Paperwork Hell

[Joules]

have you ever felt like you were suffocating under a mountain of paperwork?

at my hospital, pitt county memorial hospital, in greenville, north carolina, somebody just has too much time on their hands. the paperwork has become unbelievably atrocious. it is like a very bad joke that just isn't funny anymore. everytime i come to work, there is yet another new form hanging by the time clock. the latest round of paperwork diarrhea started when our hospital was recently audited for medicare/medicaid chart compliance and failed miserably. now our hospital is in danger of loosing all medicare/medicaid funding. so, tptb are frantic. result: we now have this "hot pink" monster of a form that has to be filled out on all new patients, either by the unit clerks or rn's. it has now become our job to police the doctors, to see that all orders are being signed off in a timely/legal fashion, history and physicals are on the charts within 24 hours of an admit, pre-procedure and post-procedure notes are on the chart, etc. etc. etc.--we have to call the docs to come in to fix what they didn't do, if the chart is found lacking:( we have the usual bothersome critical pathways, now with each carepath, also have an infection pathway and a skin care pathway, to fill out on each patient daily under the threat of a bad eval if not done. we have computer charting also, and our patient admission record has become a nightmare!!!! link after link, with sublinks literally being added daily to fill out on new admits. it has gotten so complicated and burdensome, that there is very little time left for patient care. we are supposed to be clocked out by 7:15 each shift, no exceptions. on a very busy day, there is absolutely no time to fill out all this paperwork. jchao is coming to audit the hospital in a year, and i foresee a very unhappy year as the frantic "suits" are trying to get everything in compliance. i don't know how much more of this i can stand.

sorry for the down post; just need to vent:o :o

[Nurse Ratched, RN]

Wow - and I thought ours was bad. I have to say that since we got the computer charting my admissions DO go faster - all the data from previous admits comes forward and you don't have to spend time with pts dickering with their families about what year their tonsillectomy was, etc. .

Because of the type of unit we are, we process our own admissions (rather than through the admitting dept) so there is all the usual crap that would typically be done downstairs added onto our stuff. PLUS, if they come in after normal business hours or on the weekend, we have to *precert* the patients through their insurance companies (assuming they have insurance.) HELLO????? Dammit, Jim, I'm a nurse, not a UR person.

[Jolly]

Hey Hoolahan ---

I lasted 6 months in homecare and left because of the lousy, stinkin', god-awful paperwork -- I spent anywhere from 4 to 6 hours PER NIGHT and every night documenting, documenting, documenting. What an absolute nightmare. When I left the hospital to go into homecare, everyone warned me about the paperwork, but I figured how bad could it be? OMG! - it's bad, bad, bad.

Much happiness with the new career - can honestly say that I understand wanting the change.

[adrienurse, LPN]

What I hate is when you've already charted something, but not in the place that counts and then you forget to put it in the nurses notes because you had it in your mind that you'd already done it.

That's the part in all this paperwork that is dangerous legally.

Like incident reports, I just hate those because what do they actually do except pile up in corners?

Last week I was actually was asked to recopy an incident report by my boss because she didn't want it on record that I had given the person prn sedation after he'd gone ballistic (we "don't" use chemical restraints). What's the freaken point if you aren't stating what happened?

[OrthoNutter]

Originally posted by fedupnurse

Let's see. There is the flow sheet, the teaching sheet, the problem list, clothing sheet, advance directive, latex allergy, admission form, med variance sheet, med sheet, patient care activites sheet....

You are kidding right???? We just have an obs sheet (or flow chart), nursing care plan (tick and flick kind of thing), med chart, fluid order chart, maybe a fluid balance if they still have IVT going, and an admission/history sheet. That is it....we're supposed to put in a manual handling sheet but because that's incorporated into the care plan, hardly any of us ever bother doing it. Why document something two, three, four times?? I guess our admin people are a little bit more understanding of unnecessary double-documentation.

[VickyRN, MSN, DNP, RN]

{{{{{{Joules, Hoolahan, and every nurse}}}}}}

The never-ending stream of documentation is truly the bane of nursing.

[VickyRN, MSN, DNP, RN]

See pic below...

[NRSKarenRN, BSN, RN]

In the Good old days ( now), we have TWO Intake admission forms ( 1 demographics/services , another for insurance verification and auth) ... third if patient has auto insurance or work comp insurance. Takes us 5-10 min max to do referral; 5-15 min verrify insurance on average.

NEW computer HBOC Pathways homecare system has 8 screens just to place insurance authorization---can't easily tell which auth goes with which type service. GRRRR

Computer system kept crashing as power system not designed for 11 computers, projector AND fan (forget the coffee pot) in one 8 x 12 room. Nashing teeth and only day one of orientation.

[KBaldwinLVN]

Originally posted by fedupnurse

Let's see. There is the flow sheet, the teaching sheet, the problem list, clothing sheet, advance directive, latex allergy, admission form, med variance sheet, med sheet, patient care activites sheet....

You forgot the master care plan, the standard care plan that works with the master care plan, the clinical pathway care plan that takes the place of the master and standard if a planned LOS is anticipated.....

And we wonder why there's a nursing shortage.....(tah-heeee).