regimen.. Scratch propofol, remifentanil and sevoflurane.. Too much charting required. Instead I’ll serve my patients a cup of soothing chamomile tea and rub some lavender oil on their ear lobes (and obviously NOT chart about it. duh!)
I have a little update for you guys.
Sooo, I’ve trialed my new method. I was so sure I was onto a good thing.. But.. it was a resounding and undeniable fiasco. We didn’t even make it past the midline incision.. The patient was screaming bloody murder and the surgeon had a major conniption fit. For real, for a moment there, I worried that he was about to self-combust.. And surprisingly, my manager actually turned out to have a much more dramatic reaction than I had anticipated. Go figure.
In my opinion, someone deleting an order they don't like would be comparable to me canceling a care conference because I don't enjoy that type of meeting. In fact, I detest most Care Conferences and would avoid all of them if I could. BUT, both documentation and Care Conferences are important to patient care, even if one would rather be doing something else. Unfortunately, we can't always do what we want or like.
There's a difference between properly managing the nursing plan of care and just cancelling things you don't like, examples might help.
SilverBells, BSN
1,108 Posts
I've made some progress, I think. I haven't completed any disciplinary action, yet but I have done the following:
1. I've re-entered orders that absolutely needed to be there. I've then followed up with the nurse deleting them to explain why an order was entered and why it's important to keep it. So far, no issues with this.
2. I've asked staff for feedback as to which orders are helpful and which ones are distracting. Within reason, I've tried getting orders from the provider to discontinue or at least reduce the frequency of the order if at all possible. I feel that a good manager listens to the staff. I'm also hopeful that by listening to their feedback and incorporating suggestions, they'll be more willing to comply with orders that are more of a must