Paperwork and Mental Health

[pleasantly mad]

Over the past few years I have worked in every imaginable area of nursing as both a Student and as a Healthcare Assistant. The problem I find now, as an RMN in Mental Health, that my day to day life seems to be consumed by paperwork, never ending , exceedingly tedious and in many cases there seems to be paperwork to back up paperwork. I find some days stretched to the point of breaking , staying after my shift is done to ensure I get to speak with my patients. I feel at times that I have to do things myself, save handing them over, for fear it will be forgotten or completed wrongly, leaving me the primary nurse to redo it. Most days I do not take a break and am glad to finally be on nights to catch up on everything.

Although I truly love my job and wouldn't change it I sometimes think back to my student days when it was all about the patient and wish I could just stop time, finish all the mindless administration work that needs done and spend some quality time working with my patients.

All I keep thinking is, if the amount of paperwork we do now has increased so much since the commencement of my post what will it be like in years to come?

Does anyone ever feel the same?

[chevyv, BSN, RN]

There is so much paperwork and almost duplicate forms to fill out that my fear is to forget to consistently fill one or two out and it's my butt!

[NCindasun21]

Are most psych hospitals still paper driven? I can't believe how much paper is wasted (IMHO) and how much data is duplicated or lost.

At least we have a Pyxis

[bessieb]

Working in quality for state operated mental health hospitals, so much of the paperwork/forms are in compliance to the 'data driven worlds' of accreditations...Joint Commission/CMS/etc. So much has to be done to be in compliance and it grows more every year. 1:1 time with patients is so limited for RNs today and the 'doing more with less' mindsets of todays budgets have many staff doing the jobs of 2 or more positions. I can't see it getting better, sadly. For those working in the psych world, (with paper, not electronics), do you see more SOAP or PIE or narrative notes? Thanks.

[NCindasun21]

For me, narrative. And, given the nature of insurance's view on mental health, most of it focuses on negative aspects rather than patient improvements. The minute you say "Patient no longer responding to internal stimuli" they're cured and insurance companies want them headed for the door.

I find SOAPS to be cumbersome for psych, especially in an Acute setting.

[bessieb]

I am in complete agreement with that. Just to be able to 'write the story' of how you patient is doing, how they are acting, what they are saying, responding.....or not....thanks.

[Davey Do]

pleasantly mad:

Even going to the toilet has its share of paperwork, eh?

There's this one certain Nurse who works at making paperwork more enjoyable. This Nurse draws pictures on the forms, calligraphies, makes checks that have shadows, makes their signature look like a stamp, etc.

This nurse has been, however, critisized by their Supervisor for doing this artistic charting. The Supervisor's rationale for not charting in this manner was, "That's not the way we do it here." So, the Artistic Nurse merely changed styles and continued the Endeavor of Making Paperwork More Palatable. No repercussions as of yet.

It's a Mundane Task, paperwork. Attempt to enjoy the Inevitable anyway you can.

The best to you, pleasantly mad.

Dave

[shanon0403]

I spend so much time charting that I barely see the patients I have to look at their picture or speak with the mental health worker about their day. How can we be expected to give good care if we're stuck behind a desk all day?

I started as a tech and loved it since I started nursing the money is better but I can honestly say I hate my job.

A lot of the paperwork seems pointless. We have this one paper we have to fill out whenever we give a new medication including Tylenol. At teenage and adult age they know if they're allergic to Tylenol, and if they were having a reaction to the medication I wouldn't need the paperwork they would come find us and say hey I have a rash or hey I can't breathe.

I don't mind paper charting because you don't have to worry about computers crashing, but it does seem like we should be able to chart by exception. If they took meds and their day was unremarkable we should be able to do something shorter.

Also, I agree about being afraid to chart progress for fear that a patient who is doing better but still needs to stay will be kicked out.

Our unit is made for 17 patient's but all of agree that we give the best care when we have 10 12 at the most, but they don't care about patient care they care about money money money.

[TCASII, ADN]

Welcome to nursing!

Afterall, protection against litigation and posting a profit are what drive this business. We'd love to believe that it's all about patient care but this is a business. Unfortunately, malpractice suits, government oversight, and insurance requirements have practically destroyed patient care.

It's the same everywhere. I'm lost when I have time to talk to a patient. It's a foreign concept.

ETA: That is why I work NOC shift. The likelihood that everyone will sleep 8 or more hours out of 12 gives me the opportunity to complete my administrative duties. At the end of the day, the paperwork is what your company really cares about.

[Davey Do]

Our unit is made for 17 patient's but all of agree that we give the best care when we have 10 12 at the most, but they don't care about patient care they care about money money money.

ETA: That is why I work NOC shift. The likelihood that everyone will sleep 8 or more hours out of 12 gives me the opportunity to complete my administrative duties. At the end of the day, the paperwork is what your company really cares about.