Quality of nursing care

[lcnursingstudent]

Looking for best practices around the following two questions, thanks:)

Question # 1: Is the amount of paperwork an RN required to do taking away from providing good quality care....what are some ideas to combat this, or does your organization have something in place that helps in this area?

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Question # 2: What are some ways we as nurses can deal with the patient to nurse ratio. It seems each RN is assigned a heavy patient load. I know time managment is a big thing but what are other ideas or suggestions out there so we can still give each patient high quality care?

[jadelpn, LPN, EMT-B]

Most of one's charting is done on a computer in a number of facilities. Lot's of checkboxes, little elaboration. There is paper charting some places, but that is becoming more and more not the norm. One of the difficulties in this is that it is hard to look at a computer screen and your patient as well.

I have no good ideas to combat ratio overload. From a business standpoint, facilities are increasing demands and decreasing nurses. This is how they make a profit. Which seems to go against the grain of nurses to provide good quality care.

[lcnursingstudent]

Yeah you make a great point in the variation between different types of charting.

I know our OB department has pretty fast charting system, vs the med/surge set up.

I know in the near future the med/surge will be updating their software setup, so maybe this

is to help with time management.

Thanks for the reply:)

[Okami_CCRN, BSN, RN]

1. In short yes, the amount of paperwork that must be completed per patient per shift is taking away from quality nursing care. Often times facilities want charting to be pristine for reimbursement purposes and liability. This means that the RN must spend more time charting than actually providing care for the patient. One way this can be reduced is by decreasing the areas that forces nurses to double or triple chart or allowing an RN to write/type a narrative note instead of clicking countless checkboxes.

2. Nurse staffing is an ongoing issue that the state of California has addressed by their patient ratio law, If more nurses wound band together instead of suffering in silence maybe we could break the wall and achieve safe ratios across all the fields and states. I have mentioned before that it is impossible to deliver quality and appropriate care to 8 patients on a med/surg floor or 3 patients in a critical care unit. Often times these nurses are asked to take on a 9th or 10th patient, which increases their chances to miss something or make an error, and yet we accept the extra patient.

[Episteme]

Question #1. Yes. But it remains for the next generation of nurses to do the research to prove it. EMR is so new, it was supposed to save time and increase accuracy. (Lunacy!) But it has done the opposite. People cut and paste. I also don't know if the final word is in yet on whether it is possible for hospitals to erase inconvenient items from an electronic record. Another variable that will make the research difficult to do is the just the massive flux in what is going on in the health care industry now. No one (sincerely... whatever you politics are) NO one can say how the ACA will impact medicine and nursing 5 years down the road. So how could you do a retrospective study comparing outcomes pre-EMR and post?

Question #2: The nurses in CA addressed this by organizing. They got results. It doesn't mean that the hospitals haven't "cheated" by getting rid of auxiliary personnel... but the ratios are in place.

In the immediate event of your getting an unsafe assignment... you just pray you have a good manager and house supervisor. I was staff nurse not that long ago, and if the wheels came off, I would be quick to notify the people in my chain of command. Sometimes they actually called in another nurse, or floated someone our way. If you get abused for being polite but factual, leave.

As the nurses in CA proved, the squeaky wheel gets the grease. You don't get results by being passive. You have to do your research and collect your data, then hang together and get loud enough to get people in power to listen.

[nurseprnRN, BSN, RN]

Don't mourn (or complain), organize. It takes a lot of effort to do this, and it can be thankless and scary. But in the end, there is nothing like a committed group of hardworking people to change the world. If you can dream it you can do it.

[lcnursingstudent]

Thank you for all the great feedback. Yes I agree that it comes down to getting all your ducks in a row and having factual information

to back your concern and most important like it was stated above, get a committed group and stick together, and really push for that change.

[lcnursingstudent]

Also it was mentioned above to organize. I havent been with a set number of patients on my own, but

I did just get hired at our local hospital on the surgical floor, and I know they take up to 6 patients.

This is nothing compared to 8 or 9 so I should be thankful. When it comes organizing, I was wondering if it would

be helpful to come on shift about 15 minutes early, quickly glance over the orders, and set an alarm on vibrate for

every major task, or critical meds. This way if your in the middle of something else, and your urgent task comes up,

you will get a silent vibration for patient 6, so you can quickly wrap up your tasks with patient 5 for example.

Just an idea that I was thinking about.....trying to get organized before starting.

[Okami_CCRN, BSN, RN]

Honestly I think that's a little too much, your preceptor will go over some important time management skills with you during your orientation.

On a busy surgical floor orders change all the time, best way is to just keep on top of the charts and physicians making rounds. Eventually you will find your own grove and settle into it.

[nurseprnRN, BSN, RN]

Also it was mentioned above to organize. I havent been with a set number of patients on my own, but

I did just get hired at our local hospital on the surgical floor, and I know they take up to 6 patients.

This is nothing compared to 8 or 9 so I should be thankful. When it comes organizing, I was wondering if it would

be helpful to come on shift about 15 minutes early, quickly glance over the orders, and set an alarm on vibrate for

every major task, or critical meds. This way if your in the middle of something else, and your urgent task comes up,

you will get a silent vibration for patient 6, so you can quickly wrap up your tasks with patient 5 for example.

Just an idea that I was thinking about.....trying to get organized before starting.

I don't mean organize your shift workload, I mean, like, ORGANIZE, start up a union or working group of practicing nurses with a common goal.

[Episteme]

Yeah... sorry. You're right, we get better at organizing our plans of care and it does make our workload seem lighter (sometimes.)

My suggestion is start with your state student nurses' assn. And after graduation, the state nurses association. In our state, the nurses' assn has a lobbiest at the legislature and hound-dogs legislation that is favorable to nurses. I think that's something you can begin to research now. (And... it's funny how the legislators listen to us. We are WAY more well thought of than they are!)

It's not as expensive as union dues (which can add up! Around here they take a bite out of every paycheck.) BUT... sometimes the unions are more aggressive than the nurses associations. Our hospital was organized by SiEU and I cannot speak except from my own experience... they're not worth a bucket of warm spit.

So do some homework. Bottom line is that nurses have to speak with united, informed voices.

[Esme12, ASN, BSN, RN]

Also it was mentioned above to organize. I havent been with a set number of patients on my own, but

I did just get hired at our local hospital on the surgical floor, and I know they take up to 6 patients.

This is nothing compared to 8 or 9 so I should be thankful. When it comes organizing, I was wondering if it would

be helpful to come on shift about 15 minutes early, quickly glance over the orders, and set an alarm on vibrate for

every major task, or critical meds. This way if your in the middle of something else, and your urgent task comes up,

you will get a silent vibration for patient 6, so you can quickly wrap up your tasks with patient 5 for example.

Just an idea that I was thinking about.....trying to get organized before starting.

brain sheets.......here are a few.

mtpmedsurg.doc

1 patient float.doc‎

5 pt. shift.doc‎

finalgraduateshiftreport.doc‎

horshiftsheet.doc‎

report sheet.doc‎

day sheet 2 doc.doc

ICU report sheet.doc‎